scholarly journals The status of fetal autonomic nervous regulation in women with «short cervix» syndrome

2021 ◽  
Vol 4 ◽  
pp. 36-39
Author(s):  
I.V. Lakhno ◽  
S.V. Korovai
Keyword(s):  
Relative Risk ◽  
Pregnant Women ◽  
Preterm Births ◽  
Fetal Distress ◽  
Cervical Length ◽  
Nervous Regulation ◽  
Short Cervix ◽  
Autonomic Nervous ◽  
Vaginal Progesterone ◽  
Group I

The objective: was to investigate the coefficients of acceleration capacity (AC) and deceleration capacity (DC) in women with «short cervix» syndrome.Materials and methods. A total of 292 pregnant women were examined. They were divided into several groups according to the results of the study of cervical length and methods of prevention of premature birth. Group I included women with normal cervicometry data. In other groups there were women with a «short cevix». In group II, there were women who underwent cerclage. In group III – used a pessary; Group IV – prescribed intravaginal progesterone; V – used cerclage and pessary; and in VI – cerclage and progesterone vaginally.Results. The level of preterm births was 2.1%, 10.9%, 8.9%, 9.3%, 6.9% and 7.5% in women of groups I, II, III, IV, V and VI, respectively (p<0.05 by criterion χ2 compared with women with normal cervical length).The values of AC/DC at 26 weeks were low and did not differ by groups. Subsequently, the values of AC/DC in women with cervical shortening were equal to the control only in groups III and VI. The fact that women who received vaginal progesterone as monotherapy or additionally to cervical cerclage significantly reduced the relative risk of fetal distress is of great interest. Thus, the normalization of AC/DC in pregnant women with «short cervix» syndrome under the influence of progesterone reflected the development of nervous regulation, which contributed the reduction the level of fetal distress.Conclusions. In patients with «short cervix» syndrome, there was a decrease in the level of AC/DC, which reflected the deterioration of the processes of autonomic nervous regulation of fetal hemodynamics. This captured the increased level of fetal distress. The use of vaginal progesterone contributed to normalize AC/DC and reduce the relative risk of fetal distress.

scholarly journals Sildenafil Citrate Versus Nifedipine and Dydrogesreone in Prevention of Preterm Labor with Short Cervix

2018 ◽  
Vol 2 (1) ◽  
pp. 01-05
Author(s):  
Abd El-Naser Abd El-Gaber Ali ◽  
Khaled M Abdallah ◽  
Ahmed Abdelhamid
Keyword(s):  
Pregnant Women ◽  
Preterm Labor ◽  
Cervical Length ◽  
Sildenafil Citrate ◽  
Health Concern ◽  
P Value ◽  
Short Cervix ◽  
Group I ◽  
Significant Difference ◽  
Group Ii

Background: Prevention of the premature birth occurrence remains is considered one of the most tough challenges for obstetricians worldwide, mainly to avoid neonatal prematurity complications leading to short and long term morbidities additionally prematurity prevention will reduce premature neonatal mortality rates which is considered a major health concern of obstetricians, neonatologists and families. Objective: To compare and contrast the efficacy of Sildenafil citrate, Nifedipine and Dydrogesrone in prevention of premature labor in gestations with short cervix. Setting: Obstetrics & Gynecology Departments, Faculties of medicine, south Valley and Al-Azhar (Asyut) Universities, Egypt. Duration: from September 2014 to March 2018. Patients And Methds: the study was conducted on 300 pregnant women who randomly divided into three groups: Group I included 100 cases received Sildenafil citrate (Respatio tablet 20mg twice daily orally), Group II included 100 cases received Nifedipine (Epilat retard tablets 20mg twice daily orally) and Group III included 100 pregnant women received dydrogesreone 10 mg (Duphaston) twice daily orally. Results: incidence of preterm labor was (9.37, 8.51 and 14.28) in (Group I, Group II and Group II) respectively. Mean ± SD of cervical length at 32 weeks of gestation was mildly statistically significant among groups (p value <0.05) but no significance in neonatal outcome (p value >0.05) except birth weight which had a highly statistically significant difference (p value < 0.001). There was a highly statistically significant difference among studied groups as regard to drug side effects in (p value <0.001). Conclusion: Sildenafil citrate was as effective as Nifedipine and better than oral Dydrogesterone on myometrial relaxation and prevention of preterm birth in pregnant women who had short cervix.

