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Introduction: Preterm birth, before 37 weeks of gestation, is the main determinant of neonatal morbidity and mortality and is associated with serious consequences,including compromised quality of life for the affected individual and physical, psychological, and economic costs. Objective: To evaluate the correlation of obstetric history, cervicovaginal infections, and cervical length with preterm birth. A prospective, blind cohort study evaluated 1,370 pregnant women from Ribeirão Preto between 20 and 25 weeks of gestation. Materials and methods: The correlation between obstetric history, cervical length, and gestational age at birth was obtained by calculating the relative risk of the different variables. Results: The distribution of pregnant women according to cervical length (CL) showed a predominance of women with a cervix longer than 2.5 cm (n = 1,308, 95.8%), followed by women with a cervix between 2 and 2.49 cm (n = 42, 3.1%) and < 2 cm (n = 15, 1.1%). Among the 1,370 pregnant women evaluated, 133 had spontaneous preterm birth (< 259 days); 14 (10.5%) preterm births occurred in women under 19 years of age, 105 (79%) in women between 19 and 35 years, and 14 (10.5%) in women older than 35 years. Microbiological analysis showed the growth of Mycoplasma hominis, Ureaplasma urealyticum, and other bacteria in 8, 17, and 16 women with preterm birth, respectively. Among the 133 women with spontaneous preterm birth, CL was < 2.5 cm in 15 women, < 2 cm in 3, < 1.5 cm in 3, and < 1 cm in 2. Conclusion: The identification of pregnant women at high risk for preterm delivery can reduce the incidence of preterm birth. Although no gold standard test exists for the prediction of preterm birth, this study confirms that the measurement of CL is a good individual predictor.
Introducción: El nacimiento pretérmino, antes de las 37 semanas de gestación, es el principal determinante de la morbimortalidad neonatal y se asocia a graves consecuencias,incluyendo el compromiso de la calidad de vida del individuo afectado y costes físicos, psicológicos y económicos. Objetivo: Evaluar la correlación de los antecedentes obstétricos, infecciones cervicovaginales y longitud cervical con el parto prematuro. Estudio de cohorte prospectivo, ciego, evaluando 1.370 gestantes de Ribeirão Preto entre 20 y 25 semanas de gestación. Material y métodos: La correlación entre los antecedentes obstétricos, la longitud cervical y la edad gestacional al nacer se obtuvo calculando el riesgo relativo de las diferentes variables. Resultados: La distribución de las gestantes según la longitud cervical (LC) mostró un predominio de mujeres con cuello uterino mayor de 2,5 cm (n = 1,308, 95.8%), seguidas de mujeres con cuello uterino entre 2 y 2,49 cm (n = 42, 3.1%) y menor de 2 cm (n = 15, 1.1%). De las 1,370 embarazadas evaluadas, 133 tuvieron un parto prematuro espontáneo (< 259 días); 14 (10.5%) partos prematuros se produjeron en mujeres menores de 19 años, 105 (79%) en mujeres de entre 19 y 35 años, y 14 (10.5%) en mujeres mayores de 35 años. Los análisis microbiológicos mostraron la proliferación de Mycoplasma hominis, Ureaplasma urealyticum y otras bacterias en 8, 17 y 16 mujeres con parto prematuro, respectivamente. Entre las 133 mujeres con parto prematuro espontáneo, la CL fue < 2.5 cm en 15 mujeres, < 2 cm en 3, < 1.5 cm en 3 y < 1 cm en 2. Conclusión: La identificación de las gestantes con alto riesgo de parto prematuro puede reducir la incidencia de parto prematuro. Aunque no existe una prueba de referencia para la predicción del parto prematuro, este estudio confirma que la medición de la longitud cervical es una buena predicción individual.
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Abstract Objective: To ascertain how screening for preterm birth is performed among obstetricians working in public and private practice in a middle-income country. Methods: Cross-sectional study of 265 obstetrician-gynecologists employed at public and private facilities. An online questionnaire was administered, with items designed to collect data on prematurity screening and prevention practices. Results: The mean age of respondents was 44.5 years; 78.5% were female, and 97.7% had completed a medical residency program. Universal screening (i.e., by ultrasound measurement of cervical length) was carried out by only 11.3% of respondents in public practice; 43% request transvaginal ultrasound if the manual exam is abnormal, and 74.6% request it in pregnant women with risk factors for preterm birth. Conversely, 60.7% of respondents in private practice performed universal screening. This difference in screening practices between public and private practice was highly significant (p < 0.001). Nearly all respondents (90.6%) reported prescribing vaginal progesterone for short cervix. Conclusion: In the setting of this study, universal ultrasound screening to prevent preterm birth was used by just over half of doctors in private practice. In public facilities, screening was even less common. Use of vaginal progesterone in cervical shortening was highly prevalent. There is an unmet need for formal protocols for screening and prevention of preterm birth in middle-income settings.
Subject(s)
Humans , Infant, Newborn , Infant, Premature , Health Knowledge, Attitudes, Practice , Mass Screening , Premature Birth , Cervical Length MeasurementABSTRACT
Introducción : el tratamiento de la insuficiencia cervical es el cerclaje cervical. Pese a este tratamiento el riesgo de parto prematuro persiste elevado en mujeres con insuficiencia cervical. La mejor forma y utilidad del seguimiento ecográfico de mujeres cercladas es desconocida. El objetivo de esta revisión fue evaluar la capacidad pronóstica de la ecografía transvaginal para predecir riesgo de parto prematuro luego de un cerclaje cervical. Materiales y métodos : realizamos una revisión sistemática de la literatura incluyendo estudios que evaluaran el valor pronóstico de la ecografía transvaginal luego de un cerclaje cervical, para predecir parto prematuro. Resultados : incluimos 14 estudios en la revisión. El parámetro más frecuentemente asociado con parto prematuro fue la longitud cervical posterior al cerclaje, aunque con capacidad predictiva moderada. El punto de corte para definir pacientes en riesgo varió entre 15-28 mm. Conclusión : la longitud cervical disminuida posterior a un cerclaje se asocia con mayor riesgo de parto prematuro. No se ha establecido un valor de corte único ni la utilidad clínica del seguimiento ecográfico de mujeres cercladas.
