scholarly journals Position Paper of the Task Force for Obstetrics and Prenatal Medicine (AGG – Section Preterm Birth) on the Placement, Removal and Surveillance of the Arabin Cervical Pessary in Patients at Risk for Spontaneous Preterm Birth

2019 ◽  
Vol 79 (11) ◽  
pp. 1171-1175 ◽  
Author(s):  
Ioannis Kyvernitakis ◽  
Holger Maul ◽  
Werner Rath ◽  
Katrina Kraft ◽  
Ruben Kuon ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Task Force ◽  
Transvaginal Ultrasound ◽  
Cervical Length ◽  
Position Paper ◽  
Treatment Modalities ◽  
Clinical Use ◽  
Spontaneous Preterm Birth ◽  
Emergency Situations ◽  
Cervical Pessary

AbstractThis position paper describes clinically important, practical aspects of cervical pessary treatment. Transvaginal ultrasound is standard for the assessment of cervical length and selection of patients who may benefit from pessary treatment. Similar to other treatment modalities, the clinical use and placement of pessaries requires regular training. This training is essential for proper pessary placement in patients in emergency situations to prevent preterm delivery and optimize neonatal outcomes. Consequently, pessaries should only be applied by healthcare professionals who are not only familiar with the clinical implications of preterm birth as a syndrome but are also trained in the practical application of the devices. The following statements on the clinical use of pessary application and its removal serve as an addendum to the recently published German S2-consensus guideline on the prevention and treatment of preterm birth.

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.

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

scholarly journals Effect of Cervical Pessary on Spontaneous Preterm Birth in Women With Singleton Pregnancies and Short Cervical Length

JAMA ◽  
2017 ◽  
Vol 318 (23) ◽  
pp. 2317 ◽  
Author(s):  
Gabriele Saccone ◽  
Giuseppe Maria Maruotti ◽  
Antonia Giudicepietro ◽  
Pasquale Martinelli ◽  
Keyword(s):  
Preterm Birth ◽  
Cervical Length ◽  
Spontaneous Preterm Birth ◽  
Cervical Pessary ◽  
Singleton Pregnancies

scholarly journals Uterocervical Angle Measurement Improves Prediction of Preterm Birth in Twin Gestation

2017 ◽  
Vol 35 (07) ◽  
pp. 648-654 ◽  
Author(s):  
Emily Tenbrink ◽  
Mitchell Onslow ◽  
Avinash Patil ◽  
Jordan Knight
Keyword(s):  
Preterm Birth ◽  
Transvaginal Ultrasound ◽  
Cervical Length ◽  
Angle Measurement ◽  
Spontaneous Preterm Birth ◽  
Increased Risk ◽  
The Mean ◽  
Gestational Age At Birth ◽  
Twin Pregnancies ◽  
Better Than

Objective Twin pregnancies are associated with an increased risk of spontaneous preterm birth. Our objective was to compare the performance of uterocervical angle to cervical length as predictors of spontaneous preterm birth in this population. Methods We conducted a retrospective cohort study of twin gestations at a single center from May 2008 to 2016 who received a transvaginal ultrasound for the evaluation of the cervix between 16 0/7 and 23 0/7 weeks. The primary outcome was prediction of preterm birth <28 and <32 weeks by uterocervical angle and cervical length. Results Among 259 women with twin gestation, the mean gestational age at birth was 34.83 ± 3.48 weeks. Receiver operator characteristic curves demonstrated optimal prediction of spontaneous preterm birth prior to 32 weeks at a uterocervical angle >110° (80% sensitivity, 82% specificity) [odds ratio (OR), 15.7 (95% confidence interval (CI), 7.2–34.4)] versus cervical length <20 mm (53% sensitivity, 85% specificity; p < 0.001, OR, 6.4 [95% CI, 2.3–17.8]) and similarly, prior to 28 weeks at a uterocervical angle >114° (OR, 24.3 [95% CI, 6.7–88.5]) compared with cervical length <20 mm (OR, 11.4 [95% CI, 3.5–36.7]). Conclusion Uterocervical angles >110° performed better than cervical length for the prediction of spontaneous preterm birth in twin gestations.

scholarly journals The Predictive Value of the Cervical Consistency Index to Predict Spontaneous Preterm Birth in Asymptomatic Twin Pregnancies at the Second-Trimester Ultrasound Scan: A Prospective Cohort Study

2020 ◽  
Vol 9 (6) ◽  
pp. 1784
Author(s):  
Johannes van der Merwe ◽  
Isabel Couck ◽  
Francesca Russo ◽  
Xavier P. Burgos-Artizzu ◽  
Jan Deprest ◽  
...  
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Transvaginal Ultrasound ◽  
Characteristic Curve ◽  
Cervical Length ◽  
Consistency Index ◽  
Spontaneous Preterm Birth ◽  
Twin Pregnancies