The efficacy of preventive methods and their combinations in the preterm birth prevention

2021 ◽  
Vol 42 (2) ◽  
pp. 18-21
Author(s):  
O. V. Grishchenko ◽  
◽  
S. V. Korovai ◽  
I. V. Lakhno ◽  
◽  
...  
Keyword(s):  
Premature Birth ◽  
Small Sample Size ◽  
Cervical Length ◽  
Small Sample ◽  
Short Cervix ◽  
Group Iii ◽  
Placental Angiogenesis ◽  
Vaginal Progesterone ◽  
Group I ◽  
Prediction And Prevention

Prediction and prevention of premature birth is a significant problem of modern obstetrics. The use of ultrasound cervicometry and the index of placental angiogenesis for the prediction of premature birth is promising. The aim of the study was to investigate the effectiveness of cerclage, pessary, intravaginal progesterone or their combinations in the prevention of premature birth. A total of 292 pregnant women were examined. They were divided into several groups according to the results of the detection of cervical length and the level of the ratio between placental growth factor (PlGF) and fms-like tyrosine kinase (sFlt-1). Group I included women with a negative screening’ resuls. Other groups included women with a «short» cervix and disturbed placental angiogenesis. In group II, women with cervical cerlage were observed. In group III — used a pessary; Group IV — vaginal progesterone; V — cobined use of cerclage and pessary; and in VI — use of cerclage and vaginal progesterone. The pregnancy was completed at term in 159 patients, and 133 women had preterm delivery. Among patients who had positive miscarriage screening results, the use of preventive measures or combinations resulted in fairly equal results. However, the use of progesterone and cervical cerclage has shown the best efficacy. Some limitations in this study were the small sample size and the lack of information on the use of anticoagulants, disaggregants and tocolytics in the examined women.

scholarly journals ULTRASOUND ASSESSMENT OF FETALADRENAL GLAND VOLUME (FAGV) AND ADRENAL FETAL ZONE ENLARGEMENT(AFZE):VIABLE AND SUPERIOR ALTERNATIVES TO CERVICAL LENGTH (CL) IN ACCURATE PREDICTION OF PRETERM BIRTHS.

2020 ◽  
pp. 26-28
Author(s):  
Jatin Venugopal Kutnikar ◽  
Saravanan Kannan ◽  
Prabhakaran Maduraimuthu
Keyword(s):  
Adrenal Gland ◽  
Pregnant Women ◽  
Preterm Delivery ◽  
Preterm Births ◽  
Cervical Length ◽  
Public Health Issue ◽  
Zone Length ◽  
Gland Volume ◽  
Study Results ◽  
Adrenal Gland Volume

BACKGROUND: Owing to associated neonatal death, morbidity and impairment in later life, preterm birth is a major public health issue. Pregnant ladies presenting to the antenatal clinic were recruited in order to predict spontaneous preterm births bythe novel method of assessing the Fetal Adrenal Gland Volume (FAGV) and Adrenal Fetal ZoneEnlargement(AFZE) and comparing it with Cervical length. MATERIAL AND METHODS:This was a prospective observational study done at a tertiary hospital in Chennai.The formulae,AFZE=Gland length/Central fetal zone length and FAGV=0.523 x length x width x depth. cFAGV=fetal adrenal gland volume/estimated fetal weight =FAGV/EFW, were employed for the purpose of this study.𝛘2 or Fisher’s exact tests,Mann-Whitney or student-t test were calculated for appropriate variables. Pregnant women with uncomplicated pregnancy with gestational age between 21-34 weeks were recruited for this study. RESULTS:70 pregnant women were studied from May2019 to August 2020 and had an average age of 25 years and mean age of gestation being 27.1 weeks.26(37.1%) of these had a preterm delivery of ≤7 days.AFZE emerged as the best predictor among the three metrics with sensitivity of 100% and specificity of ~90 %.cFAGV showed ~80%/~89% sensitivity and specificity.This was in contrast to cervical length of ≤16 mm having just 55% and 60% sensitivity and specificity respectively. SUMMARY:USG estimation of AFZE and cFAGV are more reliable and accurate indicators than CL for spontaneous preterm delivery and can be used in the routine scanning of patients with early symptoms of preterm labour to plan the management more effectively.

scholarly journals Effect of Clinical and Subclinical Hypothyroidism on Fetal Outcomes among Pregnant Women: A Sub-Specialty Department Experience

