scholarly journals Diagnosis and Management of Short Cervix in Singleton Pregnancies

2011 ◽  
Vol 2 (1) ◽  
pp. 15-18
Author(s):  
Igal Wolman ◽  
Arnon Agmon ◽  
J Ariel
Keyword(s):  
Perinatal Mortality ◽  
Gestational Age ◽  
Preterm Labor ◽  
Transvaginal Ultrasound ◽  
Cervical Length ◽  
Ultrasound Screening ◽  
Cervical Cerclage ◽  
Short Cervix ◽  
Fetal Fibronectin ◽  
Singleton Pregnancies

ABSTRACT Prevention of preterm labor will reduce perinatal mortality. Screening of cervical length by ultrasound should begin at 16 weeks by transvaginal ultrasound. If the cervical length is more than 35 mm, the exam should be repeated every 2 to 3 weeks till 32 weeks. If the cervical length is between 25 and 35 mm the ultrasound screening should be done weekly or biweekly. Fetal fibronectin estimation should provide supplemental information. If the cervical length is less than 25 mm cervical cerclage should be performed if gestational age is less than 22 weeks. Progesterone therapy is preferred if the gestational age is more than 22 completed weeks.

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 Preterm labor: issues of prognosis, prevention and management (Literature rewiew)

2021 ◽  
Vol 3 ◽  
pp. 57-64
Author(s):  
Ye. Petrenko ◽  
K.P. Strubchevka
Keyword(s):  
Neonatal Mortality ◽  
Preterm Labor ◽  
Transvaginal Ultrasound ◽  
Perinatal Care ◽  
Cervical Length ◽  
Fetal Fibronectin ◽  
Uterine Contractions ◽  
Therapeutic Measures ◽  
Group B ◽  
Amniotic Membranes

Preterm labor is the leading cause of neonatal mortality and the most common cause for antenatal hospitalization. Approximately 15 million babies are born preterm each year worldwide. Of those, one million babies die before the age of 5, which is 18% of all deaths of children at this age. 35% of early and late neonatal mortality (under 28 days of age) is associated with preterm birth.The pathophysiology of preterm labor includes at least four major pathogenetic mechanisms. The studied components of this process are premature activation of the maternal or fetal hypothalamic-pituitary-adrenal system, inflammation or infection, decidual hemorrhage and pathological overdistension of the uterus. The diagnosis of preterm labor is based on the determination of concomitant regular uterine contractions and cervical changes. Vaginal bleeding and/or rupture of the amniotic membranes only increase the likelihood of this diagnosis. To improve the accuracy of diagnosis and assess the potential risk of preterm birth in the presence of symptoms in pregnant women, it is proposed to use such diagnostic tests as transvaginal ultrasound to measure cervical length; detection in vaginal fluids of fetal fibronectin (fFN), phosphorylated protein-1, which binds insulin-like growth factor (IGFBP-1), placental alpha-microglobulin, the ratio of insulin-like growth factorebinding protein 4 (IBP4) and sex hormoneebinding globulin (SHBG) – PreTRM-test.Correct identification of women in the true preterm labor allows performing appropriate actions, which results in better outcomes for the newborn. These are using of corticosteroids to prevent respiratory distress syndrome (RDS) of the newborn; prevention of group B streptococcal infection; magnesium sulfate to protect the baby’s nervous system; transportation to the institution of the third level of perinatal care, which can provide a newborn with appropriate medical care. Preventative and therapeutic measures for women, which have a high risk of preterm labor, include taking progesterone, cervical cerclage and an application of obstetric pessary.

scholarly journals Transvaginal Ultrasound-indicated Cervical Cerclage Versus Vaginal Progesterone in Singleton Women with a Short Cervical Length: A Retrospective Study

2021 ◽  
Author(s):  
Yijun Liu ◽  
Tiantian Cao ◽  
Shuai Zeng ◽  
Ruixin Chen ◽  
Xinghui Liu ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Transvaginal Ultrasound ◽  
Latency Period ◽  
Preterm Births ◽  
Cervical Length ◽  
Secondary Outcome ◽  
Cervical Cerclage ◽  
Primary Methods ◽  
Vaginal Progesterone ◽  
Singleton Pregnancies

