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

2021 ◽  
Vol 15 (3) ◽  
pp. 119-127 ◽  
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.

scholarly journals Prediction of Spontaneous Preterm Birth in At-risk Women Using Thrombospondin 1 from Cervicovaginal Fluid: A Prospective Observational Study

2021 ◽  
Vol 81 (09) ◽  
pp. 1055-1064
Author(s):  
Johannes Stubert ◽  
Kathleen Gründler ◽  
Bernd Gerber ◽  
Dagmar-Ulrike Richter ◽  
Max Dieterich
Keyword(s):  
At Risk ◽  
Preterm Birth ◽  
Predictive Value ◽  
Transvaginal Ultrasound ◽  
Area Under The Curve ◽  
Cervical Length ◽  
Multiple Gestation ◽  
Spontaneous Preterm Birth ◽  
Thrombospondin 1 ◽  
Cervicovaginal Fluid

Abstract Introduction Thrombospondin 1, desmoplakin and stratifin are putative biomarkers for the prediction of preterm birth. This study aimed to validate the predictive capability of these biomarkers in patients at risk of preterm birth. Materials and Methods We included 109 women with symptoms of threatened spontaneous preterm birth between weeks 20 0/7 and 31 6/7 of gestation. Inclusion criteria were uterine contractions, cervical length of less than 25 mm, or a personal history of spontaneous preterm birth. Multiple gestations were also included. Samples of cervicovaginal fluid were taken before performing a digital examination and transvaginal ultrasound. Levels of cervicovaginal thrombospondin 1, desmoplakin and stratifin were quantified by enzyme-linked immunosorbent assays. The primary endpoint was spontaneous preterm birth before 34 + 0 weeks of gestation. Results Sixteen women (14.7%) delivered before 34 + 0 weeks. Median levels of thrombospondin 1 were higher in samples where birth occurred before 34 weeks vs. ≥ 34 weeks of gestation (4904 vs. 469 pg/mL, p < 0.001). Receiver operator characteristics analysis resulted in an area under the curve of 0.86 (p < 0.0001). At an optimal cut-off value of 2163 pg/mL, sensitivity, specificity, positive predictive value and negative predictive value were 0.94, 0.77, 0.42 and 0.99, respectively, with an adjusted odds ratio of 32.9 (95% CI: 3.1 – 345, p = 0.004). Multiple gestation, cervical length, and preterm labor had no impact on the results. Survival analysis revealed a predictive period of more than eight weeks. Levels of desmoplakin and stratifin did not differ between groups. Conclusion Thrombospondin 1 allowed long-term risk estimation of spontaneous preterm birth.

Inter- and intra-observer variability in cervical measurement by ultrasound in the first and second trimesters of pregnancy: does it matter?

2015 ◽  
Vol 43 (1) ◽  
Author(s):  
Cíntia França ◽  
Teresa Carraca ◽  
Sofia Bessa Monteiro ◽  
Teresa Rodrigues ◽  
Nuno Montenegro ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Small Proportion ◽  
Transvaginal Ultrasound ◽  
Correlation Coefficients ◽  
Cervical Length ◽  
Observer Variability ◽  
Intra Class Correlation ◽  
Reproducible Method

AbstractThe aim of this study was to evaluate the inter- and intra-observer variabilities in the cervical length (CL) measurement by transvaginal ultrasound (TVU) in the first and second trimesters of pregnancy.A total of 55 singleton pregnant women were evaluated in the first or second ultrasound. Each patient was blindly evaluated by three of the four observers who performed three measurements each.In the first and second trimesters, patients were evaluated at 12.3 weeks (mean) and 21.3 weeks (mean), respectively. The intra-class correlation coefficients (ICC) between observers in the first and second trimesters were 0.76 and 0.72, respectively, and the ICCs within observers were 0.889 and 0.899, respectively. In both trimesters, the main source of variance was the patient and the second source of variance was the interaction, Patient×Observer (12.0% and 13.5%, respectively). The observer and measurement explained a small proportion of variance in both trimesters (1.4% and 0.4%, respectively in the 1TVU is a reliable and reproducible method by which to predict preterm birth in both the first and second trimesters.