2021 ◽  
Vol 7 (1) ◽  
pp. 29-32
Author(s):  
Farzana Sharmin ◽  
Mahfuja Asma ◽  
Khandaker Shehneela Tasnim ◽  
Afzal Momin ◽  
Shimul Akhter ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Subclinical Hypothyroidism ◽  
Apgar Score ◽  
Fetal Distress ◽  
Fetal Outcome ◽  
Fetal Outcomes ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
Medical University

Background: Hypothyroidism can effect on the fetal outcomes during pregnancy. Objective: The purpose of the present study was to compare the effects of clical and subclinical hypothyroidism on fetal outcomes among pregnant women. Methodology: This cohort study was conducted in the Feto-Maternal Department of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from a period of 6 months dated from September 2019 to February 2020. All cases of the clinical and sub-clinical hypothyroid pregnant women admitted in this department. Fetal outcomes of clinical and sub-clinical hypothyroid pregnant women during delivery were recorded. Findings of the cases recorded carefully. Result: A total number of 75 patients were recruited for this study who were divided in to two group designated as group I or sub clinical hypothyroidism and group II or clinical hypothyroidism. Fetal distress was 22(51.1%) cases in group I and 9(33.3%) cases in group II. The fetal outcome of the study patients had observed that 8(27.6%) and 12(80.0%) of the baby had low (<2.5 kg) birth weight in group I and group II' respectively. In group I most (62.1%) of the baby APGAR score was >7 and 11(73.3%) cases had < 6 APGAR score at 1st minute. Majority of the study patients had >7 APGAR score at 5 min in both groups which was 25(86.2%) and 12(80.0%) in group I and group II respectively. Conclusion: In conclusion there is a significant difference found in overt and sub-clinical hypothyroidism considering fetal stress, IUD and prematurity. Journal of National Institute of Neurosciences Bangladesh, January 2021, Vol. 7, No. 1, pp. 29-32

scholarly journals Women's Obstetric History and Midtrimester Cervical Length Measurements by 2D/3D and Doppler Ultrasound

2020 ◽  
Vol 42 (09) ◽  
pp. 540-546
Author(s):  
Juliana Valente Codato Marinelli ◽  
Antonio Gomes de Amorim Filho ◽  
Monica Fairbanks de Barros ◽  
Agatha Sacramento Rodrigues ◽  
Rossana Pulcineli Vieira Francisco ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Uterine Artery ◽  
Cervical Length ◽  
Flow Index ◽  
Control Group ◽  
Short Cervix ◽  
Uterine Artery Doppler ◽  
Obstetric History ◽  
Ultrasound Parameters

Abstract Objective The aim of the present study was to compare the obstetric history and both two- and tri-dimensional ultrasound parameters according to different cervical lengths. Methods The present cross-sectional study analyzed 248 midtrimester pregnant women according to cervical length and compared the data with the obstetric history and 2D/3D ultrasound parameters. Patients were divided into 3 groups according to cervical length: The Short Cervix group for cervical lengths ≥ 15 mm and < 25 mm (n = 68), the Very Short Cervix group for cervical lengths < 15 mm (n = 18) and the Control group, composed of 162 pregnant women with uterine cervical lengths ≥ 25 mm. Results When analyzing the obstetric history of only non-nulliparous patients, a significant association between the presence of a short cervix in the current pregnancy and at least one previous preterm birth was reported (p = 0.021). Cervical length and volume were positively correlated (Pearson coefficient = 0.587, p < 0.0001). The flow index (FI) parameter of cervical vascularization was significantly different between the Control and Very Short Cervix groups. However, after linear regression, in the presence of volume information, we found no association between the groups and FI. Uterine artery Doppler was also not related to cervical shortening. Conclusion The present study showed a significant association between the presence of a short cervix in the current pregnancy and at least one previous preterm birth. None of the vascularization indexes correlate with cervical length as an independent parameter. Uterine artery Doppler findings do not correlate with cervical length.

scholarly journals Optimization of monitoring of contractile uterus activity and fetus status in women with the threat of preterm birth

2021 ◽  
pp. 32-34
Author(s):  
S.V. Korovai ◽  
I.V. Lakhno ◽  
O.V. Gryshchenko ◽  
K.V. Drogovoz ◽  
Y.S. Blazhko ◽  
...  
Keyword(s):  
At Risk ◽  
Preterm Birth ◽  
Diagnostic Accuracy ◽  
Pregnant Women ◽  
Sensitivity And Specificity ◽  
Comparison Group ◽  
Fetal Distress ◽  
Uterine Activity ◽  
Non Invasive ◽  
Group I

