Minireview: Utilidad de las pruebas predictivas para parto pretérmino utilizadas en la práctica clínica

Preterm labor, defined as delivery before 37 weeks of gestation, is a serious obstetric condition that accounts for 11% of pregnancies worldwide. Predictive tests for preterm birth are important, given the personal, economic, and health impact of preterm birth. This review explores the utility of both, the current predictive tests used in clinical practice (maternal characteristics, cervical length and biochemical markers), as well as the new emerging tests. An electronic search was carried out in the scientific health databases: PUBMED, COCHRANE, SCIELO, national universities virtual repositories were also reviewed, using the following search items and their combinations: preterm delivery, cervical length, cervical shortening, cervicometry, fetal fibronectin, risk factors, and maternal characteristics. We included papers in English and Spanish published from 2006 to 2020, which responded to the aim of the review: the utility of predictive test for preterm delivery. A total of 30 articles were included in this review. There are multiple scientific criteria on the different current techniques to identify patients at risk and achieve adequate prevention of preterm birth. Measurement of cervical length by transvaginal ultrasound is the most cost-effective method in women with a history of preterm labor or symptoms of preterm labor; the current evidence allows us to affirm that it is also essential to perform routine cervicometry in all patients, even with low risk. There are promising ultrasound predictive methods such as cervical elastography and cervical consistency index, but there are limitations in their technical implementation, it is proposed that they could be a possible alternative in the future, that can be combined with cervical length measurement. Also, adding cervical length easurement to biochemical tests appears to improve predictive accuracy.

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Association Between Cervical Length at 18-23 Weeks of Gestation and Spontaneous Preterm Delivery: A Cross Sectional Study

Case Reports in Obstetrics Gynecology and Reproductive ◽

10.31487/j.crogr.2020.03.02 ◽

2020 ◽

pp. 1-4

Author(s):

Trupti Ruge ◽

Emanuel Gracias

Keyword(s):

Preterm Birth ◽

Preterm Delivery ◽

Transvaginal Ultrasound ◽

Demographic Data ◽

Cross Sectional Study ◽

Cervical Length ◽

Sectional Study ◽

Cross Sectional ◽

Mortality And Morbidity ◽

Spontaneous Preterm Delivery

Introduction: Preterm birth is childbirth occurring at less than 37 completed weeks or 259 days of gestation, is a major determinant of neonatal mortality and morbidity and has long-term adverse consequences for health. Identifying ways to address preventable causes of preterm birth should be a top priority in developing regions of the world. the present study was planned to find the association between cervical length at 18 to 23 weeks of gestation done as a routine during all second level scans and spontaneous preterm delivery. Patients and Methods: This is a hospital based cross sectional study conducted during the period from January 2019 to December 2019. A total of 205 women presenting with singleton pregnancies between 18- 23 weeks of gestations were assessed by transvaginal ultrasound for the measurement of cervical length. Patients were interviewed and their demographic data such as age, obstetric index(GPALD), obstetric history such last menstrual period (LMP), estimated delivery date (EDD) and current pregnancy details such as BP, pulse rate, pallor, period of gestation, were recorded in a predesigned pro forma. Results: In a total of 205 subjects, the average age was found to be 23.26 ± 3.49 years with 52.2% of the women being primigravida. The mean gestation age at the time of enrollment was 20.72 ± 1.00 weeks with 33% of women showing a cervical length of 26-30 mm. The delivery outcome was found as 11% preterm, majority (89.27%) was term delivery. Conclusion: The present study showed that a significantly higher number of women with cervical length ≤ 30 mm (assessed at 18 to 23 weeks of gestation) had preterm labour compared to a woman with cervical length > 30 mm.