Comparison of a novel test for placental alpha microglobulin-1 with fetal fibronectin and cervical length measurement for the prediction of imminent spontaneous preterm delivery in patients with threatened preterm labor

2015 ◽  
Vol 43 (4) ◽  
Author(s):  
Tanja Nikolova ◽  
Oleg Bayev ◽  
Natasha Nikolova ◽  
Gian Carlo Di Renzo
Keyword(s):  
Preterm Delivery ◽  
Transvaginal Ultrasound ◽  
Cervical Length ◽  
Fetal Fibronectin ◽  
Spontaneous Preterm Delivery ◽  
Bedside Test ◽  
Study Population ◽  
Threatened Preterm Labor ◽  
Singleton Pregnancies ◽  
Spontaneous Delivery

AbstractPartoSure is a bedside test for the prediction of time-to-spontaneous preterm delivery by the detection of placental alpha microglobulin-1 (PAMG-1). The objectives of this study were to further determine the test’s efficacy in predicting delivery within 7 or 14 days from testing, and to compare it with fetal fibronectin (fFN) and cervical length (CL) measurement by transvaginal ultrasound.The study population consisted of 203 consecutively recruited women with singleton pregnancies between 20The sensitivities for PartoSure (n=203), fFN (n=66), and CL (n=203) for predicting imminent spontaneous preterm delivery within 7 days were 80%, 50%, and 57%, respectively. The specificities were 95%, 72%, and 73% for PartoSure, fFN and CL, respectively. The NPVs were 96%, 87%, and 89% for PartoSure, fFN and CL, respectively. The PPVs were 76%, 29%, and 30% for PartoSure, fFN and CL, respectively.PAMG-1 detection by PartoSure is the single best predictor of imminent spontaneous delivery within 7 days compared to fFN and CL. In settings where CL is used as an initial screen, PartoSure has the greatest clinical utility in patients with CL between 15 and 35 mm. In situations where CL is not an initial screen, PartoSure is the most accurate test compared to fFN and CL.

scholarly journals The Impact of Routine Transvaginal Ultrasound Measurement of the Cervical Length on the Prediction of Preterm Birth: A Retrospective Study in a Tertiary Hospital

2021 ◽  
Vol 43 (04) ◽  
pp. 264-274
Author(s):  
Joana Patricia Rodrigues Félix Peixoto de Almeida ◽  
Carla Maria Magno Bartosch ◽  
Alexandra Matias Pereira Cunha Coelho Macedo
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Maternal Age ◽  
Transvaginal Ultrasound ◽  
Cervical Length ◽  
Ultrasound Measurement ◽  
Inverse Association ◽  
Second Trimester ◽  
Cervical Surgery ◽  
The Impact

AbstractPreterm birth (PTB) is a major obstetric problem associated with high rates of neonatal morbidity and mortality. The prevalence of PTB has not changed in the last decade; thus, the establishment of a screening test and effective treatment are warranted. Transvaginal ultrasound measurement of the cervical length (TUCL) has been proposed as an effective method to screen pregnant women at a higher risk of experiencing PTB. Objective To evaluate the applicability and usefulness of second-trimester TUCL to predict PTB in a cohort of Portuguese pregnant women. Methods Retrospective cross-sectional cohort study including all singleton pregnant women who performed their second-trimester ultrasound (between weeks 18 and 22 + 6 days) from January 2013 to October 2017 at Centro Hospitalar Universitário São João. Results Our cohort included 4,481 women. The prevalence of spontaneous PTB was of 4.0%, with 0.7% occurring before the 34th week of gestation. The mean TUCL was of 33.8 mm, and percentiles 3, 5 and 10 corresponded to TUCLs of 25.0 mm, 27.0 mm and 29.0 mm respectively. The multiple logistic regression analysis, including maternal age, previous PTB and cervical surgery showed a significant negative association between TUCL and PTB, with an odds ratio (OR) of 0.92 (95% confidence interval [95%CI]: 0.90–0.95; p < 0.001). The use of a TUCL of 20 mm is the best cut-off, when compared with the 25-mm cut-off, improving the prediction of risk. Conclusion The present study showed an inverse association between TUCL and PTB, and that the inclusion of other risk factors like maternal age, previous PTB and cervical surgery can improve the screening algorithm. Furthermore, it emphasizes that the TUCL cut-off that defines short cervix can differ according to the population.