Research objective: to study the use of uterine activity and variables of acceleration capacity (AC) and deceleration capacity (DC) in uterine contractile activity and fetal well-being monitoring in women at risk of preterm birth.Materials and methods. 292 pregnant women were included in the prospective study. All involved women underwent ultrasound cervicometry at 16 weeks. 124 pregnant women with a “short cervix” of the III (main) group were observed in the dynamics, as well as uterine activity and fetal AC/DC at 26, 32 and 38 weeks of gestation, and during labor were studied. In 112 women of group II the variables of fetal AC/DC were detected at these terms of pregnancy. They were monitored via conventional cardiotocography during labor. 56 pregnant women in group I with normal cervicometry were monitored.Results. Sensitivity and specificity of the diagnosis of the threatened preterm birth in the main group was 97.30% and 94.74% respectively. Diagnostic accuracy in the case of uterine activity according to fetal non-invasive electrocardiography was 96.18%. Sensitivity and specificity of the diagnosis of the threatened preterm birth in the comparison group were significantly lower: 89.29% and 87.80% respectively. The diagnostic accuracy was 88.41%.Patients in all clinical groups at 26 weeks had low AC/DC values. However, later in women of group I was found highest AC/DC level. AC/DC values in patients with risk of preterm birth were reduced compared with controls (p < 0.05). Sensitivity and specificity of the diagnosis of fetal distress if AC/DC was used were 91.67% and 99.12% respectively. Diagnostic accuracy of the test was 98.41%. In the comparison group the sensitivity was 77.78%, and the specificity was 89.22%. Diagnostic accuracy of intranatal cardiotocography was 86.82%.Conclusions. Uterine activity extracted from the maternal abdominal signal can significantly improve the diagnosis of the threatenedpreterm delivery. Patients at risk of preterm birth have a delayed fetal neurological, which leads to fetal distress. AC/DC variables obtained via fetal non-invasive electrocardiography allow increasing the accuracy of fetal distress diagnosis.

scholarly journals STUDY OF THE INFLUENCE OF HORMONAL FUNCTION IMPAIREMENT OF THE PLACENTA ON THE STATE OF FETUS AND NEWBORN IN WOMEN WITH NODULAR GOITER

2021 ◽  
Vol 20 (2) ◽  
Author(s):  
S.E. Kosilova
Keyword(s):  
Blood Serum ◽  
Pregnant Women ◽  
Nodular Goiter ◽  
Fetal Distress ◽  
Maternal Blood ◽  
The State ◽  
Placental Lactogen ◽  
Control Group ◽  
Hormonal Function ◽  
Group I

The thyroid gland pathology is one of the most common in the world and is on the samelevel with diabetes mellitus and diseases of the cardiovascular system in its importance.Extragenital pathology, in particular, nodular goiter in pregnant women acts as anadditional stress factor that can negatively affect hormonal relationships in the motherplacenta-fetus system and contribute to an increase in the frequency of complications ofpregnancy, childbirth, and impairment of the fetus and newborn condition.The aim of this work – to study the disturbance effect in the hormonal function of theplacenta on the condition of the fetus and newborn from women with nodular goiter.Material and methods. The analysis of the state of the fetus and newborn of 20 apparentlyhealthy women (control group) and 54 women with nodular goiter (main group). Of these,30 newborns from women with grade I nodular goiter were included into group I, and24 newborns from women with grade II nodular goiter were included into group II. Theintrauterine fetus state was judged about according to the data of cardiotocography, fetalbiophysical profile (FBP), ultrasound examination, and Doppler results. The functionalstate of the fetoplacental complex was assessed by determining the serum concentrationof estradiol (Е2), estriol Е3), progesterone, placental lactogen, as well as the results ofhistological examination of the placentas.Results. The study of the placenta hormonal function, the results of ultrasound diagnosticsand histological examination of the placentas indicate the presence of placentaldysfunction in pregnant women with nodular goiter, that affected the condition of thefetus and newborn. Thus, the cardiotocographic index in fetuses from pregnant women,suffering from nodular goiter, is significantly less than in healthy pregnant women(p<0.05). The average PPI score in women with nodular goiter is also significantly lowerthan in the control group (p<0.05). Doppler data indicate a change in the parameters of the maternal hemodynamics, that led to a violation of the uteroplacental blood flow, thedevelopment of fetal hypoxia.Conclusions. The presence of nodular goiter in the mother is a risk factor for placentaldysfunction. Starting from the second trimester of pregnancy, there are significant changesin the content of placental hormones in the blood. A decrease in the concentration ofprogesterone in the blood serum in pregnant women with nodular goiter, in the latestages of pregnancy, can serve as a marker of the threat of termination of pregnancyand premature birth. A decrease in the content of estradiol and placental lactogen inthe maternal blood serum can be used as a marker of fetal distress in pregnant womenwith nodular goiter. The condition of the fetus and newborn is in direct proportion to thedegree of manifestation of the nodular goiter and the functional state of the placenta.