Introduction : The management of cervical insufficiency involves a cervical cerclage. Despite this treatment, patients with cervical insufficiency remain at high risk of preterm delivery. The best method and utility of ultrasound monitoring for women with cervical cerclage is unknown. The objective of this revision was to evaluate the prognostic performance of ultrasonographic cervical assessment to predict preterm labor after a cervical cerclage. Material and methods : We conducted a systematic literature review, including studies that assessed the prognostic value of transvaginal ultrasound after cervical cerclage in predicting premature birth. Results : We included 14 studies in our review. The most frequently evaluated parameter was cervical length after the cerclage, although with only moderate predictive capacity. The length used to define prognosis varied from 15 to 28 mm. Conclusion : Short cervical length after a cerclage is associated with a higher risk of preterm delivery. A single cutoff value and the clinical utility of ultrasound monitoring for women with cervical cerclage have not been established.
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Objective:To explore the clinical significance of cervical length (CL) measured by transabdominal ultrasound during fetal structural anomalies screeing at 20-24 +6 weeks of gestation. Methods:This was a retrospective nested case-control study based on a prospective longitudinal cohort of "Prediction and Prevention of Early-onset Preeclampsia", which recruited 4 995 singleton pregnant women at the gestational age of 11-13 +6 weeks in Nanjing Drum Tower Hospital from April 2019 to August 2022. All the subjects underwent second-trimester ultrasound screening for fetal structural anomalies in our hospital with image records. This study excluded the women who were lost to follow-up, underwent cervical cerclage, terminated the pregnancy due to personal or social factors, or had miscarriage before 20 weeks of gestation, and those with iatrogenic preterm births, intrauterine fetal death or no second-trimester cervical sonography images. Propensity score matching was used to match pregnant women with spontaneous preterm birth ( n=101) and those with full-term delivery ( n=101) in a 1∶1 ratio, with factors of maternal age, body mass index, preterm birth history, cesarean section history, and pregnancy interval ≥5 years. CL was measured based on the retained ultrasound images. Nonparametric test or Chi-square test were used for statistical analysis. Receiver operating characteristic (ROC) curve was used to evaluate the correlation between CL measured by transabdominal ultrasound in the second trimester and spontaneous preterm birth. Results:The CL measured by transabdominal ultrasound at 20-24 +6 weeks of gestation was significantly shorter in the spontaneous preterm birth group than that in the full-term group [2.8 cm (2.5-3.3 cm) vs. 3.4 cm (3.0-3.9 cm), Z=-5.85, P<0.001]. If CL<3.4 cm was used as the cut-off value for predicting spontaneous preterm birth (20-36 +6 weeks), the specificity and the sensitivity were 0.50 and 0.77, respectively, and the sensitivity reached 0.92 for predicting preterm birth before 32 weeks and 1.00 for predicting preterm birth before 28 weeks. If CL<3.7 cm was used as the cut-off value, the specificity and the sensitivity were 0.36 and 0.87, respectively, and the sensitivity was 1.00 for predicting preterm birth before 32 weeks. The efficacy of preterm birth screening at 28-36 +6 weeks of gestation was comparable to that at 20-36 +6 weeks, if CL<3.4 cm and CL<3.7 cm were used as the cut-off value, the sensitivity were 0.76 and 0.86, respectively. Conclusion:Transabdominal ultrasound measurement of CL in the second trimester can be a preliminary screening to determine whether further transvaginal ultrasound measurement of CL is needed for women without a history of preterm birth or late spontaneous abortion.
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Abstract Objective To describe a reference curve for cervical length (CL) in mid-trimester twin gestations using transvaginal ultrasound (TVU) and to investigate whether short CL increases spontaneous preterm birth (sPTB) in asymptomatic twin pregnancies. Methods This was a prospective cohort study performed at 17 outpatient antenatal facilities of Brazil with women at 18 0/7 to 22 6/7 weeks of gestation who participated in a randomized clinical trial screening phase (P5 trial) between July 2015 and March 2019. TVU was performed to provide CL measurement in all screened women. Almost all women with CL ≤ 30 mm received vaginal progesterone 200mg/day and they were also randomized to receive cervical pessary or not. We considered data from the CL distribution among asymptomatic twin pregnancies and analyzed CL and its association with PTB generating receiver operating characteristics (ROC) curves and Kaplan-Meier curves. Results A total of 253 pregnant women with twins were included in the distribution curve. The mean CL was 33.7 mm and median was 35.5mm. The 10th percentile was 17.8mm. We identified a PTB rate of 73.9% (187/253) with 33.6% of sPTB < 37 (85/253) and 15% (38/253) of sPTB < 34 weeks. The best cutoff point to predict sPTB < 37 was 24.15 mm. However, the ROC curve showed a poor performance (0.64). The Kaplan-Meier survival curves identified that only CL values ≤ 20mm were associated to sPTB < 34 weeks. Conclusion A cutoff point of CL ≤ 20 mm can be interesting point to identify short cervix in Brazilian twin pregnancies. However, in Brazilian asymptomatic twin pregnancies, CL does not show a good performance to predict PTB.
Resumo Objetivo Descrever uma curva de referência da medida do colo uterino no Segundo trimestre de gestações gemelares através de ultrassonografia transvaginal (TVU) e investigar a correlação entre a medida do colo uterino (CL) e o parto prematuro espontâneo (sPTB) em pacientes assintomáticas. Métodos Foi realizado uma coorte prospectiva multicêntrica em 17 centros de referência do Brasil com mulheres com gestação gemelar entre 18 0/7 a 22 6/7 semanas de gestação que participaram da primeira fase de um ensaio clínico randomizado (P5 trial) entre Julho/2015 a Março/2019. TVU foi realizada para obter a medida do colo uterino em todas as mulheres. A maioria das mulheres com CL ≤30 mm receberam progesterona por via vaginal 200mg/dia e estas foram randomizadas para receber ou não um pessário cervical. Este estudo considerou dados da medida do colo uterino entre mulheres assintomáticas, desenvolvendo uma curva de referência para gestantes gemelares e sua capacidade de predição do parto prematuro através de curva ROC (receiver operating characteristics) e curvas de sobrevida de Kaplan-Meyer. Resultados O total de 253 gestantes foram incluídos no estudo, A média do CL foi 33.7mm e a mediana 35.5mm. O Percentil 10 do CL foi 17.8mm. A taxa de parto prematuro foi de 73.9% (187/253) com 33.6% de sPTB < 37 (85/253) e 15% (38/253) de sPTB < 34 semanas. O melhor ponto de corte para predizer sPTB < 37 foi 24.15 mm, entretanto a curva ROC demonstrou baixa performance (0.64). A curva de Kaplan-Meier para sPTB identificou que apenas CL ≤ 20 mm estavam associados a sPTB < 34 semanas. Conclusão Colo uterino ≤20 mm pode ser um interessante ponto de corte para identificar colo curto entre gestações gemelares assintomáticas brasileiras. Entretanto, a medida do colo uterino não apresentou boa performance para predizer parto prematuro.
