scholarly journals Pre-Cerclage Cervical Length—A Reliable Predictor of Long-Term Pregnancy Sustenance After Therapeutic Cervical Cerclage: A Retrospective Study

2021 ◽  
Author(s):  
Emi Kondo ◽  
Eiji Shibata ◽  
Toshihide Sakuragi ◽  
Yukiyo Aiko ◽  
Takeshi Kawakami ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Inflammatory Marker ◽  
Cervical Length ◽  
Multiple Gestation ◽  
Cervical Insufficiency ◽  
Term Pregnancy ◽  
Cervical Cerclage ◽  
Term Birth

Abstract Background: The indication of therapeutic cerclage is still controversial. The purpose of this study was to assess pregnancy outcomes after cervical cerclage in women with shortened cervical length (CL) during pregnancy and/or with a medical history of cervical insufficiency. Methods: We included pregnant women who underwent cerclage in four perinatal medical centers between January 2009 and December 2010. We compared the outcomes of cerclage in terms of non-term and term births, as well as successful and unsuccessful cerclages. Cervical cerclage was defined as successful if pregnancy was continued for more than 13 weeks post-cerclage. Therapeutic and prophylactic cerclages were performed in pregnant women with pre-cerclage CL < 25 mm and ≥ 25 mm, respectively.Results: We screened 114 pregnant women, of whom 91 were included; 15 and 8 women were excluded for unknown pregnancy outcomes and multiple gestation, respectively. The rate of therapeutic cerclage was significantly higher in the non-term birth (68% vs. 38%, p <0.01; non-term group vs. term birth group), unsuccessful cerclage (79% vs. 43%, p =0.01; unsuccessful cerclage vs. successful cerclage) groups. Inflammatory marker levels (white blood cell count and C-reactive protein) were normal in both group sets, albeit no significantly different between-group differences. Receiver-operating characteristic curve analysis revealed that 87% of patients with pre-cerclage CL ≥ 17 mm sustained their pregnancies for more than 13 weeks post-cerclage. However, 64% of patients with pre-cerclage CL < 17 mm did not sustain their pregnancies for more than 13 weeks post-cerclage.Conclusions: Therapeutic cerclage should be performed in patients with cervical insufficiency having CL ≥ 17 mm, for long-term pregnancy sustenance.

scholarly journals Ambispective study on Mac Donald suturing in pregnant ladies with cervical incompetence in Dhulikhel Hospital

2012 ◽  
Vol 8 (3) ◽  
pp. 321-324
Author(s):  
S R Tamrakur ◽  
C D Chawla
Keyword(s):  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Previous History ◽  
Cervical Length ◽  
University Teaching ◽  
Third Trimester ◽  
Cervical Cerclage ◽  
Trimester Abortion ◽  
Cervical Incompetence ◽  
History Of

Background Cervical incompetence is one of the main contributors to repeated pregnancy loss, accounting for approximately 25% of the cases. Typically it results in progressive cervical dilatation, leading to a painless second- or early-third-trimester abortion. Objectives The main objective of the study was to explore the benefit from cervical cerclage in pregnant women with anatomical cervical incompetence Methods In a review of the operation and labour registers from January 2006 till January 2010, a total of 38 cervical cerclage procedures were performed at Dhulikhel Hospital (DH). In the study caste, parity, gestational age, diagnostic criteria, postoperative complications and pregnancy outcomes of the cases were analyzed. Results Two of the 38 cases didn’t come for delivery at Dhulikhel Hospital (Kathmandu University Teaching Hospital). Four women haven’t delivered at the time of data analysis. So pregnancy outcomes were analyzed among 32 cases while rests of the variables were analyzed among 38 cases. Of them 18 cases (47%) were Brahmin, 22 cases (58%) were between 20-25 years old and 32 cases (84%) were from Kavre district.  All cases were booked cases (they had antenatal care in the hospital) and 14 patients (37%) were third gravida. Most cases had 2 to 4 antenatal visits prior to suturing. Two cases were diagnosed with a bicornuate uterus. 21 cases (55%) had a previous history of at least one dilatation and evacuation.  33 cases (87%) were diagnosed with cervical incompetence clinically and confirmed by ultrasound. The remaining 13% were assessed, in the absence of a history of mid-trimester abortion, of having a high suspicion of cervical incompetence after mid-trimester scan with measurement of cervical length. In 18 cases (47%), cervical cerclage were done at 15 to 20 weeks of gestation. The postoperative period was uneventful in all 38 cases.  All cases (32) delivered in DH were assisted by consultant obstetricians. 19 out 32 cases (59%) were delivered vaginally at term. Conclusions38 cases were included in the study. Pregnancy outcomes were analyzed among 32 cases while rests of the variables were analyzed among 38 cases. 31 out 32 cases were delivered with good foetal weight. It clearly shows pregnant women with anatomical cervical incompetence were benefitted from cervical cerclage. The authors recommend an early trans vaginal scan in any patient with a history of mid trimester abortion or preterm labour. The cervical cerclage procedure therefore should be available more widely to benefit those patients with proven or strongly suspected cervical incompetence.DOI: http://dx.doi.org/10.3126/kumj.v8i3.6222 Kathmandu Univ Med J 2010;8(3):321-24 