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Correlation of cervical length, fetal fibronectin, phIGFBP-1, and cytokines in spontaneous preterm birth up to 14 days from sampling

Journal of Perinatal Medicine ◽

10.1515/jpm-2014-0275 ◽

2015 ◽

Vol 43 (5) ◽

Cited By ~ 4

Author(s):

Marija Hadži-Lega ◽

Ana Daneva Markova ◽

Milan Stefanovic ◽

Mile Tanturovski

Keyword(s):

Preterm Birth ◽

Preterm Delivery ◽

Preterm Labor ◽

Cervical Length ◽

Outcome Variable ◽

Spontaneous Preterm Birth ◽

Fetal Fibronectin ◽

Tnf Α ◽

Vaginal Swabs ◽

The Relationship

AbstractThe aim of this study was to determine the relationship between sonographic cervical length, fetal fibronectin (fFN), phIGFBP-1 (actim partus test), cytokines (IL-6, IL-2R, and TNF-α), and spontaneous preterm birth (SPTB) up to 14 days from sampling.Fifty-eight patients were recruited in a period of 6 months from September 2013 until March 2014 with symptoms or complaints suggestive of preterm labor. Consenting women were treated according to usual hospital protocol, with addition of vaginal swabs taken for fetal fibronectin, phIGFBP-1 (actim partus test) and cervical IL6, IL2R, and TNF-α. The outcome variable was occurrence of preterm delivery within 14 days from the day of hospital admission.Thirty-six patients (62.07%) were delivered within 14 days from admission. Our results indicated that the cervical length significantly inversely correlates with the concentration of IL-6 in the CVF (Spearman’s coefficient R=–0.382, P<0.05). Cervical length also correlated with a positive phIGFBP-1 test, i.e., patients with a positive test had an average cervical length of 18.5±4.63 mm, which is significantly lower than patients with a negative test –23.43±7.39 mm (P=0.003).The studied biochemical markers were only moderately successful in the prediction of preterm delivery.

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Role of transvaginal ultrasound in predicting preterm labor in singleton pregnancies

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20180172 ◽

2018 ◽

Vol 7 (2) ◽

pp. 561

Author(s):

Mehbooba Beigh ◽

Mohammed Farooq Mir ◽

Rifat Amin ◽

Simrath Shafi

Keyword(s):

Preterm Delivery ◽

Predictive Value ◽

Preterm Labor ◽

Transvaginal Ultrasound ◽

Cervical Length ◽

Spontaneous Preterm Birth ◽

Threatened Preterm Labor ◽

Length Changes ◽

A Prospective Study

Background: Preterm delivery (PTD) is a major cause of perinatal morbidity and mortality. Objective of present study was to identify the women at risk of preterm delivery with the help of trans-vaginal ultrasound by assessing cervical length changes, funneling of lower uterine segment, cervical dilatation.Methods: A prospective study was carried out over a period of 2 years on 50 patients with 24-36 weeks of gestation who clinically presented with signs of threatened preterm labor and were subjected to transvaginal sonographic measurement of cervical length.Results: Prediction of spontaneous preterm birth at <37 weeks of gestation with cervical length to be 2.75 cm has sensitivity of 95%, specificity of 96.5%, positive predictive value of 86.36% and negative predictive value of 98.7%.Conclusions: Transvaginal ultrasonography is the reliable, reproducible and objective method to assess cervix and to predict the risk of preterm delivery.

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Role of cervical length evaluation with transvaginal ultrasound for prediction of preterm delivery in low risk pregnancy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20182894 ◽

2018 ◽

Vol 7 (7) ◽

pp. 2852

Author(s):

Sirupa Venkata Geetika Reddy ◽

S. R. Mudanur

Keyword(s):

