Effect of cervical cerclage on uterine artery doppler parameters and small for gestational age births

Objective To study the role of prophylactic cervical cerclage in pregnancy outcomes after cold knife conization (CKC). Methods From January 2009 to August 2013, a total of 62 cases of pregnant women who underwent routine gestational examination and delivered in Beijing Obstetrics and Gynecology Hospital, Capital Medical University were selected as research subjects. All the 62 cases of pregnant women received CKC treatment before pregnancy. According to whether the pregnant women received prophylactic cervical cerclage or not after CKC, they were divided into prophylactic cervical cerclage group (n=14) and without prophylactic cervical cerclage group (n=48). The basic clinical data, delivery conditions and perinatal maternal and neonatal complications of both two groups were collected by retrospective method and analyzed by statistical methods. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Results ①There were no statistical differences between two groups in age, gravidity, parity, assisted reproduction, adverse pregnancy history, the duration of CKC treatment to this pregnancy, complication of chronic diseases, uterine fibroids and scarred uterus (P>0.05). ②Among the 62 cases of pregnant women who received CKC treatment before pregnancy, the successful delivery rate was 95.2% (59/62), and the cesarean section delivery rate was 88.1% (52/59), 15.3% (9/59) pregnant women tried vaginal delivery first, and at last the vaginal delivery rate was 11.9% (7/59), the successful vaginal delivery rate was 77.8%(7/9). ③There were no statistical differences between two groups in gestational age of delivery, cesarean section rate, vaginal delivery rate and rate of vaginal delivery trial (P>0.05). The rate of spontaneous abortion during second trimester in prophylactic cervical cerclage group was 21.4% (3/14) which was statistically higher than that in without prophylactic cervical cerclage group (0, 0/48), and the difference was statistically significant (P=0.010). ④There were no statistical differences between two groups in the incidences arrested labor, premature rupture of membrane, abnormal amniotic fluid, premature infants, intra-uterine asphyxia, anomaly of placenta, postpartum hemorrhage, cervical laceration, postnatal infection, small for gestation age infant and low birth weight infant (P>0.05). The incidences of premature infants and preterm premature rupture of the membranes in prophylactic cervical cerclage group were 36.4% (4/11) and 18.2% (2/11), respectively, and they were three times higher than those in without prophylactic cervical cerclage group which were 10.4% and 4.2%, respectively. Conclusions Prophylactic cervical cerclage could not improve the pregnancy outcomes of pregnant women after CKC, and may improve the risk of spontaneous abortion during second trimester instead, and the incidences of premature delivery and preterm premature rupture of the membranes. So as to the woman of childbearing age who has a birth plan, routine prophylactic cervical cerclage may not be recommended after CKC treatment. As the sample size in this study is small, the roles of prophylactic cervical cerclage on pregnancy outcomes in pregnant women after CKC remains to be confirmed by further studies. Key words: Cold knife conization; Cerclage, cervical; Pregnancy outcome

Background This study aimed (i) to assess the potential effect of placental location on uterine artery (UtA) pulsatility index (PI) and offspring birthweight (BW), and (ii) to examine the potential association of unilaterally increased UtA PI with preeclampsia (PE) or low BW. Materials and methods This was an asynchronous cohort study of singleton pregnancies between 20+0 and 23+6 gestational weeks resulting in live birth, for whom the placental site (posterior, anterior, fundal, previa, right lateral, or left lateral) and bilateral UtA PI measurements were recorded. The effect of placental location on mean BW and UtA mean PI z-scores was assessed using t-test or ANOVA and post-hoc tests, as appropriate. The UtA PI measurements were then grouped into three categories (normal mean PI; unilaterally increased PI with normal mean; increased mean PI) and we calculated the odds ratios (ORs) of unilaterally increased or increased mean PI vs. normal mean PI for PE, BW <10th centile and BW <5th centile. The independent association of placental location, UtA PI category (normal mean, unilateral increase with normal mean, increased mean PI) and UtA PI z-score with PE, BW <10th centile and BW <5th centile was then assessed using logistic regression. Results The analysis included 5506 pregnancies. A lateral placenta was associated with higher mean PI z-score (p = .0001) and lower BW (p = .003) than non-lateral placenta. Compared with normal mean UtA PI, a unilaterally increased PI with a normal mean was associated with increased risk for PE (OR 4.3, 95%CI 1.9–9.7), BW <10th centile (OR 1.7, 95%CI 1.3–2.4) and BW <5th centile (OR 1.8, 95%CI 1.1–2.9). Similarly, increased mean UtA PI was also associated with increased risk for PE, BW <10th and BW <5th centile (OR 9.1, 95%CI 4.8–17.3; OR 4.4, 95%CI 3.5–5.7; OR 7.0, 95%CI 5.1–9.6, respectively). When assessing the independent association of placental location and UtA PI with PE and low BW, only mean UtA PI remains a significant predictor. Conclusions A lateral placenta is associated with a higher mean UtA PI and lower BW. Unilaterally increased UtA PI still carries a greater risk of PE and low BW than bilaterally normal PI, however this effect appears to be eventually mediated through mean UtA PI z-score, which is relatively increased in these cases.