Subject(s)
Humans , Female , Pregnancy , Cervix Uteri/anatomy & histology , Pregnancy, Twin , Obstetric Labor, PrematureABSTRACT
Introduction: The majority of pregnant women with a short cervix will deliver at term and, thus, may unnecessarily receive advanced monitoring and treatment. It is still necessary to define more accurately which sub-population of women with a short cervix is at elevated risk for early delivery. Objective: To determine if vaginal microbiome composition influenced the rate of spontaneous preterm birth in women with a short cervical length. Methods: In an exploratory, observational prospective study, vaginal secretions were obtained from 591 women at 2124 week gestation. Vaginal microbiome composition was determined by analyzing the V1V3 region of the bacterial 16S ribosomal RNA gene. Results: Lactobacillus crispatus was numerically dominant in the vagina in 41.7% of subjects, followed by L. iners in 32% and Gardnerella vaginalis in 12%. In women whose cervix was ≤25mm, the sensitivity to predict an spontaneous preterm birth was 11.8%. However, when L. crispatus was not the dominant vaginal bacterium, this sensitivity increased to 81.8%. Similarly, in women with a cervical length ≤30mm, the sensitivity to predict an spontaneous preterm birth increased from 21.7 to 78.3% when L. crispatus was not the dominant vaginal bacterium.In women with a prior spontaneous preterm birth and a cervix ≤25 or ≤30mm, L. crispatus dominance was also associated with a reduced rate of spontaneous preterm birth in the current pregnancy (p<0.001). Conclusion: In pregnant women with a cervix ≤25mm or ≤30mm, the risk for an spontaneous preterm birth is increased if L. crispatus is not dominant in the vagina.
Introdução: A maioria das mulheres grávidas com colo do útero curto dará à luz a termo e, portanto, pode receber desnecessariamente monitoramento e tratamento avançados. Permanece a necessidade de definir com mais precisão qual subpopulação de mulheres com colo do útero curto está em risco elevado de parto prematuro. Objetivo: Determinar se a composição do microbioma vaginal influenciou a taxa de parto prematuro espontâneo em mulheres com colo curto. Métodos: Em um estudo prospectivo exploratório observacional, os conteúdos vaginais foram obtidos de 591 mulheres com 2124 semanas de gestação. A composição do microbioma vaginal foi determinada pela análise da região V1V3 do gene de RNA ribossômico bacteriano 16S. Resultados: Lactobacilluscrispatus foi numericamente dominante na vagina em 41,7% dos indivíduos, seguido por L. iners em 32% e Gardnerella vaginalis em 12%. Em mulheres cujo colo do útero era <25 mm, a sensibilidade para prever uma taxa de parto prematuro espontâneo foi de 11,8%. No entanto, quando L. crispatus não era a bactéria vaginal dominante, essa sensibilidade aumentou para 81,8%. Da mesma forma, em mulheres com comprimento cervical <30 mm, a sensibilidade para prever uma taxa de parto prematuro espontâneo aumentou de 21,7 para 78,3% quando L. crispatus não era a bactéria vaginal dominante. Em mulheres com taxa de parto prematuro espontâneo anterior e colo do útero <25 ou <30 mm, a dominância de L. crispatus também foi associada a uma taxa reduzida de taxa de parto prematuro espontâneo na gravidez atual (p<0,001). Conclusão: Em mulheres grávidas com colo do útero <25 ou <30 mm, o risco de parto prematuro espontâneo é aumentado se L. crispatus não for dominante na vagina.
Subject(s)
Humans , Female , Pregnancy , Vagina/microbiology , Microbiota , Lactobacillus crispatus , Obstetric Labor, Premature , Prospective Studies , Cervical Length MeasurementABSTRACT
Objective:To explore the predictive value of transvaginal ultrasound measurement of cervical length (CL) in the first and second trimester on spontaneous preterm birth in singleton pregnant women.Methods:This study retrospectively recruited 2 254 singleton pregnancies without severe comorbidities at Peking University First Hospital from January 2019 to June 2019. CL was measured for all subjects using transvaginal ultrasound in the first (11-13 +6 weeks) and second trimester (21-23 +6 weeks). Differences in CL between women with preterm (preterm group) and full-term delivery (full-term group) as well as the CL during the first and second trimester were compared. The independent risk factors for preterm birth and the predictive value of CL in the first and second trimester for spontaneous preterm birth were also explored. Fisher's exact test, t-test, χ2 test, and logistic regression analysis, etc, were adopted for statistical analysis. Results:(1) For the 2 254 subjects, CL measured in the first trimester and second trimester were (36.1±4.2) mm (22.4-52.6 mm) and (36.9±5.3) mm (2.9-59.7 mm), respectively. The incidence of short cervix in the first trimester and second trimester were 0.31% (7/2 254) and 1.46% (33/2 254), respectively. When CL was ≤25.0 mm ( OR=43.92, 95% CI:6.83-282.49) or >25.0-≤30.3 mm ( OR=6.59, 95% CI:1.97-22.0) in the first trimester, the risk of short cervix increased in the second trimester (both P<0.05). (2) The total incidence of preterm delivery was 3.06% (69/2 254). CL and the incidence of short cervix did not differ significantly in the first trimester between the preterm and full-term group [(35.2±4.5) and (36.1±4.1) mm, t=-1.78, P=0.076; 1.5% (1/69) and 0.3% (6/2 185), χ 2=2.98, P=0.084]. Compared with the full-term group, CL was shorter and the incidence of short cervix was higher in the second trimester in the preterm group [(33.6±6.7) vs (37.0±5.2) mm, t=-5.12;8.7% (6/69) vs 1.2% (27/2 185), χ 2=25.80, P<0.001]. (3) Multivariate regression analysis showed that age ≥35 years ( OR=2.05, 95% CI:1.22-3.46), history of spontaneous preterm birth ( OR=25.25, 95% CI:5.01-127.28), conception assisted by reproductive technology ( OR=10.39, 95% CI:2.39-50.33), and short cervix during the second trimester were independent risk factors for premature delivery. (4) There was no significant difference in the risk of preterm delivery when comparing to those with CL≤25.0 mm, >25.0-≤30.3 mm, >30.3-≤33.0 mm, >33.0-≤35.7 mm, >35.7-≤38.7 mm women with CL>38.7 mm during the first trimester (all P>0.05). The risk of premature delivery was relatively increased for those with CL≤25.0 mm,>25.0-≤29.5 mm, >29.5-≤33.6 mm, >33.6~≤36.8 mm, >36.8~≤40.1 mm during the second trimester compared to those with CL>40.1 mm [ OR (95% CI):17.64 (4.99-62.32), 6.89 (2.11-22.55), 3.58 (1.34-9.59), 4.04 (1.58-10.32), 3.34 (1.28-8.67), respectively , all P<0.05]. (5) When CL≤25.0 mm and ≤29.5 mm in the second trimester were used as the cut-off value, the prediction of preterm delivery was with a sensitivity of 8.70% and 17.39%, specificity of 98.80% and 95.29%, positive predictive value of 18.20% and 10.43%, negative predictive value of 97.16% and 97.34%, and the accuracy rate of 96.01% and 92.90%, respectively. Conclusions:There were no significant differences in CL and the incidence of short cervix during the first trimester among women with preterm or full-term delivery. CL in the first trimester is not an independent risk factor for preterm birth, but the risk of short cervix in the second trimester is increased when CL≤30.3 mm in the first trimester. The shorter the cervix during the second trimester, the greater the risk of preterm birth.
