Second Trimester Cervical Length and Its Association with Vaginal Birth after Cesarean Delivery.

OBJECTIVE: This study aims to evaluate the relationship between cervical length (CL) and trial of labor after cesarean (TOLAC) delivery. STUDY DESIGN: This retrospective cohort study evaluated second trimester CL and likelihood of successful TOLAC. Women undergoing TOLAC from January 2009 to December 2011 who underwent transvaginal ultrasound CL between 18(0/7) to 23(6/7) weeks gestation were included. The threshold for CL was assessed using a receiver operating characteristics curve, with ≥ 45 mm determined to be the optimal threshold. Women with CL < 45 mm were compared with women with CL ≥ 45 mm with respect to TOLAC. Multivariate analysis was used to assess the association of CL with TOLAC. RESULTS: A total of 45 patients met inclusion criteria, 14 (31%) with a long CL (≥ 45 mm) and 31 (69%) with CL < 45 mm. Groups did not differ in demographics or factors predictive of vaginal birth after cesarean (VBAC) delivery. More women with CL < 45 mm had successful VBAC (81%) than women with long CL (43%, relative risk 1.9, p = 0.03). Prior vaginal delivery and CL < 45 mm were both significant predictors of VBAC (odds ratio 1.8 and 2.0, respectively). CONCLUSION: CL < 45 mm is associated with VBAC.

Implementation of a universal cervical length screening program for the prevention of preterm birth.

OBJECTIVE: The objective of this article is to evaluate the implementation and acceptability of a universal cervical length (CL) screening program for prediction and prevention of preterm birth (PTB). STUDY DESIGN: We performed a prospective observational study to evaluate the implementation and acceptability of a universal CL screening program. Between January 1, 2012, and December 31, 2012, women with singleton gestations, without a cerclage or prior spontaneous PTB, were offered transvaginal ultrasound (TVU) for CL between 18(0/7) and 23(6/7) weeks' gestation. Sonographers and medical staff received education before implementation. Intervention for a short CL was interpreted according to a standard protocol. On June 1, 2012, our program was modified from "opt-in" to "opt-out." SPSS 20.0 (released 2011, IBM statistics for Windows version 20, IBM Corp., Armonk, NY) was used for analysis. RESULTS: Over 12 months, 1,484 (87%) of 1,706 eligible women were offered CL screening, and 1,119 (75%) were actually screened. Women were more likely to accept CL screening if they were nulliparous versus multiparous (83 vs. 68%, p < 0.001) and if the sonographer was female versus male (83 vs. 42%, p < 0.001). Implementation of an "opt-out" protocol did not increase the overall number of women accepting CL screening compared with an "opt-in" approach (76 vs. 75%, p = 0.81) CONCLUSION: Universal CL screening can be feasibly implemented and is acceptable to most women.

Predicting adverse neonatal outcomes in fetuses with abdominal wall defects using prenatal risk factors.

OBJECTIVE: The aim of this study was to determine whether prenatal variables can predict adverse neonatal outcomes in fetuses with abdominal wall defects. STUDY DESIGN: A retrospective cohort study that used ultrasound and neonatal records for all cases of gastroschisis and omphalocele seen over a 16-year period. Cases with adverse neonatal outcomes were compared with noncases for multiple candidate predictive factors. Univariable and multivariable statistical methods were used to develop the prediction models, and effectiveness was evaluated using the area under the receiver operating characteristic curve. RESULTS: Of 80 fetuses with gastroschisis, 29 (36%) had the composite adverse outcome, compared with 15 of 33 (47%) live neonates with omphalocele. Intrauterine growth restriction was the only significant variable in gastroschisis, whereas exteriorized liver was the only predictor in omphalocele. The areas under the curve for the prediction models with gastroschisis and omphalocele are 0.67 and 0.74, respectively. CONCLUSION: Intrauterine growth restriction and exteriorization of the liver are significant predictors of adverse neonatal outcome with gastroschisis and omphalocele.