Preoperative Cervical Length Predicts the Risk of Delivery within One Week after Pleuroamniotic Shunt in Fetuses with Severe Hydrothorax

2021 ◽  
pp. 1-7
Author(s):  
Alma Gámez-Varela ◽  
Miguel Martínez-Rodríguez ◽  
Hugo López-Briones ◽  
Jonahtan Luna-García ◽  
Eréndira Chávez-González ◽  
...  
Keyword(s):  
Fetal Surgery ◽  
Predictive Performance ◽  
Cervical Length ◽  
Pleural Space ◽  
Fetal Intervention ◽  
Short Cervix ◽  
Mediastinal Shift ◽  
Prelabor Rupture Of Membranes ◽  
Bilateral Lung ◽  
Surgery Center

<b><i>Objective:</i></b> The objective of this study was to assess the predictive performance of preoperative cervical length (CL) for delivery within 1 week after pleuroamniotic shunting (PAS) in fetuses with severe hydrothorax. <b><i>Methods:</i></b> A prospective cohort of fetuses with severe hydrothorax referred to our fetal surgery center in Querétaro, Mexico from January 2012 to July 2020. Severe fetal hydrothorax was diagnosed as an accumulation of fluid within the fetal pleural space accompanied with severe bilateral lung compression, mediastinal shift, polyhydramnios, and/or hydrops. Transvaginal CL was measured immediately before PAS, and a short cervix was defined as that &#x3c;25 mm. The interval from fetal intervention to delivery, prevalence of preterm prelabor rupture of membranes (PPROMs), and associations with delivery within the first week after PAS according to a short or a normal CL, were evaluated. <b><i>Results:</i></b> Thirty-five pregnancies with severe fetal hydrothorax treated with PAS were evaluated. Median gestational age at PAS was (weeks + days) 31<sup>+2</sup> (range, 26<sup>+0</sup>–36<sup>+1</sup>). Two (5.7%) and 7 (20.0%) cases delivered within the first 24 h and 1 week after PAS, respectively. Ten (28.6%) women had a short cervix before PAS, while 25 (71.4%) had normal preoperative CL. Women with a short cervix showed lower mean interval between fetal intervention and delivery (2.4 vs. 5.5 weeks, <i>p</i> = 0.01), and higher prevalence of PPROM (50 vs. 12%, <i>p</i> = 0.01), as compared to women with a nonshort cervix. Preoperative short cervix was associated with significantly higher risk of delivery within the first 24 h (20.0 vs. 0%, respectively, <i>p</i> &#x3c; 0.05) and 1 week after PAS (50.0 vs. 8.0%, respectively, <i>p</i> &#x3c; 0.01) compared with pregnancies with normal preoperative CL. <b><i>Conclusion:</i></b> In pregnancies with severe fetal hydrothorax candidates for pleuroamniotic shunt, identification of a short cervix before fetal intervention can predict delivery within 1 week after the surgical procedure.

Single Uterine Access for Bilateral Pleuroamniotic Shunting in Fetuses with Severe Hydrothorax by an Internal Rotational Maneuver: Feasibility and Outcomes between Successful and Failed Procedures

2021 ◽  
Vol 48 (3) ◽  
pp. 209-216
Author(s):  
Rogelio Cruz-Martínez ◽  
Cristian Sosa Sosa ◽  
Miguel Martínez-Rodríguez ◽  
Alma Gámez-Varela ◽  
Rosa Villalobos-Gómez ◽  
...  
Keyword(s):  
Survival Rate ◽  
Prospective Cohort ◽  
Lower Risk ◽  
Perinatal Death ◽  
Fetal Surgery ◽  
Perinatal Outcomes ◽  
Fetal Intervention ◽  
Surgical Time ◽  
Final Population ◽  
Surgery Center

<b><i>Objective:</i></b> The objective of this study was to describe the feasibility of single percutaneous uterine access for bilateral pleuroamniotic shunting (PAS) in fetuses with severe hydrothorax by using an internal rotational maneuver and to compare perinatal outcomes between successful and failed procedures. <b><i>Methods:</i></b> A prospective cohort of 25 fetuses with isolated bilateral hydrothorax and hydrops were referred to our fetal surgery center in Queretaro, Mexico during an 8-year period. Bilateral PAS was first attempted through a percutaneous single uterine access by internal rotation of the fetus, which was achieved by using the blunt tip of the same cannula, and in case of a failed procedure, a second uterine port was used to place the second shunt. The perinatal outcomes between successful (single uterine port) and failed (2 uterine ports) fetal procedures were compared. <b><i>Results:</i></b> Placing of bilateral shunts through a percutaneous single uterine access was feasible in 15/25 (60%) cases. Overall, median GA at delivery was 35.2 weeks with a survival rate of 64.0% (16/25). Three cases were excluded due to shunt dislodgement, leaving a final population of 22 fetuses; 13/22 (59.1%) and 9/22 (40.9%) managed using 1 and 2 uterine ports, respectively. The group with bilateral PAS placement through a successful single uterine port showed a significantly higher GA at birth (36.5 vs. 32.8 weeks, <i>p</i> = 0.001), lower surgical time (11.0 vs. 19.0 min, <i>p</i> = 0.01), longer interval between fetal intervention and delivery (5.7 vs. 2.7 weeks, <i>p</i> = 0.01), lower risk of preterm delivery (46.2 vs. 100%, <i>p</i> &#x3c; 0.01), and lower rate of perinatal death (15.4 vs. 55.6%, <i>p</i> &#x3c; 0.05) than the failed procedures requiring 2 uterine ports. <b><i>Conclusion:</i></b> In fetuses with severe bilateral hydrothorax and hydrops, bilateral pleuroamniotic shunting through a successful single percutaneous uterine access is feasible in up to 60% of cases and is associated with better perinatal outcomes.

