scholarly journals Role of cervical length assessment at mid-trimester scan for predicting preterm births: An experience from Tertiary Hospital

2020 ◽  
Vol 8 (4) ◽  
pp. 187-192
Author(s):  
Suman Raj Tamrakar ◽  
Rubina Shrestha
Keyword(s):  
Preterm Delivery ◽  
Predictive Value ◽  
Preterm Births ◽  
Tertiary Hospital ◽  
Cervical Length ◽  
Singleton Pregnancy ◽  
Pattern Of Care ◽  
Short Cervix ◽  
Sensitivity Specificity ◽  
A Prospective Study

Background: Ultrasound has revolutionized the pattern of care and management. Mid trimester ultrasound (transabdominal) is a valuable method for pregnant clients to predict preterm births. Objectives: To assess cervical length at 20 to 24 weeks obstetric scan for predicting risk of preterm delivery and to determine the sensitivity and specificity of assessing cervical length as a predictor of preterm delivery. Methodology: This is a prospective study conducted at a Tertiary Hospital. Pregnant clients with singleton pregnancy at 20 to 24 weeks were enrolled for transabdominal ultrasound for assessing cervical length as a predictor of preterm delivery. Results: Of 1027 pregnant clients screened, the mean age was 22.92±3.45. Mean gestational age during scan was 21+5 weeks of gestation. About 2.43% of clients were found to have short cervix < 2.5 cm with mean cervical length 3.8 cm. The risk of preterm delivery was almost two fold when cervical length was < 2.5 cm. The sensitivity, specificity, positive predictive value and negative predictive value to predict preterm delivery were 32%, 85.9%, 5.44% and 98.04% respectively. Conclusion: Assessment of the cervical length at mid-trimester can be useful tool for predicting risk of preterm delivery.

scholarly journals Evaluation of uterine cervix with transvaginal ultrasonography in women with threatened preterm labor and or preterm labor

2018 ◽  
Vol 7 (2) ◽  
pp. 704 ◽  
Author(s):  
Akila Shree ◽  
Chitra A. K.
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Preterm Delivery ◽  
Predictive Value ◽  
Preterm Labor ◽  
Cervical Length ◽  
Transvaginal Ultrasonography ◽  
Singleton Pregnancy ◽  
Significant Difference ◽  
A Prospective Study

Background: Preterm delivery can be associated with substantial perinatal morbidity and mortality. Nearly in 5 to 13% of pregnancies, happening deliveries are preterm before 37 weeks' gestation. Thus, prediction of preterm labor in parturient can provide a window of opportunity to prevent these complications and to be better prepared to deal with them. Hence the current study has been conducted with an objective to assess the efficiency of cervical length and funneling as assessed by transvaginal ultrasonography in predicting preterm labor.Methods: The current study was a prospective study, conducted in the Department of Obstetrics Emergencies, Dhanalakshmi Srinivasan Medical College and Hospital between November 2015 to April 2017. The study population included 60 women with singleton pregnancy of gestational age between 28 + 0 and 36 + 6 weeks and with painful and regular contractions (>1/10 min for at least 1 hour). Cervical length, funnelling length measured at presentation and after 48 hours were considered as predictor variables. The outcomes of interest were delivery within 1 week, delivery before 37 weeks and delivery before 34 weeks.Results: There was a statistically significant difference in cervical length and funnelling length between term and preterm groups at the time of diagnosis and after 48 hours (P <0.001). The positive predictive value increased from 33.3% to 100% with cervical length ≤ 40 mm to ≤ 20 mm. The negative predictive value decreased from 100% to 79.2% with cervical length ≤40 mm to ≤20 mm. To predict a preterm delivery in threatened preterm delivery patients, the sensitivity of a cervical length of ≤25 mm was 77.7%, specificity was 95.2%, the positive predictive value was 87.5% and negative predictive value is 90.9%.Conclusions: Cervical length and funnelling as assessed by transvaginal ultrasonography are efficient in predicting preterm labor.

scholarly journals A soft cervix, categorized by shear-wave elastography, in women with short or with normal cervical length at 18–24 weeks is associated with a higher prevalence of spontaneous preterm delivery

