Use of cervical length, measured by transvaginal sonography at 22 to 26 weeks, as a predictor of preterm labour in twin pregnancy

Background: Preterm labour and delivery contributes significantly to perinatal morbidity and mortality in twin gestation. Measurement of cervical length during antenatal period and subsequent follow up may identify women at risk for preterm labour. The purpose of this study was to determine if measurement of cervical length at 22 to 26 weeks can be used as a predictor of preterm labour in twin pregnancy.Methods: This prospective observational study was carried out in 50 women with twin gestation in a tertiary care teaching hospital. Cervical length was measured using transvaginal sonography and repeated every four weeks till delivery. Cervical length of ≤30 mm was taken as short cervix and delivery before 37 weeks was taken as preterm delivery.Results: Total of 18 out of 50 women (36%) delivered between 32 to 34 weeks, 14 out of 50 (28%) delivered between 34 to 37 weeks, 7 out of 50 (14%) delivered at less than 32 weeks. Therefore, total preterm deliveries at less than 37 weeks were 78%. Total 11 out of 50 (22%) delivered at term i.e. at more than 37weeks. In women, who had short cervical length (≤ 30 mm) at the time of presentation, 14 out of 37 (38 %) delivered between 30 to 34 weeks, 12 out of 37 (32 %) women delivered between 34 to 37 weeks, 5 out of 37 (14%) delivered at ≤ 30 weeks. Rest 6 out of 37 (16 %) delivered after 37 weeks.Conclusions: Short cervical length of ≤30 mm on transvaginal sonography at 22-26 weeks of gestation in twin pregnancy may be used as a screening tool in prediction of preterm labour in asymptomatic twin pregnancy.

Download Full-text

Evaluation of the Arabin cervical pessary for prevention of preterm birth in women with a twin pregnancy and short cervix (STOPPIT-2): An open-label randomised trial and updated meta-analysis

PLoS Medicine ◽

10.1371/journal.pmed.1003506 ◽

2021 ◽

Vol 18 (3) ◽

pp. e1003506

Author(s):

Jane E. Norman ◽

John Norrie ◽

Graeme MacLennan ◽

David Cooper ◽

Sonia Whyte ◽

...

Keyword(s):

Preterm Birth ◽

Standard Care ◽

Twin Pregnancy ◽

Preterm Labour ◽

Meta Analysis ◽

Cervical Length ◽

Open Label ◽

Short Cervix ◽

Link Type ◽

Cervical Pessary

Background Preterm-labour-associated preterm birth is a common cause of perinatal mortality and morbidity in twin pregnancy. We aimed to test the hypothesis that the Arabin pessary would reduce preterm-labour-associated preterm birth by 40% or greater in women with a twin pregnancy and a short cervix. Methods and findings We conducted an open-label randomised controlled trial in 57 hospital antenatal clinics in the UK and Europe. From 1 April 2015 to 14 February 2019, 2,228 women with a twin pregnancy underwent cervical length screening between 18 weeks 0 days and 20 weeks 6 days of gestation. In total, 503 women with cervical length ≤ 35 mm were randomly assigned to pessary in addition to standard care (n = 250, mean age 32.4 years, mean cervical length 29 mm, with pessary inserted in 230 women [92.0%]) or standard care alone (n = 253, mean age 32.7 years, mean cervical length 30 mm). The pessary was inserted before 21 completed weeks of gestation and removed at between 35 and 36 weeks or before birth if earlier. The primary obstetric outcome, spontaneous onset of labour and birth before 34 weeks 0 days of gestation, was present in 46/250 (18.4%) in the pessary group compared to 52/253 (20.6%) following standard care alone (adjusted odds ratio [aOR] 0.87 [95% CI 0.55–1.38], p = 0.54). The primary neonatal outcome—a composite of any of stillbirth, neonatal death, periventricular leukomalacia, early respiratory morbidity, intraventricular haemorrhage, necrotising enterocolitis, or proven sepsis, from birth to 28 days after the expected date of delivery—was present in 67/500 infants (13.4%) in the pessary group compared to 76/506 (15.0%) following standard care alone (aOR 0.86 [95% CI 0.54–1.36], p = 0.50). The positive and negative likelihood ratios of a short cervix (≤35 mm) to predict preterm birth before 34 weeks were 2.14 and 0.83, respectively. A meta-analysis of data from existing publications (4 studies, 313 women) and from STOPPIT-2 indicated that a cervical pessary does not reduce preterm birth before 34 weeks in women with a short cervix (risk ratio 0.74 [95% CI 0.50–1.11], p = 0.15). No women died in either arm of the study; 4.4% of babies in the Arabin pessary group and 5.5% of babies in the standard treatment group died in utero or in the neonatal period (p = 0.53). Study limitations include lack of power to exclude a smaller than 40% reduction in preterm labour associated preterm birth, and to be conclusive about subgroup analyses. Conclusions These results led us to reject our hypothesis that the Arabin pessary would reduce the risk of the primary outcome by 40%. Smaller treatment effects cannot be ruled out. Trial registration ClinicalTrials.gov ISRCTN 02235181. ClinicalTrials.gov NCT02235181.