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El parto prematuro, definido como el parto que ocurre antes de las 37 semanas de gestación, es una condición obstétrica grave que representa el 11% de los embarazos en todo el mundo. Las pruebas predictivas para parto prematuro son importantes, dado el impacto personal, económico y de salud del parto prematuro. Esta revisión explora la utilidad tanto de las pruebas predictivas actuales utilizadas en la práctica clínica (características maternas, longitud cervical y marcadores bioquímicos), así como nuevas pruebas emergentes. Se realizó una búsqueda electrónica en las bases de datos científicas en salud: PUBMED, COCHRANE, SCIELO, revisión de repositorios virtuales de universidades nacionales utilizando los siguientes ítems de búsqueda y sus combinaciones: parto pretérmino, longitud cervical, acortamiento cervical, cervicometría, fibronectina fetal, factores de riesgo, características maternas. Se incluyeron trabajos publicados en inglés y español, desde el año 2006 hasta el año 2020, que respondían al objetivo de la revisión: La utilidad de los diferentes predictores para parto pretérmino. En total se incluyeron 30 artículos en la presente revisión bibliográfica. Existen múltiples criterios científicos sobres las diferentes técnicas actuales para identificar pacientes de riesgo y lograr una prevención adecuada del parto pretérmino. La medición de la longitud cervical por ecografía transvaginal es el método más rentable en mujeres con historia de parto prematuro o síntomas de amenaza de parto prematuro; la evidencia actual permite sostener que también es indispensable realizar cervicometría de rutina a todas las pacientes, aún de bajo riesgo. Existen métodos ecográficos de predicción como la elastografía cervical y el índice de consistencia cervical que son prometedores, pero existen limitaciones en su implementación técnica y se propone que podrían ser una posible alternativa en el futuro, que puede combinarse con la longitud cervical. También, la adición de la medición de la longitud cervical a las pruebas bioquímicas parece mejorar la precisión predictiva(au)
Preterm labor, defined as delivery before 37 weeks of gestation, is a serious obstetric condition that accounts for 11% of pregnancies worldwide. Predictive tests for preterm birth are important, given the personal, economic, and health impact of preterm birth. This review explores the utility of both, the current predictive tests used in clinical practice (maternal characteristics, cervical length and biochemical markers), as well as the new emerging tests. An electronic search was carried out in the scientific health databases: PUBMED, COCHRANE, SCIELO, national universities virtual repositories were also reviewed, using the following search items and their combinations: preterm delivery, cervical length, cervical shortening, cervicometry, fetal fibronectin, risk factors, and maternal characteristics. We included papers in English and Spanish published from 2006 to 2020, which responded to the aim of the review: the utility of predictive test for preterm delivery. A total of 30 articles were included in this review. There are multiple scientific criteria on the different current techniques to identify patients at risk and achieve adequate prevention of preterm birth. Measurement of cervical length by transvaginal ultrasound is the most cost-effective method in women with a history of preterm labor or symptoms of preterm labor; the current evidence allows us to affirm that it is also essential to perform routine cervicometry in all patients, even with low risk. There are promising ultrasound predictive methods such as cervical elastography and cervical consistency index, but there are limitations in their technical implementation, it is proposed that they could be a possible alternative in the future, that can be combined with cervical length measurement. Also, adding cervical length easurement to biochemical tests appears to improve predictive accuracy.(au)
Subject(s)
Humans , Female , Pregnancy , Risk Factors , Ultrasonography , Premature Birth , Cervical Length Measurement , Obstetric Labor, Premature , Biomarkers , HazardsABSTRACT
OBJETIVO: Comparar el índice de consistencia cervical con la longitud cervical en la predicción de parto pretérmino inminente en pacientes sintomáticas. MÉTODO: Estudio prospectivo realizado en mujeres con embarazos únicos entre 24 y 35 semanas, con diagnóstico clínico de amenaza de parto pretérmino, que asistieron al Hospital Central Dr. Urquinaona en Maracaibo, Venezuela. Al momento del diagnóstico, las pacientes fueron evaluadas con ecografía transvaginal para establecer los valores del índice de consistencia cervical y la longitud cervical. La resultante principal fue parto inminente (en los 7 días siguientes a la evaluación). RESULTADOS: Se incluyeron 657 pacientes, de las que 152 presentaron parto pretérmino inminente (grupo A) y 505 fueron consideradas como controles (grupo B). No se encontraron diferencias entre los grupos en cuanto a edad materna, nuliparidad, antecedente de parto pretérmino, antecedente de hábito tabáquico e índice de masa corporal. Las pacientes del grupo A presentaron valores significativamente más bajos del índice de consistencia cervical y de longitud cervical que las del grupo B (p < 0,0001). El índice de consistencia cervical mostró un valor de área bajo la curva de 0,857, mientras que para la longitud cervical este fue de 0,977. La diferencia de la capacidad de discriminación entre las áreas bajo la curva de cada prueba fue significativa (p < 0,0001). CONCLUSIÓN: El índice de consistencia cervical no es superior a la longitud cervical en la predicción de parto pretérmino inminente en pacientes sintomáticas.
OBJECTIVE: To compare the cervical consistency index with the cervical length in predicting imminent preterm delivery in symptomatic patients. METHOD: This prospective study was conducted in women with single pregnancies between 24 and 35 weeks, with a clinical diagnosis of threatened preterm delivery who attended the Central Hospital Dr. Urquinaona, in Maracaibo, Venezuela. At the time of diagnosis, the patients were evaluated using transvaginal ultrasound to establish the values of the cervical consistency index and cervical length. The main result was imminent delivery (in the 7 days following the evaluation). RESULTS: 657 patients were included, 152 women presented imminent preterm delivery (group A) and 505 were considered as controls (group B). No differences were found between the groups concerning maternal age, nulliparity, history of preterm delivery, history of smoking, and body mass index. Group A patients presented significantly lower values of cervical consistency index and cervical length compared to group B patients (p < 0.0001). The cervical consistency index and cervical length showed an area value under the curve of 0.857 and 0.977, respectively. The difference in the ability to discriminate between the areas under the curve of each test was significant (p < 0.0001). CONCLUSIONS: The cervical consistency index is not superior to the cervical length in the prediction of imminent preterm delivery in symptomatic patients.