scholarly journals Prediction of Outcome for Transabdominal Cerclage in Women with Cervical Insufficiency

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Ji Eun Song ◽  
Keun Young Lee ◽  
Ga Hyun Son
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Cohort Study ◽  
Pregnancy Outcomes ◽  
Retrospective Cohort ◽  
Multivariate Analyses ◽  
Univariate Analysis ◽  
Cervical Length ◽  
Cervical Insufficiency ◽  
Prediction Of Outcome

We investigated pregnancy outcome following transabdominal cerclage (TAC) in women with cervical insufficiency (CI) and explored parameters for predicting pregnancy outcomes following TAC. In this retrospective cohort study, we included 161 women with TAC. We considered demographic, obstetric, and gynecologic histories, pre- and postoperative cervical length (CL), and CL at 20–24 weeks as parameters for predicting outcomes following TAC. Univariate and multivariate analyses were used to identify risk factors for predicting delivery before 34 weeks after TAC. 182 pregnancies occurred after TAC, and 290 pregnancies prior to TAC were identified. The rate of delivery <34 weeks significantly decreased following TAC (5% versus 82%,P<0.001). Univariate analysis demonstrated that a short CL (<25 mm) at 20–24 weeks and adenomyosis were associated with delivery at <34 weeks’ gestation following TAC (P=0.015andP=0.005, resp.). However, multivariate analysis demonstrated that only a short CL (<25 mm) at 20–24 weeks was a significant predictor (P=0.005). TAC is an efficacious procedure that prolongs pregnancy in women with CI. A short CL at 20–24 weeks may predict the delivery at <34 weeks’ gestation following TAC.

scholarly journals The Pregnancy Outcomes and Child Development Effects of SARS-CoV-2 Infection Study (PROUDEST): A Multicenter Prospective Cohort Study Protocol (Preprint)

2020 ◽  
Author(s):  
Geraldo Magela Fernandes ◽  
Lizandra Moura Paravidine Sasaki ◽  
Felipe Motta ◽  
Ângelo Pereira Da Silva ◽  
Andreza Monforte Miranda ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Child Development ◽  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Comparison Groups ◽  
Long Term Follow Up ◽  
Group A ◽  
Group B ◽  
Infection Study