Preterm Birth ◽

Predictive Value ◽

Predictive Accuracy ◽

Transvaginal Ultrasound ◽

Birth Asphyxia ◽

Cervical Length ◽

Low Risk ◽

Risk Pregnancy ◽

Endocervical Canal

Background: Preterm birth possess a major health burden to the society due to its long - term morbidity, perinatal mortality and high financial expenditures associated with it. Transvaginal ultrasonographic measurement is an effective and objective way of measuring the cervical length. Cervical length <25 mm is considered as the best cervical parameter with a good predictive accuracy for preterm birth. This study was taken up to study the role of cervical length measurement in predicting preterm labor by Trans vaginal sonography (TVS) and to measure cervical length and follow up cases to study the fetal outcome.Methods: Sagital long-axis view of endocervical canal along the entire length was obtained with high frequency endovaginal probe and the length of cervix from external to the internal os was measured. Atleast three measurements were obtained and the best shortest measurement in millimeters was recorded. Transfundal pressure was applied for 15 seconds and cervical length was obtained again. The cases are followed till delivery and outcome is noted.Results: Out of 134 study group of low risk women, 5.9% women and 50% of the women with short cervical length (<25 mm) had preterm birth. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of our study are 75%, 95.2%, 50%, 98.4%, 94% respectively. Among the 134 newborns, majority of the admissions (14) were due to birth asphyxia followed by meconium aspiration syndrome.Conclusions: TVS is a useful technique in assessing the cervical changes during pregnancy and predicting the preterm birth especially when performed between 16-24 weeks of gestational age could identify all the women having short cervical length along with other changes of cervix.

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Placental α-microglobulin-1 in cervicovaginal fluid and cervical length to predict preterm birth by Thai women with symptoms of labor

Asian Biomedicine ◽

10.2478/abm-2021-0015 ◽

2021 ◽

Vol 15 (3) ◽

pp. 119-127 ◽

Cited By ~ 1

Author(s):

Saifon Chawanpaiboon ◽

Vitaya Titapant ◽

Julaporn Pooliam

Keyword(s):

Preterm Birth ◽

Pregnant Women ◽

Preterm Labor ◽

Transvaginal Ultrasound ◽

Cervical Length ◽

Cervical Dilatation ◽

Bedside Test ◽

Test Result ◽

Cervicovaginal Fluid ◽

Spontaneous Delivery

Abstract Background Presence of placental α microglobulin-1 (PAMG-1) in cervicovaginal fluid is a bedside test to predict preterm delivery. Objective To determine whether the accuracy of a positive PAMG-1 test result to predict preterm birth within 7 days and 14 days in our hospital setting can be improved by adding cervical length. Methods We recruited 180 pregnant women who attended the labor ward of Siriraj Hospital, Thailand, from 2016 to 2018 for this prospective observational study of diagnostic accuracy. We used data from 161 women who met inclusion criteria including symptoms of preterm labor between 200/7 and 366/7 weeks’ gestation without ruptured membranes and with cervical dilatation <3 cm and effacement <80%. Presence of PAMG-1 in cervicovaginal fluid was tested using a PartoSure kit, cervical length was measured by transvaginal ultrasound, and the time to spontaneous delivery was calculated. Results Pregnant women with labor pain who had cervical length <30 mm (45/161; 28%) went into delivery within 7 days, and women with a cervical length <15 mm (11/14; 79%) went into delivery within 7 days. When the PAMG-1 test result was positive and cervical length was ≤15 mm, the positive predictive value (PPV) was 83%; and when cervical length was ≤30 mm the PPV was 69%. The optimal cut off from receiver operating characteristic curve analysis showed that a cervical length <25 mm and PAMG-1 positive result has a PPV of 80% to predict preterm birth within 7 days and 90% within 14 days. The area under the curve (95% confidence interval) for a positive PAMG-1 result and cervical length ≤25 mm to predict preterm birth <7 days was 0.61 (0.50, 0.73) and <14 days was 0.60 (0.49, 0.70). Conclusions Cervical length ranging 15–30 mm combined with a positive PAMG-1 test result has a high accuracy to predict imminent spontaneous delivery within 7 days by women with preterm labor and cervical dilatation <3 cm in clinical practice.