Novel transvaginal ultrasound (TVU) markers have been proposed to improve spontaneous preterm birth (sPTB) prediction. Preliminary results of the cervical consistency index (CCI), uterocervical angle (UCA), and cervical texture (CTx) have been promising in singletons. However, in twin pregnancies, the results have been inconsistent. In this prospective cohort study of asymptomatic twin pregnancies assessed between 18+0–22+0 weeks, we evaluated TVU derived cervical length (CL), CCI, UCA, and the CTx to predict sPTB < 34+0 weeks. All iatrogenic PTB were excluded. In the final cohort of 63 pregnancies, the sPTB rate < 34+0 was 16.3%. The CCI, UCA, and CTx, including the CL was significantly different in the sPTB < 34+0 weeks group. The best area under the receiver operating characteristic curve (AUC) for sPTB < 34+0 weeks was achieved by the CCI 0.82 (95%CI, 0.72–0.93), followed by the UCA with AUC 0.72 (95%CI, 0.57–0.87). A logistic regression model incorporating parity, chorionicity, CCI, and UCA resulted in an AUC of 0.91 with a sensitivity of 55.3% and specificity of 88.1% for predicting sPTB < 34+0. The CCI performed better than other TVU markers to predict sPTB < 34+0 in twin gestations, and the best diagnostic accuracy was achieved by a combination of parity, chorionicity, CCI, and UCA.

scholarly journals Effect of Cervical Pessary on Spontaneous Preterm Birth in Women With Singleton Pregnancies and Short Cervical Length

2018 ◽  
Vol 73 (5) ◽  
pp. 267-268
Author(s):  
Gabriele Saccone ◽  
Giuseppe Maria Maruotti ◽  
Antonia Giudicepietro ◽  
Pasquale Martinelli
Keyword(s):  
Preterm Birth ◽  
Cervical Length ◽  
Spontaneous Preterm Birth ◽  
Cervical Pessary ◽  
Singleton Pregnancies

scholarly journals Beyond Cervical Length: Association between Postcerclage Transvaginal Ultrasound Parameters and Preterm Birth

2019 ◽  
Vol 36 (13) ◽  
pp. 1317-1324 ◽  
Author(s):  
Ashley N. Battarbee ◽  
Joshua S. Ellis ◽  
Tracy A. Manuck
Keyword(s):  
Preterm Birth ◽  
Transvaginal Ultrasound ◽  
Care Center ◽  
Tertiary Care ◽  
Cervical Length ◽  
Uterine Wall ◽  
Cervical Canal ◽  
Spontaneous Preterm Birth ◽  
Chi Square ◽  
Ultrasound Parameters

Objective To assess the value of transvaginal ultrasound parameters after cerclage placement in estimating the risk of spontaneous preterm birth. Study Design This is a retrospective cohort at a single tertiary care center from 2013 to 2016. Women carrying a singleton, nonanomalous fetus with cerclage in situ and at least one postcerclage transvaginal ultrasound from 160/7 to 256/7 weeks' gestation were included. In addition to abstracting maternal demographic and obstetric characteristics, two study investigators separately reviewed each of the images from the first transvaginal ultrasound after cerclage placement, masked to pregnancy outcomes. We measured the angle between the anterior uterine wall and cervical canal at the internal os and external os, closed canal length above and below the stitch, width of the anterior and posterior cervix at the level of the cerclage, and stitch distance from the cervical canal. The presence of additional ultrasound findings such as sludge and cervical funneling was also noted. The main outcomes were preterm birth < 34 weeks and preterm birth < 37 weeks. Transvaginal ultrasound parameters were compared between women with preterm birth and those without preterm birth using chi-square, Fisher's exact, and Wilcoxon's rank-sum tests, as appropriate. Log binomial regression was used to estimate the relative risk of preterm birth for all significant obstetric and ultrasound characteristics. Results A total of 102 women met inclusion criteria: 58% had history-indicated, 20% ultrasound-indicated, and 23% exam-indicated cerclages. Of these, 28 (27.5%) women delivered at < 34 weeks' gestation, and 48 (47.0%) women delivered at < 37 weeks' gestation. Preterm birth did not vary by race, maternal age, insurance, smoking, or gestational age of the earliest prior preterm birth (for multiparous women), but women who had preterm birth were more likely to have exam-indicated cerclage. There were several transvaginal ultrasound parameters associated with preterm birth < 34 weeks and preterm birth < 37 weeks. Of these, cervical length below the stitch, stitch distance from the cervical canal, straight cervical canal, funneling to or past the stitch, and presence of sludge had the greatest effect sizes. Conclusion Rates of preterm birth are high postcerclage. In addition to measuring cervical length, utilization of postcerclage transvaginal ultrasound to evaluate the location of the cerclage within the cervix, the curvature of the cervical canal, and the presence of funneling and sludge may help identify women who are at the highest risk for preterm birth.

Prediction of spontaneous preterm birth in asymptomatic twin pregnancies with the use of combined fetal fibronectin and cervical length

2009 ◽  
Vol 201 (3) ◽  
pp. 313.e1-313.e5 ◽  
Author(s):  
Nathan S. Fox ◽  
Daniel H. Saltzman ◽  
Chad K. Klauser ◽  
Danielle Peress ◽  
Christina V. Gutierrez ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Cervical Length ◽  
Spontaneous Preterm Birth ◽  
Fetal Fibronectin ◽  
Twin Pregnancies
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