BACKGROUND A growing body of evidence suggests that infection by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) during pregnancy may affect maternal-fetal outcomes, with possible implications for the long-term development of exposed children OBJECTIVE The PRegnancy OUtcomes and child Development Effects of SARS-CoV-2 infection STudy (PROUDEST) is a multicenter prospective study designed to understand the repercussions of COVID-19 to mother-child global health. METHODS The PROUDEST trial comprises two prospective sequential substudies. The PREGNANT substudy will assess the effects of SARS-CoV-2 infection on pregnancy, childbirth and puerperium clinically and from a mechanistic standpoint to understand the inflammatory and immunological phenomena underlying COVID-19 in relation to pregnancy. Pregnant women aged 18 to 40 years with laboratory-proven exposure to SARS-CoV-2 (group A, n = 300) will be compared to control subjects with no laboratory evidence of in-pregnancy exposure to the virus (group B, n = 300). Subjects exposed to other infections during pregnancy will be excluded. The BORN substudy is a long-term follow-up study assessing the offspring of women who entered the prior substudy. It will describe the effects of SARS-CoV-2 exposure during pregnancy on children’s growth, neurodevelopment and metabolism from birth up to five years of age. It includes two comparison groups: group A (exposed, n = 300) comprises children born from SARS-CoV-2-exposed pregnancies, and group B (controls, n = 300) comprises children from nonexposed mothers. RESULTS The recruitment has begun in July, 2020 and until September, 2020, 115 pregnant women infected with SARS-CoV-2 during pregnancy and 80 newborns were included. Data analysis is scheduled to start after all inclusion data have been collected. CONCLUSIONS Upon completion of the study, we expect to have obtained comprehensive data to provide a better understanding of the effects of SARS-CoV-2 and its inflammatory and immunological processes on pregnancy, puerperium and infancy. Our findings will inform clinical decisions regarding the care of exposed mothers and children and support the development of evidence-based public health policies. CLINICALTRIAL The PROUDEST study was registered on the Brazilian Register of Clinical Trials website (https://www. http://www.ensaiosclinicos.gov.br), ID RBR-65qxs2, on June 13th, 2020, where Brazilian clinical trials are exclusively registered.

The features of hormonal homeostasis in women with cervix maturation

2018 ◽  
pp. 38-42
Author(s):  
I. Zhabchenko ◽  
◽  
I. Lishchenko ◽  
O. Sudmak ◽  
O. Bondarenko ◽  
...  
Keyword(s):  
At Risk ◽  
Blood Serum ◽  
Pregnant Women ◽  
Adrenergic Receptors ◽  
Cervical Insufficiency ◽  
Hormonal Changes ◽  
Term Pregnancy ◽  
Fetoplacental Complex ◽  
Post Term Pregnancy ◽  
Group 1

The problem of untimely maturation of the cervix (belated in pregnancy or premature in the case of obstructive function of the cervix) in modern obstetrics is considered as a biological process closely related to such factors as chronological duration of pregnancy, mechanisms of start and duration of labor, the state of the fetoplacental complex and neck uterus. The objective: the determination of the features of hormonal homeostasis in women with cervix maturation. Materials and methods. In the dynamics of pregnancy, 28 pregnant women who were on treatment and birth in the department of the Pathology of Pregnancy and Childbirth were examined by the MI «IPOG them. Acad. O.M. Lukyanova NAMS of Ukraine». The distribution of women with cervix ripening is as follows: group 1 – pre-pregnant women at risk of post-term pregnancy – 13, 2-group – 15 pre-term women with ischemic-cervical insufficiency. Results. On the eve of labor in 39–40 weeks, the concentration of estradiol in the blood serum of women in group 1 reached the maximum values and amounted to 68.2±1.3 nmol/l. In women with isthmic-cervical insufficiency, the concentration of estradiol in the blood serum was within the limits of gestational norm. As the study shows, the concentration of progesterone in serum in group 1 – 759.9±23.2 nmol/l, the coefficient P/E2 – 10.9±0.78. It should be noted that in the 2nd study group, there is a shift in the estrogen / progesterone balance towards the estrogen, indicating an increase in the activity of α2-adrenergic receptors and a decrease in the representation and activity of β-adrenergic receptors. In the overwhelming number of women under study, 2 groups according to colpocytology had an estrogen type of smear (68.4%), corresponding to their hormonal changes in the concentration of estradiol and progesterone in serum. An increase in the concentration of cortisol in the blood of pregnant women in group 1 indicates a high level of psychoemotional stress and strain of neuroendocrine mechanisms of adaptation, which may be one of the causes of pregnancy. At the same time, the secretion of prolactin was significantly reduced in pregnant women in groups 2 with respect to women in group 1. Conclusions. The given data testify to the specific progesterone deficiency characteristic for pregnant women with functional impairment of obstructive function of cervix, which manifests itself by displacement of estrogen-progesterone ratio and is a sign of instability of hormonal production function of the placenta and one of the main pathogenetic parts of its dysfunction and failure of the cervix during pregnancy. The course of pregnancy in women at risk of post-term pregnancy is accompanied by a violation of the function of the fetoplacental complex represented by absolute and relative hypoestrogeny in the presence of unchanged relative to the norm of concentration of progesterone in serum. Key words: pregnancy, post-term pregnancy, fetoplacental complex, cortisol, thyroid hormones, colpocytology, isthmic-cervical insufficiency.