2018 ◽  
Vol 46 (5) ◽  
pp. 489-501 ◽  
Author(s):  
Edgar Hernandez-Andrade ◽  
Eli Maymon ◽  
Suchaya Luewan ◽  
Gaurav Bhatti ◽  
Mohammad Mehrmohammadi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Preterm Delivery ◽  
Shear Wave ◽  
Wave Speed ◽  
Shear Wave Elastography ◽  
Cervical Length ◽  
Singleton Pregnancy ◽  
Short Cervix ◽  
Shear Wave Speed ◽  
Spontaneous Preterm Delivery

AbstractObjective:To determine whether a soft cervix identified by shear-wave elastography between 18 and 24 weeks of gestation is associated with increased frequency of spontaneous preterm delivery (sPTD).Materials and methods:This prospective cohort study included 628 consecutive women with a singleton pregnancy. Cervical length (mm) and softness [shear-wave speed: (SWS) meters per second (m/s)] of the internal cervical os were measured at 18–24 weeks of gestation. Frequency of sPTD <37 (sPTD<37) and <34 (sPTD<34) weeks of gestation was compared among women with and without a short (≤25 mm) and/or a soft cervix (SWS <25thpercentile).Results:There were 31/628 (4.9%) sPTD<37 and 12/628 (1.9%) sPTD<34 deliveries. The combination of a soft and a short cervix increased the risk of sPTD<37 by 18-fold [relative risk (RR) 18.0 (95% confidence interval [CI], 7.7–43.9); P<0.0001] and the risk of sPTD<34 by 120-fold [RR 120.0 (95% CI 12.3–1009.9); P<0.0001] compared to women with normal cervical length. A soft-only cervix increased the risk of sPTD<37 by 4.5-fold [RR 4.5 (95% CI 2.1–9.8); P=0.0002] and of sPTD<34 by 21-fold [RR 21.0 (95% CI 2.6–169.3); P=0.0003] compared to a non-soft cervix.Conclusions:A soft cervix at 18–24 weeks of gestation increases the risk of sPTD <37 and <34 weeks of gestation independently of cervical length.

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

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
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.

scholarly journals Role of transvaginal ultrasound in predicting preterm labor in singleton pregnancies

2018 ◽  
Vol 7 (2) ◽  
pp. 561
Author(s):  
Mehbooba Beigh ◽  
Mohammed Farooq Mir ◽  
Rifat Amin ◽  
Simrath Shafi
Keyword(s):  
Preterm Delivery ◽  
Predictive Value ◽  
Preterm Labor ◽  
Transvaginal Ultrasound ◽  
Cervical Length ◽  
Spontaneous Preterm Birth ◽  
Threatened Preterm Labor ◽  
Length Changes ◽  
A Prospective Study

Background: Preterm delivery (PTD) is a major cause of perinatal morbidity and mortality. Objective of present study was to identify the women at risk of preterm delivery with the help of trans-vaginal ultrasound by assessing cervical length changes, funneling of lower uterine segment, cervical dilatation.Methods: A prospective study was carried out over a period of 2 years on 50 patients with 24-36 weeks of gestation who clinically presented with signs of threatened preterm labor and were subjected to transvaginal sonographic measurement of cervical length.Results: Prediction of spontaneous preterm birth at <37 weeks of gestation with cervical length to be 2.75 cm has sensitivity of 95%, specificity of 96.5%, positive predictive value of 86.36% and negative predictive value of 98.7%.Conclusions: Transvaginal ultrasonography is the reliable, reproducible and objective method to assess cervix and to predict the risk of preterm delivery.

scholarly journals COMPARISON OF THE PREDICTIVE VALUE OF TRANSVAGINAL CERVICAL LENGTH AT 11-14 WEEKS AND AT 20-22 WEEKS OF GESTATION IN PRETERM LABOUR

2020 ◽  
pp. 41-43
Author(s):  
Sudha Rani Mangalampeta
Keyword(s):  
Preterm Birth ◽  
Preterm Delivery ◽  
Gestational Age ◽  
Predictive Value ◽  
Preterm Labour ◽  
Statistical Significance ◽  
Cervical Length ◽  
Low Risk ◽  
Singleton Pregnancy ◽  
Low Risk Women