Objective Marijuana (MJ) use is associated with adverse effects on fetal growth. We aimed to investigate the timing of suboptimal fetal growth onset in MJ-exposed pregnancies. In addition, we aimed to explore the relationship between MJ-exposure and both abnormal uterine artery (UtA) Doppler parameters and small for gestational age (SGA). Study design This was a secondary analysis of a prospective multicenter cohort that enrolled nulliparous individuals delivering non-anomalous fetuses beyond 20 weeks’ gestation. Marijuana exposure was ascertained by self-report or clinical urine toxicology testing. Ultrasound estimated fetal weights (EFWs) were assessed in participants at both 16w0d–21w6d and 22w0d–29w6d. EFWs and birth weight (BW) were converted to weight percentiles (wPCT). EFW and BW wPCTs were calculated using population-based standards. Additionally, a customized standard designed to be applicable to both EFWs and BWs within the same model was also used to allow for EFW to BW percentile trajectories. The primary outcome, longitudinal wPCT, was compared between individuals with and without MJ use in a linear mixed-effects regression model adjusting for tobacco. For modeling, wPCT was smoothed across gestational age; MJ was estimated as an intercept and linear difference in the slope of gestational age. UtA Doppler notching, resistance index (RI), and pulsatility index (PI) at 16w0d–21w6d were compared using t-test and χ 2. SGA at delivery was also compared. Results Nine thousand one hundred and sixty-three individuals met inclusion criteria; 136 (1.5%) used MJ during pregnancy. Individuals who used MJ were more likely to be younger, identify as non-Hispanic Black, and have had less education. Fetuses exposed to MJ had lower wPCT beginning at 28 weeks using population-based and customized standards, when compared to those without exposure. UtA notching, PI, and RI were similar between groups. SGA was more frequent in neonates exposed to MJ using both population-based (22 vs. 9%, p<.001) and customized (25 vs. 14%, p<.001) curves. Conclusions MJ-exposed fetuses were estimated to be smaller than unexposed fetuses starting at 28 weeks’ gestation across both growth standards without a difference in UtA Doppler parameters.

361. Effectiveness of cervical cerclage in twin pregnancies

Cervical stitch (cerclage) in combination with other treatments for preventing spontaneous preterm birth in singleton pregnancies.

Background: The effectiveness of cervical cerclage (CC) in mothers suffering cervical incompetence (CI) for preventing preterm birth (PTB) in twin gestations remains controversial. Some studies show that it plays a preventive role in the occurrence of PTB, while others suggest it is ineffective. Objectives: Our aim was to evaluate the effectiveness of CC in preventing PTB and negative neonatal outcome (e.g., respiratory distress syndrome (RDS) and birth weight) based on a new statistical framework: multilevel analysis and propensity score matching (PSM) in twin pregnancies. Methods: A cross-sectional study was conducted in the maternity wards of three general and teaching hospitals in Tehran, Iran, during January 2014 to February 2015. Using stratified random sampling with the proportional allocation method, twin pregnancies were randomly selected from the medical files list. Of 431 eligible individuals, 31 patients underwent CC as a result of CI, and the others had healthy cervixes and no CC. Next, variables that confound the relationships between CC and PTB (e.g., assisted reproductive technology (ART), preterm rupture of membrane (PROM), nulliparous, history of abortion, and mother’s age) by applying 1:2 PSM were matched in both groups. The CC group was considered the case group and, based on PSM, 61 patients, whose characteristics were similar to the CC group, were selected from 400 healthy mothers as a control group. For considering twins dependencies, multilevel modeling was used, and prevalence of PTB, LBW, and RDS, as well as mean gestational age in the two groups, were compared. Results: The standardized mean difference (SMD) shows that the distribution of confounding variables in the propensity-matched data is the same in both groups. Results revealed that, although gestational age in the case group was significantly less than the control group, the prevalence of PTB in case and control was not significantly different (P = 0.190). The prevalence of neonatal outcome of RDS and LBW in the case and control groups was not significant (P > 0.05). Conclusions: It appears that CC has an effective role in prevention of PTB, LBW, and RDS, because their prevalence in both groups was the same. However, drawing a clear conclusion regarding its role requires more research with a random clinical trial (RCT) design.