Download Full-text

Cervical length measurement by transvaginal sonography in predicting preterm labour in low risk women

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20175282 ◽

2017 ◽

Vol 6 (12) ◽

pp. 5563

Author(s):

Sandeep Sethumadhavan P. ◽

Raju Agarwal ◽

Jayamol M. Anilkumar ◽

Anup Ramchandran Pillai

Keyword(s):

Preterm Delivery ◽

Gestational Age ◽

Preterm Labour ◽

Screening Method ◽

Cervical Length ◽

Low Risk ◽

Military Hospital ◽

Transvaginal Sonography ◽

Short Cervix ◽

Low Risk Women

Background: Preterm birth is the leading cause of perinatal morbidity and mortality. Transvaginal sonographic measurement of the cervix is a reliable alternative method for the assessment of cervical length as it allows better quality and more accurate visualization of the uterine cervix. Several studies have reported that cervical assessment on transvaginal sonography may be useful in the prediction of preterm delivery. The objective of this study was to assess cervical length at 20 to 24 weeks of gestation in low risk women and correlate with the gestational age at delivery.Methods: A prospective cohort study conducted in a tertiary care Military Hospital in Pune, India. 354 asymptomatic low risk antenatal women with gestational age of 20 to 24 weeks were studied. Cervical assessment with transvaginal sonography for the measurement of cervical length was performed using a 10 MHz transvaginal probe.Results: 7 percent women delivered preterm. The incidence of short cervix in low risk women was only 0.56%. 100% women with short cervix delivered preterm and, only 6.9% patients who had cervical length more than 25 mm delivered preterm. Cervical length 25 mm has got sensitivity and NPV of 100% and a specificity of 93.46%. However, the PPV was only 8%.Conclusions: The study reported significant inverse relation between short cervix and the occurrence of preterm delivery. Our findings suggest that cervical length can be used as a screening method for preterm labour in low risk women. However strong evidences from large randomized control trials would be required to assess its cost-effectiveness.

Download Full-text

Association of first trimester serum level of placental growth factor (PlGF) and cervical length with onset of preterm labour

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20191234 ◽

2019 ◽

Vol 8 (4) ◽

pp. 1641

Author(s):

Ipsita Sahoo ◽

Madhusudan Dey ◽

Jayamol A.

Keyword(s):