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Cervical Length Measurement in Obstetrics: From Academic Luxury to Clinical Practice

Donald School Journal of Ultrasound in Obstetrics & Gynecology ◽

10.5005/jp-journals-10009-1229 ◽

2012 ◽

Vol 6 (1) ◽

pp. 93-96

Author(s):

Badreldeen Ahmed ◽

Zohra Hasnani

Keyword(s):

Clinical Practice ◽

Preterm Birth ◽

High Risk ◽

Amniotic Fluid ◽

Pregnant Women ◽

Preterm Delivery ◽

Preterm Labor ◽

Cervical Length ◽

Length Measurement ◽

Cervical Length Measurement

ABSTRACT Preterm birth is the main cause of perinatal mortality and morbidity and can be very costly to the healthcare system. Although improvements in neonatal care have led to higher survival of very premature infants, there is a need for the development of a sensitive method with which to identify women at high risk of preterm delivery and find an effective strategy for the prevention of preterm labor.1 Considering the increased incidence of preterm birth, it has become more important now to be able to early diagnose this problem. The measurement of cervical length to predict the risk of preterm birth can be extremely useful in diagnosing this condition. The use of transvaginal ultrasound in measuring cervical length is safe, reliable and well accepted by women.2 The use of vaginal progesterone has shown to be effective in the prevention of preterm delivery in women with short cervix. Tocolytics are used to delay labor for a minimum of 24 to 48 hours3 for up to 1 week but they have not shown to improve neonatal outcomes and most have undesirable side effects. Steroids can assist with fetal lung maturity when the diagnosis of preterm labor is made,3 they can be used unnecessarily when preterm labor is misdiagnosed. The measurement of cervical length can also be helpful in patients with preterm premature rupture of membrane and in patients with the presence of amniotic fluid (AF) sluge.4 Therefore, performing cervical length measurements in all pregnant women and use it as a screening tool at around 20 weeks of pregnancy to identify patients at high risk of preterm labor can assist with true diagnosis. There is a great expectation from cervical assessment and subsequent addition of progesterone to reduce preterm birth and have better neonatal outcomes. The aim of this review is to bring forward evidence that highlights the importance of performing cervical length measurement in midpregnancy in all pregnant women to predict the risk of preterm birth. Medline, PubMed, MD Consult and Science Direct were searched using the terms cervical length measurement, ‘preterm delivery’, ‘amniotic fluid sludge’ and ‘treatment for preterm birth’. How to cite this article Ahmed B, Hasnani Z. Cervical Length Measurement in Obstetrics: From Academic Luxury to Clinical Practice. Donald School J Ultrasound Obstet Gynecol 2012;6(1):93-96.

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Effect of Bacterial Vaginozis and cervikal length on preterm delivery in second trimester

Medical Science and Discovery ◽

10.36472/msd.v6i11.325 ◽

2019 ◽

Vol 6 (11) ◽

pp. 305-309

Author(s):

Hacı Öztürk Şahin ◽

Ahmet Gülkılık

Keyword(s):

Preterm Birth ◽

Bacterial Vaginosis ◽

Pregnant Women ◽

Preterm Delivery ◽

Preterm Labor ◽

Cervical Length ◽

Delivery Rate ◽

Significant Difference ◽

Detailed Medical History ◽

The Mean

Objective: Preterm birth is one of the major cause of perinatal morbidity and mortality. Clinical studies have pointed out the association between preterm birth and bacterial vaginosis (BV) infection. Our aim is to discover the incidence of BV and search for the mean cervical length and parameters for the prediction of preterm delivery. Materials and Methods: 130 pregnant woman between the 16th and 24th gestational week were included in our study. A detailed medical history was obtained from all of the women, and patients with a history of preterm delivery and the Vaginal Ph values and cervical length measurement were evaluated. Vaginal samples were analyzed, gram staining was performed, and a bacterial vaginosis diagnosis was made with Nugent’s criteria. Results: Of 130 woman that we included in our study, only 19 had bacterial vaginosis (14.6 %), and the mean cervical length was measured as 41.79 mm. Preterm birth occurred in nine of the pregnant women (6.9%), and no statistically significant difference was found between BV and shortened cervical length or preterm labor. When we excluded the known preterm birth risk factors from our study, we could not find a significant difference between preterm labor and BV. Conclusion: We concluded that BV by itself is not a preterm risk factor. The frequency of BV in the pregnant women in our study group according to the preterm delivery rate and the mean cervical length were similar to those in international studies in which the relationship between cervical length and preterm delivery has been established. We did not come to a significant conclusion in our research; nevertheless, we can relate this result to the preterm delivery rate that is found to be lower than expected.

