Prediction of preterm birth: the role cervical assessment by ultrasound and cervico-vaginal biomarkers

2020 ◽  
Author(s):  
Giuseppe Rizzo ◽  
Ilenia Mappa Mappa ◽  
Victoria Bitsadze ◽  
Jamilya Khizroeva ◽  
Alexander Makatsariya
Keyword(s):  
Preterm Birth ◽  
Neonatal Morbidity ◽  
Cervical Length ◽  
Fetal Fibronectin ◽  
Neonatal Deaths ◽  
A Value ◽  
Increased Risk ◽  
Asymptomatic Women

Preterm delivery (PTB) is one of the most common and serious complications of pregnancy. PTB accounts for approximately 70% of neonatal deaths and is a major cause of neonatal morbidity including respiratory distress syndrome, necrotising enterocolitis and long-term neurological disabilities. Prevention of PTB and its complications include identification among symptomatic women those at high risk of immediate delivery requiring prenatal corticosteroids administration. Transvaginal ultrasonographic evaluation of the cervical length (CL) is predictive of PTB and a value 15 mm identifies among symptomatic women approximately 70% of women who will deliver within one week. In the range of CL within 15 and 30 mm biomarkers n cervical-vaginal fluids (fetal fibronectin, phosphorylated insulin-like growth factor protein-1, placental alpha-microglobulin-, cytokines) and other ultrasonographic cervical variables (posterior cervical angle, elastography) improve the identification of women at risk, In asymptomatic women CL can be applied as screening and has been proposed as a universal screening during the second trimester in singleton gestations. The finding of a CL25mm is associated with an increased risk of subsequent PTB with a sensitivity between 30 and 60% that is improved with the combination of biomarkers. Asymptomatic women with a CL 25mm should be offered vaginal progesterone treatment for the prevention of preterm birth and neonatal morbidity. The role of cerclage and pessary is still controversial. In this review we discuss the evidence-based role of ultrasonographic cervical assessment and cervicovaginal biomarkers in the prediction of PTB in symptomatic and asymptomatic women

Fetal Fibronectin, Endotoxin, Bacterial Vaginosis and Cervical Length as Predictors of Preterm Birth and Neonatal Morbidity in Twin Pregnancies

1998 ◽  
Vol 53 (7) ◽  
pp. 402-403
Author(s):  
U.-B. Wennerholm ◽  
B. Holm ◽  
I. Mattsby-Baltzer ◽  
T. Nielsen ◽  
J. Platz-Christensen ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Bacterial Vaginosis ◽  
Neonatal Morbidity ◽  
Cervical Length ◽  
Fetal Fibronectin ◽  
Twin Pregnancies

Influence of transvaginal ultrasound examination on quantitative vaginal fibronectin measurements: a prospective evaluation study

2017 ◽  
Vol 45 (1) ◽  
Author(s):  
Michaela Golic ◽  
Jan-Peter Siedentopf ◽  
Franziska Pauly ◽  
Larry Hinkson ◽  
Wolfgang Henrich ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Transvaginal Ultrasound ◽  
Evaluation Study ◽  
Cervical Length ◽  
Prospective Evaluation ◽  
Fetal Fibronectin ◽  
A Value ◽  
Measurement Results ◽  
Perinatal Center ◽  
Random Fluctuations

AbstractObjective:The most important parameter in prediction of preterm birth is the cervical length measured by transvaginal ultrasound. In cases with mid-range cervical length (10–30 mm), prediction of preterm birth is difficult. In these cases, testing for cervicovaginal fluid fetal fibronectin (fFN) can improve prediction. However, it is unclear whether transvaginal ultrasound itself influences the fFN result. The purpose of this study was to evaluate this issue independent of gestational age and cervical length.Methods:A prospective evaluation study with 96 cases of pregnant women at 20–41 weeks of gestation was conducted in a tertiary perinatal center. A comparison of cervicovaginal fFN samples before and immediately after transvaginal ultrasound was performed. Fetal fibronectin was measured using the Hologic Rapid fFN 10Q system. It was analyzed quantitatively and qualitatively with ≥50 ng/mL as threshold for “positive”. Changes in fFN values following transvaginal ultrasound were measured.Results:Ninety-six percent (69/72) of women with a fFN concentration of <26 ng/mL before ultrasound had a corresponding fFN value <26 ng/mL after ultrasound. Ninety-three percent (13/14) of women with a fFN concentration of ≥100 ng/mL before ultrasound had a corresponding fFN value ≥100 ng/mL after ultrasound. In 80% (4/5) of women with a positive fFN sample but with a value <100 ng/mL, it turned negative (<50 ng/mL) after ultrasound. For fFN concentrations ≥100 ng/mL, there are high random fluctuations in the measurement results.Conclusions:Fetal fibronectin values of <26 ng/mL (for “negative”) and ≥100 ng/mL (for “positive”) from samples taken after ultrasound provide the same qualitative information as when sampled before ultrasound. For the correct interpretation however, quantitative analysis is necessary.

scholarly journals Interleukin 22 prevents lipopolysaccharide- induced preterm labor in mice†

2018 ◽  
Vol 98 (3) ◽  
pp. 299-308 ◽  
Author(s):  
Svetlana Dambaeva ◽  
Sylvia Schneiderman ◽  
Mukesh K Jaiswal ◽  
Varkha Agrawal ◽  
Gajendra K Katara ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Preterm Labor ◽  
Wound Repair ◽  
Potential Role ◽  
Treatment Method ◽  
Neonatal Deaths ◽  
Interleukin 22 ◽  
Epithelial Regeneration