Background: Preterm labour is defined as the onset of labour before 37 weeks of gestation, in pregnancy beyond 20 weeks of gestation, and is responsible for nearly 75% of all neonatal mortality and neurological morbidity. Cervical length (CL) is one of the major determinants of preterm delivery. Several studies have been able to conclude that transvaginal CL assessment may be a useful tool for the prediction of preterm delivery. The risk of preterm birth varies inversely with CL measured by ultrasound in low-risk women. Objective: To evaluate and compare the predictive value of transvaginal cervical length between 11-14 weeks and 20- 22 weeks of gestation in preterm labour. Material and Methods: A total of 264 pregnant women who were primigravida, singleton pregnancy, and women at gestational age 11-14 weeks and 20-22 weeks were included in the study. They were subjected for CL measurement at 11-14 and 20-22 weeks of gestation using transvaginal ultrasonography with the standard longitudinal view of the cervix while the patient’s bladder was empty. GEL VOLUSON 730 PRO Trans Vaginal Ultrasound (TVS) probe IC 5-9 H instrument with 5-9 MHz was used to measure CL. Results: The variables analyzed were the mean cervical length at 11-14 weeks and 20-22 weeks, the rate of shortening of cervical length in those who deliver at term and preterm and the cervical length at 11-14 weeks 20-22 weeks was correlated with gestational age at delivery and the predictive value of the same was determined. Cut-off of cervical length at 11-14 and 20-22 weeks of gestation was 3.73 cm and 2.89 and was statistically significant for the prediction of pre-term labour. Reduction in cervical length from 11-14 weeks to 20-22 weeks of gestation of more than 0.7 cm is predictive of preterm labour with statistical significance (p<0.001). Conclusion: Routine mid-pregnancy cervical length assessment in low-risk women can be a cost-effective method of preterm birth reduction but the implementation of such a policy is highly dependent upon local factors. If it is to be undertaken, cervical length assessment should be performed according to a standardized technique.

scholarly journals The Feasibility of Cervical Elastography in Predicting Preterm Delivery in Singleton Pregnancy with Short Cervix Following Progesterone Treatment

2021 ◽  
Vol 18 (4) ◽  
pp. 2026
Author(s):  
Yun Ji Jung ◽  
Hayan Kwon ◽  
Jeongeun Shin ◽  
Yejin Park ◽  
Seok-Jae Heo ◽  
...  
Keyword(s):  
Preterm Delivery ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Fold Increase ◽  
Cervical Length ◽  
Singleton Pregnancy ◽  
Short Cervix ◽  
Spontaneous Preterm Delivery ◽  
Progesterone Treatment ◽  
Singleton Pregnancies

Previous studies demonstrated an association between cervical strain and risk of spontaneous preterm delivery (sPTD). The present study aimed to assess the efficacy of elastography in predicting sPTD at <32 weeks of gestation in women with singleton pregnancies receiving progesterone for short cervix (≤2.5 cm) diagnosed between 16 and 28 weeks of gestation Among 115 participants eligible for analysis, nine had sPTD at <32 weeks. Preprogesterone (PP0) mean internal os strain (IOS), elasticity contrast index (ECI), hardness ratio (HR), one-week postprogesterone (PP1) IOS, mean external os strain (EOS), ECI, and HR were significantly different between groups. Higher PP0 IOS, PP1 IOS, and PP1 EOS were associated with a 2.92, 4.39 and 3.65-fold increase in the risk of sPTD at <32 weeks, respectively (adjusted for cervical length (CL) at diagnosis; p = 0.04, 0.012 and 0.026, respectively). A combination of CL at diagnosis, PP0 IOS and PP1 EOS showed a significantly higher area under the receiver operating characteristic curve (0.858) than that of CL alone (p = 0.041). In women with singleton pregnancies receiving progesterone for short cervix, cervical elastography performed before and one week after progesterone treatment may be useful in predicting sPTD at <32 weeks of gestation.

