Vaginal examination vs. cervical length - which is superior in predicting preterm birth?

OBJECTIVE: To compare the predictive value of preterm birth (PTB) by transvaginal sonographic cervical length (CL) measurement to digital examination of the cervix (Bishop score - BS), in patients with premature contractions (PC) and intact membranes. DESIGN: A retrospective case-control study. SETTING: Meir Medical Center, Kfar Saba, Israel. POPULATION: Women at 24-34 weeks of gestation who were hospitalized with PC and intact membranes. METHODS: All patients underwent CL and BS measurements upon admission. Power analysis revealed that 375 patients were needed to show a significant difference between the two methods for predicting PTB. Each one served as her own control. MAIN OUTCOME MEASURES: PTB<37 and<34 weeks. RESULTS: Receiver-operator characteristic curve (ROC) and logistic regression analyses indicated a correlation between both shortened CL and increased BS to PTB (P<0.001). Neither test offered an advantage in predicting PTB. Areas under the curve for BS and CL ROC were similar for PTB before 37 weeks gestation (0.611 vs. 0.640, P=0.28). For nulliparous women, CL predicted PTB better that BS (0.642 vs. 0.724, P=0.03). For singleton and multiple pregnancy pregnancies, BS and CL did not differ significantly in predicting PTB (P=0.9, P=0.2, respectively). For nulliparous with multiple pregnancy, the BS and CL ROC curves differ nearly significantly (0.554 vs. 0.709, P=0.07), with better predictive ability for CL. CONCLUSIONS: CL and BS have similar value in predicting PTB in patients with PC. For nulliparous women, CL is superior over the BS.

Impaired synaptogenesis and long-term modulation of behavior following postnatal elevation of GABA levels in mice.

Antiepileptic drugs acting through the potentiation of GABAergic pathways have adverse effects on brain development. Increased risk of impaired intellectual development has been reported in children born to women treated for epilepsy during pregnancy. We have previously shown, in mice, that treatment with the antiepileptic drug vigabatrin (GVG) on postnatal days 4-14 delays reflex development in the newborn and impairs learning and memory in the adult. Here, we report the time course in which postnatal GVG treatment induced behavioral changes in an open field test and had a detrimental developmental effect on recognition memory in mice. Furthermore, GVG treatment significantly modulated the expression of synaptobrevin/vesicle-associated membrane protein (VAMP) II and synaptotagmin (Synt) I. A short-term decrease in the expression of these proteins was followed by a long-term elevation in their expression in both the hippocampus and the cerebral cortex. In contrast, no changes were detected in the levels of Synt II or in the vesicular GABA transporter. The over-expression of VAMP II and Synt I in the GVG-treated mice was associated with a significant decrease in the basal field excitatory postsynaptic potentials (fEPSP) and modulated the response to repeated stimulation. The changes observed in synaptogenesis may explain the behavioral impairment induced by postnatal GVG treatment and may suggest a possible mechanism for the detrimental effect of antiepileptic drugs acting through elevation of GABA levels.