Subject(s)
Humans , Female , Pregnancy , Adult , Cervix Uteri/diagnostic imaging , Obstetric Labor, Premature/diagnosis , Organ Size , Cervix Uteri/anatomy & histology , Predictive Value of Tests , Prospective Studies , Ultrasonography, Prenatal , Sensitivity and SpecificityABSTRACT
Abstract Pretermbirth (PTB) is a major obstetric problem associated with high rates of neonatal morbidity and mortality. The prevalence of PTB has not changed in the last decade; thus, the establishment of a screening test and effective treatment are warranted. Transvaginal ultrasoundmeasurement of the cervical length (TUCL) has been proposed as an effective method to screen pregnant women at a higher risk of experiencing PTB. Objective To evaluate the applicability and usefulness of second-trimester TUCL to predict PTB in a cohort of Portuguese pregnant women. Methods Retrospective cross-sectional cohort study including all singleton pregnant women who performed their second-trimester ultrasound (between weeks 18 and 22þ6 days) from January 2013 to October 2017 at Centro Hospitalar Universitário São João. Results Our cohort included 4,481 women. The prevalence of spontaneous PTB was of 4.0%, with 0.7% occurring before the 34th week of gestation. The mean TUCL was of 33.8mm,and percentiles 3, 5 and 10 corresponded toTUCLs of 25.0mm, 27.0mmand 29.0mmrespectively. The multiple logistic regression analysis, including maternal age, previous PTB and cervical surgery showed a significant negative association between TUCL and PTB, with an odds ratio (OR) of 0.92 (95% confidence interval [95%CI]: 0.90-0.95; p<0.001). The use of a TUCL of 20mm is the best cut-off, when compared with the 25-mm cut-off, improving the prediction of risk. Conclusion The present study showed an inverse association between TUCL and PTB, and that the inclusion of other risk factors like maternal age, previous PTB and cervical surgery can improve the screening algorithm. Furthermore, it emphasizes that the TUCL cut-off that defines short cervix can differ according to the population.
Resumo O parto pré-termo (PPT) é uma grande complicação obstétrica que se associa a elevadas taxas de morbimortalidade neonatal. A sua prevalência não tem alterado na última década, sendo esencial determinar uma forma de rastreio e tratamento eficaz. A medição ecográfica transvaginal do comprimento cervical tem sido proposta como um método eficaz de rastreio das grávidas com risco aumentado de PPT. Objetivo Avaliar a aplicabilidade e utilidade da medição ecográfica transvaginal do comprimento cervical na previsão de PPT numa amostra de grávidas portuguesas. Método Estudo de coorte retrospectivo incluindo todas as grávidas com gestação unifetal que realizaram ecografia do 2° trimestre (de 18 a 22semanasþ6 dias) no Centro Hospitalar Universitário de São João entre janeiro de 2013 e outubro de 2017. Resultados A nossa amostra incluiu 4.481 mulheres. A prevalência de PPT espontâneo foi de 4,0%, sendo que 0,7% ocorreu antes das 34 semanas de gestação. A média do comprimento cervical por ecografia transvaginal foi 33,8mm, e os percentis 3, 5 e 10 da amostra corresponderam a comprimentos cervicais de 25,0mm, 27,0mm e 29,0mm, respetivamente. A regressão logística múltipla, que incluiu a idade materna, PPT anterior e antecedentes de conização, demonstrou uma associação estatisticamente significativa entre o comprimento cervical e o risco de PPT, com um risco relativo de 0,92 (intervalo de confiança de 95% [IC95%]: 0.90-0.95; p<0.001). A utilização de um valor de referência de comprimento cervical de 20mm, quando comparado com o valor de referência de 25 mm, melhora a previsão do risco de PPT. Conclusão Este estudo demostra uma associação entre o comprimento cervical avaliado por ecografia tranasvaginal e o risco de PPT, e salienta que a inclusão de outros fatores de risco, como idade materna, PPT anterior e antecedentes de conização podem melhorar o algoritmo de rastreio. Realça ainda que o valor de comprimento cervical utilizado para definir "colo curto" varia de acordo com a população em estudo.
Subject(s)
Humans , Female , Pregnancy , Adult , Cervix Uteri/diagnostic imaging , Premature Birth , Cervical Length Measurement , Portugal , Pregnancy Trimester, Second , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Maternal Age , Tertiary Care CentersABSTRACT
A prematuridade é uma síndrome com múltiplos fatores de risco e cuja causa permanece desconhecida, mas, independentemente da etiologia, a parturição converge para uma via final comum de esvaecimento, dilatação e encurtamento do colo uterino. Do ponto de vista hormonal, o responsável por esse processo é a progesterona. A prevenção de quadros de prematuridade pode basear-se em tratamentos medicamentosos como a administração diária de comprimidos de progesterona; intervenções cirúrgicas para a contenção da cérvice uterina com fios inabsorvíveis mantidos até o termo, a cerclagem cervical; e o pessário cervical, dispositivo de silicone que envolve e inclina o colo uterino, evitando sua abertura. Para propor qualquer intervenção profilática ou terapêutica, a avaliação ultrassonográfica via transvaginal no segundo trimestre gestacional desempenha papel crucial. Apresentamos neste terceiro e último artigo da série sobre parto pré-termo espontâneo as intervenções terapêuticas e o rastreamento do colo uterino.(AU)
Preterm birth is a syndrome with multiple risk factors, with unknown etiology. Parturition converges to a final path with uterine cervix effacement, dilation and shortening and progesterone is the hormone responsible for this process. Preterm birth prevention relies on daily administration of progesterone pills; cerclage as a surgical intervention; or cervical pessary, a vaginal silicone device that enfolds and deflects the cervix, avoiding its opening. To propose any of these interventions it is crucial to evaluate the cervix during the second trimester by transvaginal ultrasound. Here, in the third and last article regarding preterm birth without membrane disruption, we present therapeutic interventions and ultrasound screening.(AU)
Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Cervix Uteri/physiology , Obstetric Labor, Premature/surgery , Obstetric Labor, Premature/prevention & control , Obstetric Labor, Premature/drug therapy , Pessaries , Progesterone/therapeutic use , Uterine Cervical Incompetence , Ultrasonography, Prenatal , Cervical Ripening , Cerclage, Cervical , Cervical Length MeasurementABSTRACT
RESUMEN Objetivo : Comparar el ángulo uterocervical con la longitud cervical en la predicción de parto pretérmino inminente en pacientes sintomáticas. Diseño : Estudio de casos-controles. Institución. Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela. Participantes : Pacientes con parto pretérmino en los siguientes 7 días (grupo A) y embarazadas con parto pretérmino más allá de los 7 días (grupo B). Métodos : Al momento del diagnóstico, las pacientes fueron evaluadas utilizando ecografía transvaginal y fueron seguidas hasta el parto. Principales medidas de resultado: Características generales, ángulo uterocervical, longitud cervical, parto pretérmino inminente y eficacia pronóstica. Resultados : Se incluyó 326 pacientes: 75 mujeres presentaron parto pretérmino inminente (grupo A) y 251 pacientes fueron consideradas como controles (grupo B). Las pacientes del grupo A presentaron valores significativamente más altos del ángulo uterocervical y más bajos de longitud cervical comparado con las pacientes del grupo B (p < 0,0001). El ángulo uterocervical mostró un valor de área bajo la curva de 0,864, mientras que el valor del área bajo la curva de la longitud cervical fue 0,985. La diferencia de la capacidad de discriminación entre las áreas bajo la curva de cada prueba fue significativa (p < 0,0001). Conclusión : El ángulo uterocervical no es superior a la longitud cervical en la predicción de parto pretérmino inminente en pacientes sintomáticas.