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.

Cervical Length Following Cerclage Placement in Twin Gestations With Ultrasound Indicated Short Cervix [30S]

2019 ◽  
Vol 133 (1) ◽  
pp. 210S-210S
Author(s):  
Christopher K. Arkfeld ◽  
J. Connor Mulhall ◽  
Ashley Shea ◽  
Joshua D. Dahlke
Keyword(s):  
Cervical Length ◽  
Short Cervix

Ultrasonographic trans-abdominal measurement of uterine cervical length for the prediction of a midtrimester short cervix

2020 ◽  
Vol 42 (5) ◽  
pp. 676
Author(s):  
Paul Guerby ◽  
Annie Beaudoin ◽  
Geneviève Marcoux ◽  
Mario Girard ◽  
Jean-Charles Pasquier ◽  
...  
Keyword(s):  
Cervical Length ◽  
Short Cervix

Mid-pregnancy cervical length as a risk factor for cesarean section in women with twin pregnancies

2018 ◽  
Vol 46 (7) ◽  
pp. 780-785 ◽  
Author(s):  
Su Jin Sung ◽  
Seung Mi Lee ◽  
Sohee Oh ◽  
Joo Hee Choi ◽  
Jee Yoon Park ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cesarean Section ◽  
Cervical Length ◽  
Spontaneous Preterm Birth ◽  
Short Cervix ◽  
Trial Of Labor ◽  
Nulliparous Women ◽  
Increased Risk ◽  
Confounding Variables ◽  
Twin Pregnancies

Abstract Objective: It is well known that a short cervix at mid-pregnancy is a risk factor for spontaneous preterm birth in both singleton and twin gestations. Recent evidence also suggests that a long cervix at mid-pregnancy is a predictor of the risk of cesarean section (C/S) in singleton gestation. The purpose of this study was to determine whether a long cervix at mid-pregnancy was associated with an increased risk of C/S in women with twin pregnancies. Methods: We enrolled 746 women pregnant with twins whose cervical length was measured by trans-vaginal ultrasonography at a mean of 22 weeks of gestation and who delivered in our institution. Cases with a short cervix [cervical length (CL) <15 mm] were excluded. Cases were divided into four groups according to the quartile of CL. Results: The rate of C/S increased according to the quartile of CL (47% in the 1st quartile, 51% in the 2nd quartile, 56% in the 3rd quartile and 62% in the 4th quartile, P<0.005, χ2 for trend). CL was an independent risk factor for C/S even after adjustment for confounding variables. When confining analysis to women who delivered after a trial of labor (n=418), to nulliparous women (n=633) or to those who delivered at late preterm or full term (n=666), the rate of C/S also increased according to the quartile of CL, and the relationship between CL and the risk of C/S remained significant after adjustment in each group. Conclusion: In women pregnant with twins, long CL at mid-pregnancy was a risk factor for C/S.

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

A predictive model of short cervix at 20-24 weeks using first-trimester cervical length measurement and maternal history

2011 ◽  
Vol 31 (2) ◽  
pp. 202-206 ◽  
Author(s):  
A. P. Souka ◽  
I. Papastefanou ◽  
V. Michalitsi ◽  
G. K. Papadopoulos ◽  
D. Kassanos
Keyword(s):  
Predictive Model ◽  
First Trimester ◽  
Cervical Length ◽  
Length Measurement ◽  
Short Cervix ◽  
Maternal History ◽  
Cervical Length Measurement

scholarly journals OP25.08: Prognostic value of intra-amniotic interleukin-6 and cervical length in monochorionic twins after fetal surgery

2017 ◽  
Vol 50 ◽  
pp. 131-131
Author(s):  
J. Vojtech ◽  
V.J. Dvorak ◽  
L. Haslik ◽  
K. Mackova ◽  
K. Behavkova ◽  
...  
Keyword(s):  
Interleukin 6 ◽  
Prognostic Value ◽  
Fetal Surgery ◽  
Cervical Length ◽  
Monochorionic Twins
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