scholarly journals COVID-19 in Pregnancy and Early Childhood (COPE): study protocol for a prospective, multicentre biobank, survey and database cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e049376
Author(s):  
Ylva Carlsson ◽  
Lina Bergman ◽  
Mehreen Zaigham ◽  
Karolina Linden ◽  
Ola Andersson ◽  
...  
Keyword(s):  
Cohort Study ◽  
Child Health ◽  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Data Encryption ◽  
Ethical Review ◽  
General Data Protection Regulation ◽  
Early Parenthood ◽  
The Impact

IntroductionThere is limited knowledge on how the SARS-CoV-2 affects pregnancy outcomes. Studies investigating the impact of COVID-19 in early pregnancy are scarce and information on long-term follow-up is lacking.The purpose of this project is to study the impact of COVID-19 on pregnancy outcomes and long-term maternal and child health by: (1) establishing a database and biobank from pregnant women with COVID-19 and presumably non-infected women and their infants and (2) examining how women and their partners experience pregnancy, childbirth and early parenthood in the COVID-19 pandemic.Methods and analysisThis is a national, multicentre, prospective cohort study involving 27 Swedish maternity units accounting for over 86 000 deliveries/year. Pregnant women are included when they: (1) test positive for SARS-CoV-2 (COVID-19 group) or (2) are non-infected and seek healthcare at one of their routine antenatal visits (screening group). Blood, as well as other biological samples, are collected at different time points during and after pregnancy. Child health up to 4 years of age and parent experience of pregnancy, delivery, early parenthood, healthcare and society in general will be examined using web-based questionnaires based on validated instruments. Short- and long-term health outcomes will be collected from Swedish health registers and the parents’ experiences will be studied by performing qualitative interviews.Ethics and disseminationConfidentiality aspects such as data encryption and storage comply with the General Data Protection Regulation and with ethical committee requirements. This study has been granted national ethical approval by the Swedish Ethical Review Authority (dnr 2020-02189 and amendments 2020-02848, 2020-05016, 2020-06696 and 2021-00870) and national biobank approval by the Biobank Väst (dnr B2000526:970). Results from the project will be published in peer-reviewed journals.Trial registration numberNCT04433364.

scholarly journals Pregnancy as a Risk Factor of Severe COVID-19

2021 ◽  
Vol 10 (22) ◽  
pp. 5458
Author(s):  
Aleksander Celewicz ◽  
Marta Celewicz ◽  
Michał Michalczyk ◽  
Paula Woźniakowska-Gondek ◽  
Kamila Krejczy ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Caesarean Delivery ◽  
Recent Literature ◽  
Healthcare Quality ◽  
Term Birth ◽  
Cellular Changes ◽  
Global Pandemic ◽  
Adverse Pregnancy ◽  
The Right

Since first being identified in December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as an etiological agent behind Coronavirus disease 19 (COVID-19), has caused three waves of a global pandemic, with a fourth in progress. Despite its high percentage of asymptomatic and low-symptomatic courses of illness, the SARS-CoV-2 pandemic has claimed a higher death toll than the SARS-CoV and MERS-CoV epidemics because of its high infectivity when compared to the other coronaviruses. High COVID-19 mortality is associated with age and other coexisting morbidities, as well as healthcare quality. According to several studies, pregnant women are at a higher risk of severe COVID-19 infection and adverse pregnancy outcomes (caesarean delivery, pre-term birth, low birth weight, preeclampsia, ICU admission, and need for mechanical ventilation). In our review of recent literature, we focused on the effects of COVID-19 in pregnant women, emphasizing the subcellular pathophysiology of SARS-CoV-2. In this paper, we concentrate on the pathophysiology of sub-cellular changes in COVID-19 and endeavor to highlight the aspects that manifest in physiological pregnancy and potentially create a higher risk of SARS-CoV-2 infection and acute COVID-19 symptoms. Understanding how pregnancy-associated changes can cause a synergistic effect with COVID-19 may point us in the right direction for future prophylaxis and treatment for women undergoing COVID-19 during pregnancy.

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