ABSTRACT Objective: To compare the uterocervical angle with the cervical length in the prediction of impending preterm delivery in symptomatic patients. Design: Case-control study. Institution: Central Hospital "Dr. Urquinaona", Maracaibo, Venezuela. Participants: Patients with preterm delivery within 7 days (group A) and pregnant women with preterm delivery beyond 7 days (group B). Methods: At the time of diagnosis, the patients were evaluated using transvaginal ultrasound and were followed until delivery. Main outcome measures: General characteristics, uterocervical angle, cervical length, impending preterm delivery, and prognostic efficacy. Results: 326 patients were included, 75 women presented impending preterm delivery (group A) and 251 patients were considered as controls (group B). The patients in group A had significantly higher values of the uterocervical angle and lower cervical length compared to the patients in group B (p <0.0001). The uterocervical angle showed an area under the curve of 0.864, while the value of the area under the curve of cervical length was 0.985. The difference in the discrimination ability between the areas under the curve of each test was significant (p <0.0001). Conclusion: The uterocervical angle is not greater than the cervical length in predicting impending preterm delivery in symptomatic patients.
ABSTRACT
Cerca de 15 milhões de prematuros nascem por ano globalmente. Em 2015 ocorreram mais de 4 milhões de mortes de crianças menores de 5 anos, e as complicações da prematuridade são a principal causa de óbito em neonatos. O parto pré-termo é uma síndrome em que múltiplas etiologias convergem para uma via final única, e os fatores de risco mais importantes são antecedente de prematuridade e gestação gemelar. O colo uterino tem a função de manter a gestação desde a concepção até o parto, e seu processo de amadurecimento gera esvaecimento, dilatação e encurtamento, num continuum que pode compreender desde quadros de insuficiência cervical até o parto pré-termo espontâneo sem rotura de membranas. Este primeiro artigo, da série de três, descreve a prevalência da prematuridade, seus fatores de risco e o papel do colo uterino no processo de parturição.(AU)
Around 15 million preterm births happen globally. In 2015 over 4 million deaths in children under 5 years of age died and preterm birth complications is the leading cause in neonates. Preterm birth is a multiple etiology syndrome, in which various causes converge to a single parturition path. The most important risk factors are multiple gestation and obstetrical history of preterm birth. Uterine cervix is responsible for pregnancy maintenance from conception to birth, and its remodeling process generates effacement, dilation and shortening in a continuum that comprises conditions from cervical insufficiency to preterm birth without membrane disruption. This is a first article, of a series of three, describing preterm birth prevalence, risk factors and uterine cervix role in parturition.(AU)
Subject(s)
Humans , Female , Pregnancy , Obstetric Labor, Premature , Obstetric Labor, Premature/diagnostic imaging , Uterine Cervical Incompetence/diagnostic imaging , Risk Factors , Databases, Bibliographic , Ultrasonography, Prenatal/methods , Cervical Ripening , Cervical Length Measurement/methodsABSTRACT
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 ≥ 15mm and< 25mm(n= 68), the Very Short Cervix group for cervical lengths< 15mm (n = 18) and the Control group, composed of 162 pregnant women with uterine cervical lengths ≥ 25mm. 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.
Resumo Objetivo O objetivo do presente estudo foi comparar a história obstétrica e os parâmetros bi- e tridimensionais ultrassonográficos de acordo com os diferentes comprimentos cervicais. Métodos O presente estudo transversal analisou 248 gestantes no segundo trimestre de acordo com o comprimento cervical e comparou os dados com a história obstétrica e os parâmetros ultrassonográficos 2D/3D. As pacientes foram divididas em 3 grupos de acordo com o comprimento do colo uterino: grupo Colo Curto para comprimentos cervicais ≥ 15mm e < 25mm (n = 68), grupo Colo Muito Curto para comprimentos cervicais < 15mm (n = 18) e grupo Controle, composto por 162 gestantes com comprimento cervical uterino ≥ 25 mm. Resultados Ao analisar a história obstétrica apenas de pacientes não nulíparas, foi relatadauma associação significativa entre a presença de colo uterino curto na gravidez atual e pelo menos um episódio de parto prematuro anterior (p = 0,021). Comprimento e volume do colo uterino foram correlacionados positivamente (coeficiente de Pearson = 0,587, p < 0,0001). O parâmetro índice de fluxo (IF) da vascularização cervical foi significativamente diferente entre os grupos Controle e Colo Muito Curto. Entretanto, após regressão linear, na presença de informações de volume, não encontramos associação entre os grupos e o parâmetro IF. Também não foi encontrada relação entre o Doppler da artéria uterina e o encurtamento cervical. Conclusão O presente estudo mostrou uma associação significativa entre a presença de colo uterino curto na gravidez atual e pelo menos um episódio de parto prematuro anterior. Nenhum dos índices de vascularização se correlaciona com o comprimento cervical como parâmetro independente, assim como o Doppler da artéria uterina também não está relacionado ao comprimento do colo uterino.