scholarly journals The Combination of the Fetal Fibronectin Bedside Test and Cervical Length in Preterm Labor Is Useful for Prediction of Preterm Birth

2015 ◽  
Vol 05 (13) ◽  
pp. 746-753
Author(s):  
Monya Todesco ◽  
Moritz Hartog ◽  
Thomas Fabbro ◽  
Olav Lapaire ◽  
Irene M. Hoesli
Keyword(s):  
Preterm Birth ◽  
Preterm Labor ◽  
Cervical Length ◽  
Fetal Fibronectin ◽  
Bedside Test

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

2021 ◽  
Vol 13 (1) ◽  
pp. 112-116
Author(s):  
Miriam Fernanda Mogrovejo Gavilanes ◽  
Estefanía Rocío Ordoñez Castro ◽  
Carlos Eduardo Molina Romero
Keyword(s):  
Preterm Birth ◽  
Preterm Delivery ◽  
Preterm Labor ◽  
Predictive Accuracy ◽  
Transvaginal Ultrasound ◽  
Cervical Length ◽  
Current Evidence ◽  
Predictive Test ◽  
Maternal Characteristics ◽  
Predictive Tests

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.

scholarly journals Predictive Accuracy of Three Dimensional Ultrasound Measurement of Fetal Adrenal Gland Volume in Preterm Labor Cases

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
W H A Eltantawy ◽  
M M N Mohyieldin ◽  
A H Mohammed
Keyword(s):  
Preterm Birth ◽  
Adrenal Gland ◽  
Pregnant Women ◽  
Preterm Labor ◽  
Cervical Length ◽  
Fetal Fibronectin ◽  
Gland Volume ◽  
Significant Difference ◽  
Threatened Preterm Labor ◽  
Adrenal Gland Volume

Abstract Background Preterm birth is one of the major clinical problems in obstetrics and neonatology as it is associated with perinatal mortality, serious neonatal morbidity and in some cases childhood disability. It is reported that more than 80% of all neonatal mortality and morbidity is due to preterm birth. Objective In this study fetal adrenal gland volume and fetal zone measurement were used as a predictors for occurrence of labor in singleton pregnancies complicated by threatened preterm labor in comparison to cervical length and cervicovaginal fetal fibronectin. Methodology The study was carried out at Ain Shams University Maternity Hospital. The current study include 88 pregnant women who presented with symptoms or signs of threatened preterm labor (PTL). All women were subjected to full history taking, full general, abdominal, pelvic examination, in addition to ultrasound fetal biometry, measurement of cervical length, measurement of fetal fibronectin, fetal adrenal gland volume AGV and fetal zone acquisitions. Results Our results showed high statistically significant difference between the two groups of women regarding CL measurement, FZE and cAGV with P values &lt; 0.001 suggesting that ultrasound examination of fetal adrenal gland and assessment of FZE at time of evaluation for symptoms of PTL may be clinically beneficial in predicting the occurrence of labor in pregnant women at risk of preterm labor. Conclusion Our results demonstrate that in women presenting with threatened preterm labor, cAGV and FZE measured by 3-dimensional ultrasound seem to be significant predictors of delivery within 7 days, when compared to CL and cervicovaginal fetal fibronectin.

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

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.

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

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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