Abstract Preterm birth is widespread and causes 35% of all neonatal deaths. Infants who survive face potential long-term complications. A major contributing factor of preterm birth is infection. We investigated the role of interleukin 22 (IL22) as a potential clinically relevant cytokine during gestational infection. IL22 is an effector molecule secreted by immune cells. While the expression of IL22 was reported in normal nonpregnant endometrium and early pregnancy decidua, little is known about uterine IL22 expression during mid or late gestational stages of pregnancy. Since IL22 has been shown to be an essential mediator in epithelial regeneration and wound repair, we investigated the potential role of IL22 during defense against an inflammatory response at the maternal–fetal interface. We used a well-established model to study infection and infection-associated inflammation during preterm birth in the mouse. We have shown that IL22 is upregulated to respond to an intrauterine lipopolysaccharide administration and plays an important role in controlling the risk of inflammation-induced preterm birth. This paper proposes IL22 as a treatment method to combat infection and prevent preterm birth in susceptible patients.

scholarly journals Quantitative fetal fibronectin and cervical length to predict preterm birth in asymptomatic women with previous cervical surgery

2016 ◽  
Vol 215 (4) ◽  
pp. 480.e1-480.e10 ◽  
Author(s):  
Brooke I. Vandermolen ◽  
Natasha L. Hezelgrave ◽  
Elizabeth M. Smout ◽  
Danielle S. Abbott ◽  
Paul T. Seed ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Cervical Length ◽  
Fetal Fibronectin ◽  
Cervical Surgery ◽  
Asymptomatic Women

scholarly journals Preterm Labour

2021 ◽  
Author(s):  
Maged Shendy ◽  
Hend Hendawy ◽  
Amr Salem ◽  
Ibrahim Alatwi ◽  
Abdurahman Alatawi
Keyword(s):  
Preterm Birth ◽  
Preterm Labour ◽  
Transvaginal Ultrasound ◽  
Neonatal Morbidity ◽  
Cervical Length ◽  
Fetal Blood ◽  
Fetal Fibronectin ◽  
High Risk Women ◽  
Fetal Blood Sampling ◽  
Fetal Scalp

Preterm delivery is defined as delivery before 37 weeks completed gestation. It represents a major cause of neonatal morbidity and mortality and accounts for 5–10% of all deliveries. Cervical length assessment between 16–24 weeks and positive fetal fibronectin beyond 21 weeks gestation are proved to useful tools in prediction of preterm labour. Treating asymptomatic bacteruia and bacterial vaginosis in high-risk women reduces the incidence of preterm labour. Cervical cerclage is recommended to reduce the incidence of preterm birth in women with 2nd trimester losses and those with cervical length of 25 mm or less on transvaginal ultrasound between 16–24 weks gestation. Atosiban and nifidipine are currently the agents of choice in tocolysis. Antenal steriods in womens with threating preterm labour reduces the perinatal morbidties. Magnisum sulphate role is established for neuroprotection especially in extreme gestations between 24–30 weeks. Vaginal delivery is mode of choice for delivery with consideration to avoid fetal blood sampling, fetal scalp electrodes and ventouse prior to 34 weeks gestations. Caesarean section is considered for obstetric reasons that guide labour management at term.

Short- and long-term outcomes of preterm spontaneous twin anemia-polycythemia sequence

2020 ◽  
Vol 48 (4) ◽  
pp. 329-334
Author(s):  
Soo Jin Han ◽  
Seung Mi Lee ◽  
Sohee Oh ◽  
Subeen Hong ◽  
Jeong Won Oh ◽  
...  
Keyword(s):  
Cord Blood ◽  
Neonatal Morbidity ◽  
Adverse Outcomes ◽  
Control Group ◽  
Long Term Outcomes ◽  
Neurodevelopmental Outcomes ◽  
Monochorionic Twin ◽  
Increased Risk ◽  
Study Population

AbstractBackgroundIn monochorionic twin pregnancy, placental anastomosis and inter-twin blood transfusion can result in specific complications, such as twin-twin transfusion syndrome (TTTS) and twin anemia-polycythemia sequence (TAPS). It is well established that adverse outcomes are increased in TTTS, but reports on the neonatal and long-term outcomes of TAPS are lacking. The objective of this study was to evaluate the neonatal and neurodevelopmental outcomes in spontaneous TAPS.MethodsThe study population consisted of monochorionic twin pregnancies with preterm birth (24–37 weeks of gestation) between November 2003 and December 2016 and in which cord blood was taken at the time of delivery. According to the result of hemoglobin in cord blood, the study population was divided into two groups: a spontaneous TAPS group and a control group. Neonatal and neurodevelopmental outcomes were compared between the two groups.ResultsDuring the study period, 11 cases were diagnosed as spontaneous TAPS (6.4%). The TAPS group had lower gestational age at delivery and had a higher risk for cesarean delivery. However, neonates with TAPS were not at an increased risk for neonatal mortality and significant neonatal morbidity. In addition, the frequency of severe cerebral lesion during the neonatal period and the risk of cerebral palsy at 2 years of age were not different between the two groups.ConclusionThe spontaneous TAPS diagnosed by postnatal diagnostic criteria was not associated with the increased risk of adverse neonatal and neurodevelopmental outcomes. Further studies are needed to evaluate the morbidity of antenatally diagnosed TAPS.

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