scholarly journals Vaginal progesterone in risk reduction of preterm birth in women with short cervix

2019 ◽  
Vol 8 (7) ◽  
pp. 2695
Author(s):  
Shubhi Srivastava ◽  
D. Borgohain
Keyword(s):  
Preterm Birth ◽  
Transvaginal Ultrasound ◽  
Perinatal Outcomes ◽  
Cervical Length ◽  
Singleton Pregnancy ◽  
Short Cervix ◽  
Mortality And Morbidity ◽  
Medical College ◽  
Vaginal Progesterone ◽  
Adverse Neonatal Outcomes

Background: Preterm birth is a global health problem affecting the neonate, family and country in general. It is the leading cause of perinatal mortality and morbidity. Short cervical length detected on transvaginal ultrasound is the most practical risk factor for prediction of preterm birth. The aim of this study was to determine the efficacy and safety of vaginal progesterone in reducing the rate of preterm birth in women with a short cervix and to determine its effect on neonatal mortality and morbidity.Methods: The study was carried out in the Department of Obstetrics and Gynaecology at Assam Medical College, Dibrugarh for a period of one year. It included 128 asymptomatic women with a singleton pregnancy and a sonographic short cervix. Women were randomly divided into two groups, one of which was given placebo and the other was given vaginal progesterone and a comparative study was conducted.Results: It was observed that delivery before 37 weeks of gestation was less frequent in the progesterone group than in the placebo group (60.94% vs. 90.63%). Vaginal progesterone was also associated with a significant reduction in adverse neonatal outcomes like the rate of sepsis (6.25% vs. 18.75%), requirement of ventilator (12.5% vs. 26.56%), admission to NICU (10.94% vs. 26.56%) and birth weight ≤1.5kg (7.81% vs. 21.88%).Conclusions: Vaginal progesterone reduces the risk of preterm birth and adverse perinatal outcomes in pregnant women without any deleterious effects on the foetus or mother.

scholarly journals A randomized controlled trial on the use of pessary plus progesterone to prevent preterm birth in women with short cervical length (P5 trial)

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Rodolfo C. Pacagnella ◽  
◽  
Ben W. Mol ◽  
Anderson Borovac-Pinheiro ◽  
Renato Passini ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Preterm Birth ◽  
Controlled Trial ◽  
Transvaginal Ultrasound ◽  
Cervical Length ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Short Cervix ◽  
Randomized Controlled ◽  
Vaginal Progesterone

Abstract Background Preterm birth is the leading cause of mortality and disability in newborn and infants. Having a short cervix increases the risk of preterm birth, which can be accessed by a transvaginal ultrasound scan during the second trimester. In women with a short cervix, vaginal progesterone and pessary can both reduce this risk, which progesterone more established than cervical pessary. The aim of this study is to compare the use of vaginal progesterone alone versus the association of progesterone plus pessary to prevent preterm birth in women with a short cervix. Methods This is a pragmatic open-label randomized controlled trial that will take place in 17 health facilities in Brazil. Pregnant women will be screened for a short cervix with a transvaginal ultrasound between 18 0/7 until 22 6/7 weeks of gestational age. Women with a cervical length below or equal to 30 mm will be randomized to the combination of progesterone (200 mg) and pessary or progesterone (200 mg) alone until 36 + 0 weeks. The primary outcome will be a composite of neonatal adverse events, to be collected at 10 weeks after birth. The analysis will be by intention to treat. The sample size is 936 women, and a prespecified subgroup analysis is planned for cervical length (= < or > 25 mm). Categorical variables will be expressed as a percentage and continuous variables as mean with standard deviation. Time to delivery will be assessed with Kaplan-Meier analysis and Cox proportional hazard analysis. Discussion In clinical practice, the combination of progesterone and pessary is common however, few studies have studied this association. The combination of treatment might act in both the biochemical and mechanical routes related to the onset of preterm birth. Trial registration Brazilian Clinical Trial Registry (ReBec) RBR-3t8prz, UTN: U1111–1164-2636, 2014/11/18.

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