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Role of Cervical Length as Predictor of Preterm Labor and a Comparison of Transabdominal versus Transvaginal Ultrasound in Determining the Accuracy of Cervical Length

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1080 ◽

2010 ◽

Vol 2 (2) ◽

pp. 129-131

Author(s):

MS Nanavati ◽

SV Desai ◽

PD Lakhani ◽

AS Bansode

Keyword(s):

Preterm Delivery ◽

Preterm Labor ◽

Transvaginal Ultrasound ◽

Prospective Trial ◽

Cervical Length ◽

Short Cervix ◽

Term Delivery ◽

The Mean ◽

The Difference

ABSTRACT Objectives 1. To evaluate the mean cervical length at 22 to 28 weeks of gestation by TAS and TVS and correlate its association with preterm labor. 2. To compare the difference in cervical length measured by the above two methods. Methods This was a prospective trial involving 100 pregnant women spanning a period of ten months. Results Eighteen women out of the 100 studied had preterm labor; of which 17 had a cervical length of less than 3 mm at 22 to 28 weeks. The percentage of women with preterm delivery with a short cervix was 83% by transabdominal scan (TAS) and 94% with transvaginal scan (TVS). Conclusion The mean cervical length was lesser amongst women who had a preterm delivery as compared to those with a term delivery. The mean cervical length by TAS was more than that by TVS thereby suggesting that TVS has a higher sensitivity for detection of preterm labor than TAS.

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Is Midtrimester Cervical Length Associated with Preterm Birth in Women Evaluated for Preterm Labor?

American Journal of Perinatology ◽

10.1055/s-0037-1606608 ◽

2017 ◽

Vol 35 (03) ◽

pp. 220-224 ◽

Cited By ~ 1

Author(s):

Jessica O'Connell ◽

Emily Miller ◽

Allie Sakowicz

Keyword(s):

Preterm Birth ◽

Preterm Delivery ◽

Preterm Labor ◽

Retrospective Cohort ◽

Clinical Characteristics ◽

Operating Characteristic ◽

Roc Curves ◽

Cervical Length ◽

Predictive Capacity ◽

Multivariable Analyses

Objective This article aims to evaluate whether midtrimester cervical length (CL) is associated with improved prediction of preterm delivery in women presenting with preterm labor. Study Design This is a retrospective cohort study of women with a singleton gestation who underwent routine CL screening between 18 and 24 weeks of gestation between 2010 and 2014 who were later evaluated for preterm labor. Women were stratified by midtrimester CL quartile. Bivariable and multivariable analyses were performed to identify factors independently associated with preterm birth <37 weeks, <34 weeks, and delivery within 7 days of evaluation. Receiver operating characteristic (ROC) curves were created for multivariable equations with and without CL quartile to determine whether addition of CL improved the predictive capacity of the model for predicting preterm birth. Results A total of 460 women were evaluated for preterm labor and had midtrimester CL measurements available. When CL quartile was incorporated into a regression model including demographic and clinical characteristics associated with preterm birth, the area under the ROC curve was not improved (0.775 vs. 0.786, p = 0.20). Conclusion While a shorter midtrimester CL quartile is associated with an increased incidence of preterm delivery in women evaluated for preterm labor, the addition of this variable to an existing model does not improve prediction of preterm birth.

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