Abstract Introduction: Cervical cerclage and vaginal progesterone are two primary methods for preventing preterm birth. However, their effectiveness in preventing singleton pregnancies with a short cervical length is unclear. We compared the effects of cervical cerclage and vaginal progesterone on the mother and neonate in asymptomatic singleton pregnancies in women with a cervical length between 10–30 mm.Material and Methods: Asymptomatic singleton pregnant women with a cervical length of 10–30 mm, measured using transvaginal ultrasound at 12–26 weeks of gestation, who delivered at our hospital were enrolled. The primary outcome measure was preterm birth at <37, 34, 32, and 28 weeks of gestation. The secondary outcome measures were neonatal mortality, latency period from diagnosis to delivery, hemorrhage during delivery, birth weight, and cesarean delivery.Results: In the unadjusted analysis, the number of preterm births was significantly higher in the cerclage group than in the vaginal progesterone group. After multivariate adjustment for confounding factors, this relationship narrowed. The latency period from diagnosis to delivery was significantly prolonged.Conclusions: Cervical cerclage showed no benefit over vaginal progesterone in preventing preterm birth. However, it prolonged gestational age by 39 days compared to vaginal progesterone treatment.

scholarly journals Triage of women with possible preterm labor using transvaginal ultrasound cervical length and fetal fibronectin

2005 ◽  
Vol 193 (6) ◽  
pp. S58
Author(s):  
Amen Ness (F) ◽  
James Airoldi ◽  
Alisa Modena ◽  
Jason Baxter ◽  
Vincenzo Berghella
Keyword(s):  
Preterm Labor ◽  
Transvaginal Ultrasound ◽  
Cervical Length ◽  
Fetal Fibronectin

The Effect of Intramuscular 17α-Hydroxyprogesterone in Women Screened for Shortened Cervical Length

2019 ◽  
Vol 37 (07) ◽  
pp. 659-665
Author(s):  
S. Lindsay Wood ◽  
Bria N. Williams ◽  
Jeff M. Szychowski ◽  
John Owen
Keyword(s):  
Gestational Age ◽  
Preterm Labor ◽  
Secondary Analysis ◽  
Cervical Length ◽  
Spontaneous Preterm Birth ◽  
Short Cervix ◽  
Hydroxyprogesterone Caproate ◽  
Gestational Age At Delivery ◽  
Risk Patients ◽  
Multivariable Regression

Abstract Objective This article assesses the effect of weekly intramuscular 17α-hydroxyprogesterone caproate (17P) on midtrimester cervical length (CL) in patients with prior spontaneous preterm birth. Study Design Retrospective cohort study of all singletons that underwent CL screening at a single institution from 2011 to 2016. The timing of 17P exposure was assessed. The primary outcome was shortest midtrimester CL. Secondary outcomes included gestational age at delivery, rate of short cervix, cerclage, preterm labor admission, and preterm premature rupture of the membranes (PROM). Multivariable regression analysis was used to model the relationship between 17P exposure and shortest CL, controlling for selected covariates. Results Of 409 women who underwent screening, 211 received and 198 did not receive 17P prior to the last CL. Rates of short cervix and cerclage were similar between groups. After adjusting for covariates, the shortest CL was significantly shorter in the 17P group. In a secondary analysis, those who received any 17P (n = 293) versus those who did not (n = 116) had higher rates of preterm PROM, preterm labor admission, and cerclage. After controlling for covariates, gestational age at delivery was significantly lower in those receiving 17P. Conclusion In high-risk patients undergoing CL screening for ultrasound-indicated cerclage, 17P did not prevent midtrimester cervical shortening or prolong gestation.

scholarly journals Role of Cervical Length as Predictor of Preterm Labor and a Comparison of Transabdominal versus Transvaginal Ultrasound in Determining the Accuracy of Cervical Length

2010 ◽  
Vol 2 (2) ◽  
pp. 129-131
Author(s):  
MS Nanavati ◽  
SV Desai ◽  
PD Lakhani ◽  
AS Bansode
Keyword(s):  
Preterm Delivery ◽  
Preterm Labor ◽  
Transvaginal Ultrasound ◽  
Prospective Trial ◽  
Cervical Length ◽  
Short Cervix ◽  
Term Delivery ◽  
The Mean ◽  
The Difference

ABSTRACT Objectives 1. To evaluate the mean cervical length at 22 to 28 weeks of gestation by TAS and TVS and correlate its association with preterm labor. 2. To compare the difference in cervical length measured by the above two methods. Methods This was a prospective trial involving 100 pregnant women spanning a period of ten months. Results Eighteen women out of the 100 studied had preterm labor; of which 17 had a cervical length of less than 3 mm at 22 to 28 weeks. The percentage of women with preterm delivery with a short cervix was 83% by transabdominal scan (TAS) and 94% with transvaginal scan (TVS). Conclusion The mean cervical length was lesser amongst women who had a preterm delivery as compared to those with a term delivery. The mean cervical length by TAS was more than that by TVS thereby suggesting that TVS has a higher sensitivity for detection of preterm labor than TAS.