Preterm Birth ◽

Serum Level ◽

Preterm Labour ◽

Tertiary Care ◽

Risk Identification ◽

Cervical Length ◽

Transvaginal Sonography ◽

Early Prediction ◽

Care Hospital ◽

Labour Group

Background: Preterm labour (PTL) or premature labour is defined as one where labour starts before the 37th completed week. The incidence of preterm birth is around 5-10% and it is the leading cause of perinatal morbidity and mortality. Diagnosis and treatment of PTL is challenging. However, owing to the availability of effective strategies for prevention of preterm birth, risk identification and early prediction is even more essential. This may provide opportunity for intervention and better obstetric care. Various biochemical markers were studied for prediction of preterm labour, but the sensitivity and specificity were found to be low. This study focuses on determining whether serum level of PlGF and ultrasound measure of cervical length at 10 – 14 weeks period of gestation can be used for early prediction of preterm labour.Methods: 296 antenatal women participated in this prospective observational study carried out from Dec 2015 to Sep 2017 at a tertiary care hospital. Serum level of PlGF was determined at 10-14 weeks. In the same sitting, cervical length was measured by transvaginal sonography. All these patients were followed up in antenatal OPD for monitoring the onset of preterm labour.Results: Incidence of preterm labour was 6.76 %. Maternal characteristics and obstetric factors were comparable in cases and controls. Serum PlGF level and cervical length values were lower in preterm labour group than term deliveries. But this result was not statistically significant.Conclusions: Lower levels of PlGF and cervical length were seen in preterm labour group, although it was not found to be statistically significant.

Download Full-text

Transvaginal Sonographic Evaluation of the Cervix in Asymptomatic Singleton Pregnancy and Management Options in Short Cervix

Journal of Pregnancy ◽

10.1155/2012/201628 ◽

2012 ◽

Vol 2012 ◽

pp. 1-10 ◽

Cited By ~ 8

Author(s):

Resul Arisoy ◽

Murat Yayla

Keyword(s):

Preterm Delivery ◽

Cervical Length ◽

Transvaginal Sonography ◽

Singleton Pregnancy ◽

Management Options ◽

Short Cervix ◽

Cervical Gland ◽

Prophylactic Cerclage ◽

Singleton Pregnancies

Preterm delivery (PTD), defined as birth before 37 completed weeks of gestation, is the leading cause of perinatal morbidity and mortality. Evaluation of the cervical morphology and biometry with transvaginal ultrasonography at 16–24 weeks of gestation is a useful tool to predict the risk of preterm birth in low- and high-risk singleton pregnancies. For instance, a sonographic cervical length (CL) > 30 mm and present cervical gland area have a 96-97% negative predictive value for preterm delivery at <37 weeks. Available evidence supports the use of progesterone to women with cervical length ≤25 mm, irrespective of other risk factors. In women with prior spontaneous PTD with asymptomatic cervical shortening (CL ≤ 25 mm), prophylactic cerclage procedure must be performed and weekly to every two weeks follow-up is essential. This article reviews the evidence in support of the clinical introduction of transvaginal sonography for both the prediction and management of spontaneous preterm labour.

Download Full-text

A prospective study of prediction of preterm delivery by cervical assessment by transvaginal sonography

Indian Journal of Obstetrics and Gynecology Research ◽

10.18231/j.ijogr.2021.109 ◽

2021 ◽

Vol 8 (4) ◽

pp. 531-534

Author(s):

Garima Bagga Arora ◽

Asmita Bodade ◽

Ritesh Bodade ◽

Lohit S Vaishnao ◽

Gourav Bagga

Keyword(s):

Preterm Birth ◽

Preterm Delivery ◽

Preterm Labour ◽

Tertiary Care ◽

Specific Treatment ◽

Cervical Length ◽

Human Potential ◽

Transvaginal Sonography ◽

Neonatal Deaths ◽

A Prospective Study

Preterm birth is a major cause of death and a significant cause of long-term loss of human potential amongst survivors all around the world. Complications of preterm birth are the single largest direct cause of neonatal deaths, responsible for 35% of the world’s 3.1 million deaths a year, and the second most common cause of under-5 deaths after pneumonia. In this study, an attempt has been made to evaluate the usefulness of cervical assessment by TVS in prediction of risk of preterm delivery in low risk pregnant women, thereby earlier management option can be planned and patients specific treatment can be given at the earliest. The present study was carried out in tertiary care teaching hospital for 1 year from 1 Jan 2019 to 31 Dec 2019. Total of 100 study participants who underwent TVS assessments of cervix regularly followed up who underwent TVS assessment of cervix and were regularly follow up and delivered. The mean cervical length in all these women was 30±6.68 mm. It was observed that 51.72% of patients with short cervical length less than 25 mm had preterm labour compared to the patients with cervical length more than 25mm i.e. 4.22%. Cervical assessment by TVS is effective in predicting preterm labour.