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 Association between regular arrangement of collecting venules and Helicobacter pylori status in routine endoscopy

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Cong Yuan ◽  
Xue-Mei Lin ◽  
Yan Ou ◽  
Lin Cai ◽  
Qian Cheng ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Predictive Value ◽  
Underlying Mechanism ◽  
High Definition ◽  
Regular Arrangement ◽  
Gastric Corpus ◽  
H Pylori ◽  
Sensitivity Specificity ◽  
A Prospective Study ◽  
Positive Pattern

Abstract Background The sensitivity of regular arrangement of collecting venules (RAC)-positive pattern for predicting Helicobacter pylori (H. pylori)-negative status greatly altered from 93.8 to 48.0% in recent two decades of various studies, while the reason behind it remained obscure. The aim of this study was to investigate the value of RAC as an endoscopic feature for judging H. pylori status in routine endoscopy and reviewed the underlying mechanism. Methods A prospective study with high-definition non-magnifying endoscopy was performed. RAC-positive and RAC-negative patients were classified according to the collecting venules morphology of the lesser curvature in gastric corpus. Gastric biopsy specimens were obtained from the lesser and greater curvature of corpus with normal RAC-positive or abnormal RAC-negative mucosal patterns. Helicobacter pylori status was established by hematoxylin and eosin staining and immunohistochemistry. Results 41 RAC-positive and 124 RAC-negative patients were enrolled from June 2020 to September 2020. The prevalence of H. pylori infection in patients with RAC-positive pattern and RAC-negative pattern was 7.3% (3/41) and 71.0% (88/124), respectively. Among all 124 RAC-negative patients, 36 (29.0%) patients were H. pylori-negative status. Ten patients (32.3%) demonstrated RAC-positive pattern in 31 H. pylori-eradicated cases. The sensitivity, specificity, positive predictive value, and negative predictive value of RAC-positive pattern for predicting H. pylori-negative status were 51.4% (95% CI, 0.395–0.630), 96.7% (95% CI, 0.900–0.991), 92.7% (95% CI, 0.790–0.981), and 71.0% (95% CI, 0.620–0.786), respectively. Conclusions RAC presence can accurately rule out H. pylori infection of gastric corpus, and H. pylori-positive status cannot be predicted only by RAC absence in routine endoscopy. Trial registration The present study is a non-interventional trial.

Ultrasonographic Transabdominal Measurement of Uterine Cervical Length for the Prediction of a Midtrimester Short Cervix

2020 ◽  
Author(s):  
Paul Guerby ◽  
Annie Beaudoin ◽  
Geneviève Marcoux ◽  
Mario Girard ◽  
Jean-Charles Pasquier ◽  
...  
Keyword(s):  
Roc Curve ◽  
False Positive Rate ◽  
Cervical Length ◽  
Ultrasound Measurement ◽  
Singleton Pregnancy ◽  
Short Cervix ◽  
Nulliparous Women ◽  
Key Points ◽  
Positive Rate ◽  
The Mean

Objective This study was aimed to estimate the value of transabdominal (TA) ultrasound measurement of cervical length (CL), as an alternative of transvaginal (TV) ultrasound, for universal screening of short cervix in the midtrimester. Study Design We conducted a prospective cohort study of nulliparous women with singleton pregnancy at 20 to 24 weeks of gestation. All participants underwent TA ultrasound followed by TV ultrasound with acquisitions of images and videos of the uterine cervix. A second sonographer, blinded to the participants' data and pregnancy outcomes, measured the CL using TA and TV images and videos. Pearson's correlation test and receiver operating characteristic (ROC) curve analyses were performed. Results A total of 805 participants were recruited, including 780 (97%) where TA CL measurement was feasible. We observed a strong correlation of CL between TA and TV (correlation coefficient: 0.57; p < 0.0001) with a mean TA measurement being 4 mm (95% confidence interval [CI]: −6 to 14 mm) below the mean TV measurement (mean of differences: 5 ± 4 mm). We observed that a TA CL <30 mm was highly predictive of a short cervix defined as a TV CL ≤25 mm (area under the ROC curve: 0.97; 95% CI: 0.95–0.99; p < 0.0001) with a sensitivity of 100% and a false-positive rate of 22%. Conclusion Universal short cervix screening in nulliparous women could be performed using TA ultrasound, which could allow the avoidance of TV ultrasound in more than three quarter of women. In low-risk population, TV ultrasound could be reserved to women with TA CL <30 mm. Key Points

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