scholarly journals Transvaginal Ultrasound Assessment of Cervical Length in Threatened Preterm Labor

2020 ◽  
pp. 81-84
Author(s):  
Prasila Ekaputri
Keyword(s):  
Preterm Labor ◽  
Primary Outcome ◽  
Uterine Contraction ◽  
Transvaginal Ultrasound ◽  
Cross Sectional Study ◽  
Cervical Length ◽  
Cross Sectional ◽  
Active Labor ◽  
Ultrasound Assessment ◽  
Threatened Preterm Labor

Objectives: To determine the cut off point of cervical length usingtransvaginal ultrasonography to predict the actual occurrence ofpreterm labor in women with threatened preterm labor. Methods: A cross sectional study with consecutive random samplingmethod. We examined 80 women with singleton pregnancycomplaining of regular, painful uterine contraction and rupturedmembrane at 24-36 weeks of gestation. Women in active labor, definedby the presence of cervical dilatation less than or equal 3 cm, and having complicationwere excluded. When the patient was admitted, a transvaginalscan was performed to measure the cervical length. Parenteralmagnesium sulfate was given as the subsequent management.The primary outcome was delivery within 24 hours of presentation.Results: We found that the optimal cut off values for cervical lengthwas 2.65 cm with sensitivity 94.4 Percent, specificity 65.4Percent, positive predictivevalue 75.4 Percent and negative predictive value 81.8 Percent. In 69cases, the cervical length was more than or 2.65 cm, with 52 patients successfullycontinued their pregnancy until more than 24 hours. In the 11cases with cervical length less than or equal 2.65 cm, delivery within 24 hours occurredin 9 cases (81,8 Percent). Conclusion: The findings of this study suggest that in women withthreatened preterm labor, cervical length more than or equal 2.65 cm may help predictthe actual occurrence of preterm labor. Keywords: cervical length, threatened preterm labor, transvaginalultrasonography

Midtrimester Cervical Length in Low-Risk Nulliparous Women for the Prediction of Spontaneous Preterm Birth: Should We Consider a New Definition of Short Cervix?

2021 ◽  
Author(s):  
Paul Guerby ◽  
Mario Girard ◽  
Geneviève Marcoux ◽  
Annie Beaudoin ◽  
Jean-Charles Pasquier ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Health Care Providers ◽  
Gestational Age ◽  
Roc Curve ◽  
Transvaginal Ultrasound ◽  
Cervical Length ◽  
Care Providers ◽  
Operating Characteristics ◽  
Spontaneous Preterm Birth ◽  
Nulliparous Women

Objective The study aimed to estimate the predictive value of midtrimester cervical length (CL) and the optimal cut-off of CL that should be applied with asymptomatic nulliparous women for the prediction of spontaneous preterm birth (sPTB). Study Design This is a prospective cohort study of asymptomatic nulliparous women with a singleton gestation. Participants underwent CL measurement by transvaginal ultrasound between 20 and 24 weeks of gestation. The participants and their health care providers remained blinded to the results of CL measurement. The primary outcomes were sPTB before 35 weeks and sPTB before 37 weeks. Receiver operating characteristics (ROC) curve analyses were performed. Analyses were repeated by using multiples of median (MoM) of CL adjusted for gestational age. Results Of 796 participants, the mean midtrimester CL was 40 ± 6 mm with a 1st, 5th, and 10th percentile of 25, 29, and 32 mm, respectively. ROC curve analyses suggest that a cut-off of 30 mm was the optimal CL to predict sPTB before 35 weeks (area under the ROC curve [AUC]: 0.70, 95% confidence interval [CI]: 0.56–0.85) and before 37 weeks (AUC: 0.70, 95% CI: 0.59–0.80). Midtrimester CL <30 mm could detect 35% of all sPTB before 35 weeks at a false-positive rate of 5% (relative risk: 9.1, 95% CI: 3.5–23.5, p < 0.001). We observed similar results using a cut-off of CL <0.75 MoM adjusted for gestational age. Conclusion A midtrimester CL cut-off of 30 mm (instead of 25 mm), or CL less than 0.75 MoM, should be used to identify nulliparous women at high risk of sPTB. Key Points

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