Download Full-text

Measurement of cervical length using transvaginal sonography for prediction of preterm labour

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20204795 ◽

2020 ◽

Vol 9 (11) ◽

pp. 4471

Author(s):

Bina M. Raval ◽

Viditsinh P. Sisodiya ◽

Pushpa A. Yadava ◽

Shital T. Mehta ◽

Sagar R. Patel ◽

...

Keyword(s):

Predictive Value ◽

Prospective Observational Study ◽

Preterm Labour ◽

Transvaginal Ultrasound ◽

Cervical Length ◽

Transvaginal Sonography ◽

Major Health ◽

Preterm Babies ◽

Sensitivity Specificity

Background: Preterm labour and delivery cause major health burden to the society due to high perinatal morbidities and mortality and long-term health implications and also affects maternal. An effective and objective way for predicting preterm delivery is measurement of cervical length by transvaginal sonography as it allows better quality and accurate visualization of uterine cervix. Cervical length (<25 mm) is good and accurate cervical biometry for prediction of preterm birth. The objective of this study was to measure cervical length by transvaginal sonography for predicting preterm labour and fetal outcome.Methods: This prospective observational study was conducted in department of obstetrics and gynaecology, at SVPIMSR hospital, Ahmedabad from July 2018 to December 2019 in 150 antenatal women to assess cervical changes (cervical length, dilatation of internal OS, funnelling etc.) between 16 to 24 weeks of gestation and these cases followed till delivery and results were analysed.Results:150 antenatal women who fulfilled the selection criteria were studied using transvaginal ultrasound between 16-24 weeks of gestation, out of them 36 (24%) women delivered preterm babies. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) recorded in this study were 80.5%, 94.73%, 82.85% and 93.91% respectively.Conclusion: Transvaginal sonography is the most useful and better, safe, accurate, most effective, less expensive, objective and acceptable technique for assessing cervical length in all antenatal women and predicting the preterm labour when assessed between 16 -24 weeks of gestational age.

Download Full-text

Evaluation of Aetiology and Outcome of Acute Kidney Injury in a Tertiary Care Hospital of India- A Prospective Observational Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/45161.13845 ◽

2020 ◽

Author(s):

VS Gaurav Narayan ◽

SG Ramya ◽

Sonal Rajesh Kumar ◽

SK Nellaiappa Ganesan

Keyword(s):

Acute Kidney Injury ◽

Intensive Care ◽

Observational Study ◽

Prospective Observational Study ◽

Tertiary Care ◽

Kidney Injury ◽

Rapid Decline ◽

Care Hospital ◽

Medical Intensive Care

Introduction: The Acute Kidney Injury (AKI) is a rapid decline in renal filtration function. The aetiological spectrum, prevalence of AKI and outcome is highly variable. This variation exists due to the difference in the criteria used, study population and demographic features. Huge differences are noted when AKI is compared in developing and developed countries. Hence, it is important to analyse the spectrum of AKI to facilitate earlier diagnosis and treatment which shall help in improving the outcome. Aim: To study the prevalence, aetiology and outcome of AKI in the medical intensive care. Materials and Methods: This was a prospective observational study conducted in a medical intensive care for 18 months where 1490 patients were screened and 403 patients were included as AKI by KDIGO criteria. History, examination, appropriate investigations and treatment details including dialysis were noted. The serum creatinine levels were obtained every day, to know the time of onset of AKI, at the time of death or discharge, and after one month for patients who turned up for follow-up. Patients were categorised based on outcome as survivors and nonsurvivors. Survivors were divided into as fully recovered and partially recovered and those who left the Intensive Care Unit (ICU) against medical advice were termed as lost to follow-up. Results: A total of 403 patients (27.04% of 1490) of medical intensive care admissions were found to have AKI. Sepsis was the most common cause of AKI. At the end of the month, 78.4% of AKI patients fully recovered, 1.2% partially recovered and the mortality was 14.9%. Mortality was higher in AKI associated with chronic medical conditions like cardiac failure, chronic liver disease and stroke. Conclusion: If treated early, AKI is mostly reversible. Regional differences in AKI should be studied extensively and local guidelines should be formulated by experts for prevention and early treatment, to improve the disease outcome.

Download Full-text