Subject(s)
Humans , Female , Adolescent , Adult , Young Adult , Parity/physiology , Pregnancy Trimester, Second/physiology , Ultrasonography, Doppler , Imaging, Three-Dimensional , Cervical Length Measurement/statistics & numerical data , Cervix Uteri/diagnostic imaging , Cross-Sectional StudiesABSTRACT
O encurtamento do colo uterino é parte da via final comum da parturição seja a termo ou pré-termo. A identificação precoce do comprimento cervical encurtado ao ultrassom transvaginal no segundo trimestre gestacional pode atuar como preditor de risco de prematuridade. Desde a década de 1990, vários estudiosos dedicaram-se a estabelecer parâmetros de referência para as medidas de colo uterino entre 16 e 24 semanas e até hoje o limite mais consensualmente aceito é de 25 mm. Especialistas são favoráveis à triagem universal, mas diretrizes internacionais são controversas quanto à investigação em casos sem antecedente de parto pré-termo, além de diversos estudos apresentarem que há custo-efetividade no rastreamento universal. Neste artigo, discutimos criticamente os parâmetros apresentados por estudos históricos e balizadores de conduta, a custo-efetividade e os guidelines internacionais. Propomos ainda uma reflexão ao pré-natalista, sugerindo a individualização da conduta perante os dados de cada gestante específica.(AU)
Cervical shortening is the final path of parturition, regardless if it is term or preterm. Precocious identification of a shortened cervix by transvaginal ultrasound during the second gestational trimester can act as a risk predictor of prematurity. Since the 1990´s decade, numerous studies established reference ranges for cervical length measurement between 16 to 24 gestational weeks and the most accepted cutoff limit is 25 mm. Experts indicate universal screening, however international guidelines are controversial, even in cases without a history of preterm birth, furthermore, many studies demonstrated cost-effectiveness about the universal screening of cervical length in middle gestation. In this article we discuss historical reference ranges, cost- -effectiveness, and international guidelines. We propose critical thinking and suggest individualized management according to specific characteristics of each patient.(AU)
Subject(s)
Humans , Female , Pregnancy , Uterine Cervical Incompetence/diagnostic imaging , Cervical Length Measurement/methods , Obstetric Labor, Premature/prevention & control , Databases, Bibliographic , Ultrasonography, Prenatal/methods , Risk Assessment , Pregnancy, High-Risk , Cervical Ripening/physiologyABSTRACT
RESUMEN Fundamento: La amenaza de parto pretérmino es una situación que requiere de una prueba útil y objetiva para descartar o confirmar el diagnóstico de sospecha. Objetivos: evaluar la cervicometría menor o igual a 30 mm como predictor de parto pretérmino en mujeres embarazadas peruanas con dicho riesgo. Métodos: estudio descriptivo, que incluyó a 100 mujeres con diagnóstico de amenaza de parto pretérmino, atendidas en el Hospital Víctor Lazarte Echegaray, Perú. Se formaron dos grupos según el factor de exposición: 50 mujeres con cervicometría≤ 30 mm y otras 50 con cervicometría> 30 mm, para evaluar la ocurrencia o no del parto pretérmino. Se aplicó análisis bivariado y multivariado con un valor de p <0,05; y se calcularon valores de sensibilidad, especificidad y valores predictivos. Resultados: la frecuencia de parto pretérmino fue del 46 %. Existieron diferencias entre los grupos respecto a la ocurrencia de parto pretérmino y el parto en los siete días siguientes al ingreso. Los factores de riesgo detectados fueron: antecedente de parto pretérmino (RR= 1,48; IC95%:1,13-1,95) y cervicometría≤ 30mm (RR= 3,81; IC95%: 2,06-7,04). La cervicometría ≤ 30 mm presentó sensibilidad de 80,43 % y especificidad de 75,93 %. Conclusión: La cervicometría ≤ 30mm es un factor de riesgo de parto pretérmino en mujeres con amenaza de parto pretérmino; y puede ser usada como una prueba discriminatoria en aquellas con esta condición, independientemente de presentar antecedente de un evento similar.
ABSTRACT Foundation: The threat of preterm birth is a situation that requires a useful and objective test to rule out or confirm the suspected diagnosis. Objectives: to evaluate cervicometry less than or equal to 30 mm as a predictor of preterm birth in Peruvian pregnant women with this risk. Method: a descriptive study, which included 100 women diagnosed with a threat of preterm birth, treated at the Víctor Lazarte Echegaray Hospital, Peru. They were grouped according to the exposure factor: 50 women with cervicometry ≤ 30 mm and another 50 with cervicometry> 30 mm, to assess the occurrence or not of preterm labor. Bivariate and multivariate analysis with a value of p <0.05 was applied; and sensitivity, specificity and predictive values were calculated. Results: the frequency of preterm birth was 46%. There were differences between the groups regarding the occurrence of preterm birth and delivery within seven days of admission. The risk factors detected were: history of preterm birth (RR = 1.48; 95% CI: 1.13-1.95) and cervicometry ≤ 30mm (RR = 3.81; 95% CI: 2.06-7.04). Cervicometry ≤ 30 mm showed sensitivity of 80.43% and specificity of 75.93%. Conclusion: Cervicometry ≤ 30mm is a risk factor for preterm birth in women with this threat; and it can be used as a discriminatory test in those with this condition, regardless of presenting a history of a similar event.
ABSTRACT
ABSTRACT Objective : To establish the prognostic usefulness of cervical length and uterine artery pulsatility index for imminent preterm delivery in symptomatic patients. Design : Case-control study. Setting: Central Hospital "Dr. Urquinaona ", Maracaibo, Venezuela. Participants : Patients with preterm delivery within 7 days (group A) and pregnant women with preterm delivery within more than 7 days (group B). Methods : Cervical length and uterine artery pulsatility index were determined at hospital admission and all were followed until delivery. Main outcome measures: General characteristics, cervical length, uterine artery pulsatility index, imminent preterm delivery, and prognostic efficacy. Results : 119 participants were assigned to group A and 362 patients to group B. Cervical length was lower in group A, and the uterine artery pulsatility index was higher compared with group B (p <0.0001). Cervical length showed an area under the curve of 0.972, while the uterine artery pulsatility index presented an area under the curve of 0.843. The difference between the two measurements was significantly different between groups A and B (p <0.001). Combination of both measurements showed a significantly lower value in prediction capacity (0.987) compared with both measurements individually (p <0.0001). Conclusion : The combined use of cervical length and pulsatility index of the uterine artery was useful in the prediction of imminent preterm delivery in symptomatic patients.
RESUMEN Objetivo . Establecer la utilidad pronóstica de la longitud cervical e índice de pulsatilidad de la arteria uterina en el parto pretérmino inminente en pacientes sintomáticas. Diseño . Estudio de casos-controles. Institución. Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela. Participantes . Pacientes con parto pretérmino en los siguientes 7 días (grupo A) y embarazadas con parto pretérmino más allá de los 7 días (grupo B). Métodos . Las mediciones de la longitud cervical e índice de pulsatilidad de la arteria uterina se realizaron al ingreso de las gestantes al hospital y todas fueron seguidas hasta el parto. Principales medidas de resultado. Características generales, longitud cervical, índice de pulsatilidad de la arteria uterina, parto pretérmino inminente y eficacia pronóstica. Resultados . 119 participantes fueron asignadas al grupo A y 362 pacientes al grupo B. La longitud cervical fue menor en el grupo A, mientras que el índice de pulsatilidad de la arteria uterina fue mayor comparado con el grupo B (p < 0,0001). La medición de la longitud cervical presentó un valor de área bajo la curva de 0,972, mientras que el índice de pulsatilidad de la arteria uterina mostró un área bajo la curva de 0,843. La diferencia de la diferencia entre ambas mediciones se consideró estadísticamente significativa (p < 0,001). La combinación de ambas mediciones tuvo un valor bajo la curva significativamente superior en capacidad de predicción (0,987) comparada con ambas mediciones en forma individual (p < 0,0001). Conclusión . El uso combinado de las mediciones de la longitud cervical y el índice de pulsatilidad de la arteria uterina resultó útil en la predicción de parto pretérmino inminente en pacientes sintomáticas.
ABSTRACT
Objective: To explore the relationship of cervical length (CL), morphology and maternal adverse outcomes in placenta praevia patients on the third trimester of pregnancy. Methods: Ultrasonic and clinical data of 84 singleton pregnancies confirmed as placenta praevia with cesarean section were retrospectively analyzed, including 20 cases with placenta accreta and 27 with massive hemorrhage. Taken 30 mm as the cut-off value of CL, the patients were divided into study group (CL≤30 mm, n=21) and control group (CL>30 mm, n=63).Then the relationship of CL, placenta praevia and massive hemorrhage during cesarean section were investigated. Results: CL was (26.9±2.9)mm in study group, lower than that in control group ([38.5±3.4]mm, P<0.001). The probability of placenta accreta and massive hemorrhage increased in patients with CL≤30 mm, cervical morphological incompleteness and cervical sinus (P<0.1), and CL≤30 mm was a risk factor for placental accreta. Taken CL=35.05 mm as the cut-off value, the best prediction of placental accrete and massive hemorrhage were obtained, with the sensitivity, specificity and AUC of the former was 81.3%, 90.0% and 0.890 (95%CI[0.813,0.967]), of the latter was 82.5%,74.1% and 0.814 (95%CI[0.717,0.912]), respectively. Conclusion: Cervical shortening (CL≤35.05 mm), cervical morphological incompleteness and cervical sinus on the third trimester are related to placenta accreta and massive hemorrhage during cesarean section, which might be used to evaluate placenta praevia and guiding adjustment of treatment plan.
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Objetivo: Avaliar a medida ultrassonográfica do colo uterino e os níveis séricos maternos (colesterol total e frações, triglicérides e arginina dimetil assimétrica), isolados ou em associação, como preditores de parto pré-termo. Métodos: Trata-se de um estudo longitudinal, prospectivo, de correlação entre variáveis bioquímicas e medida ultrassonográfica do colo com a idade gestacional do parto (< ou ≥ 37 semanas). Entre 2015 e 2016, foram avaliadas 145 gestantes portadoras de fatores de risco para parto pré-termo, entre 20 e 24 semanas de gestação, através da medida ultrassonográfica do colo uterino e dos níveis séricos dos biomarcadores. Foram excluídas as gestantes com idade inferior a 18 anos, as que utilizaram progesterona como prevenção de um possível parto prétermo e os casos de prematuridade terapêutica. Este estudo foi aprovado pelo Comitê de Ética e Pesquisa da UFMG (CAAE: 51489715.6.0000.5149). Foi realizada análise de correlação entre os biomarcadores e a medida do colo pelo teste de correlação de Spearman. A curva ROC foi utilizada para determinar a acurácia das variáveis. Foram calculadas sensibilidade e especificidade para a variável que foi considerada preditiva para parto pré-termo, com diferentes pontos de corte. Toda a análise considerou o nível de significância de 0,05, e o software utilizado foi o SPSS versão 20.0. Resultados: Apenas a medida ultrassonográfica do colo apresentou significância estatística como um preditor de parto pré-termo (AUC curva de ROC 0,698 - IC 0,540; 0,856). Colesterol total, HDL, fração não HDL, triglicérides e ADMA apresentaram baixos valores de área sob a curva ROC. Conclusão: A medida ultrassonográfica do colo uterino menor que 2,5 cm entre 20 e 24 semanas de gestação associa-se com a ocorrência de parto pré-termo em gestantes de risco, com especificidade de 98%. Os biomarcadores analisados, isolados ou em associação com a medida do colo, não apresentaram correlação.
Objective: To evaluate the measurement of uterine cervix and maternal serum levels of total cholesterol and fractions, triglycerides and asymmetric arginine di-methyl (ADMA), isolated or in association, as predictors of preterm delivery. Methods: This longitudinal, prospective study of correlation among variables and gestational age at birth (
Subject(s)
Risk Assessment , Premature Birth , Cervical Length Measurement , Cervix Uteri , Ultrasonography , Academic DissertationABSTRACT
Background: Preterm labor is a potential cause of preterm birth. Certain demographic and presenting features in pregnant women may correlate to the severity of the problem and progression to delivery. The aim of the study was to find out the clinical profile and fetal outcome in women with preterm labor pains in a tertiary care hospital of North India.Methods: 83 women with preterm labor were included in the study. Antenatal corticosteroids and tocolytic therapy were given. Women who delivered preterm comprised of Group A and who delivered at term were Group B. Clinical profile and fetal outcome was compared and statistically analyzed.Results: 39 (47.0%) women had preterm delivery (Group A) and 44 (53.0%) women delivered at term (Group B). 23.1% women in group A and 4.5% in group B had a previous preterm birth (p=0.021). 16 (41%) women in group A and 4 (9.1%) in group B had a positive microbial growth on high vaginal swab (p=0.001). The odds of having a preterm birth with cervical length of <2 cm was calculated to be 5.281 (p=0.000). A statistically significant difference was observed in the mean birth weight, Apgar score and nursery admissions in both the groups (p=0.000).Conclusions: A prior history of preterm birth, a positive growth on high vaginal swab and a cervical length of less than 2 cm were found to be significantly associated with preterm birth.