Alterations in maternal cardiovascular parameters and their impact on uterine and fetal circulation in hypertensive pregnancies and fetal growth restriction

Objective: To explore the clinical efficacy of three different surgical timings of modified cervical cerclage in twin pregnant women with cervical insufficiency. Methods: The clinical data of 73 twin pregnant women who underwent modified cervical cerclage and had pregnancy outcomes in Qilu Hospital of Shandong University (Qingdao) from April 2014 to July 2023 were retrospectively analyzed. According to the different timings of surgery, they were divided into prophylactic cerclage group, ultrasound-indicated cerclage group (further divided into cervical length (CL)≤15 mm and 15 mm<CL<25 mm subgroups) and emergency cerclage group. The differences in pregnancy and neonatal outcomes among the three groups were compared. The clinical data and pregnancy outcomes of pregnant women delivered at <34 weeks and ≥34 weeks were compared, and multivariate logistic regression was used to analyze the influencing factors of preterm birth before 34 weeks. Results: (1) The prolonged gestational age and postoperative CL in the prophylactic cerclage group were longer than those in the ultrasound-indicated cerclage group; the gestational age at delivery, prolonged gestational age, postoperative CL, live birth rate and neonatal birth weight in the prophylactic cerclage group were higher than those in the ultrasound-indicated cerclage group, and the preterm birth rate before 34, 32 and 28 weeks of gestation and premature rupture of membranes were lower than those in the emergency cerclage group; the gestational age of delivery, prolonged gestational age, postoperative CL, live birth rate and the rate of neonatal birth weight of the pregnant women in the ultrasound-indicated cerclage group were higher than those in the emergency cerclage group, and the rate of premature birth before 34, 32 and 28 weeks of gestation and late neonatal birth weight <1 500 g were lower than those in the emergency cerclage group; the differences were statistically significant (all P<0.05). (2) The gestational age and postoperative CL in the 15 mm<CL<25 mm group were longer than those in the CL≤15 mm group, and the gestational age at delivery and neonatal birth weight in the CL≤15 mm group were higher than those in the emergency cerclage group. The incidence of preterm birth before 32 weeks of gestation and birth weight <1 500 g in the cervical dilatation group were significantly lower than those in the emergency cerclage group (all P<0.05). (3) The incidence of abnormal cervicovaginal discharge and postoperative C-reactive protein (CRP) level of pregnant women with delivery gestational age <34 weeks were significantly higher than those of pregnant women with delivery gestational age ≥34 weeks, while preoperative CL and postoperative CL were significantly shorter than those of pregnant women with delivery gestational age ≥34 weeks (all P<0.05). Multivariate logistic regression analysis showed that postoperative CRP>10 mg/L was a risk factor for preterm birth before 34 weeks of gestation (OR=5.230, 95%CI: 1.616-16.929; P=0.006). Conclusions: In twin pregnant women with cervical insufficiency, prophylactic cerclage has the same surgical effect as ultrasound-indicated cerclage, while both prophylactic cerclage and ultrasound-indicated cerclage could significantly improve maternal and fetal outcomes compared with emergency cerclage. Twin pregnancies with CL≤15 mm might benefit from cervical cerclage. Postoperative CRP>10 mg/L is an independent risk factor for preterm birth before 34 weeks of gestation.

Cervical cerclage is widely used to reduce the risk of preterm birth in pregnant women. The effects of cervical cerclage on the vaginal microbiota and its metabolites are not fully clear. The purpose of this study was to explore the influence of cervical cerclage on the vaginal microbiota and its metabolites. Our results showed that the clinical characteristics [white blood cell (WBC), neutrophil, lymphocyte, monocytes, platelet, NLR, PLR, SII, SIRI, and C-reactive protein (CRP)] and α-diversity (Observed, Shannon, Chao1, and Simpson indexes) of the vaginal microbiota were not altered during pregnancy after cervical cerclage. 16S rRNA gene sequencing found that the relative abundance of Muribaculaceae and Blautia was significantly increased in the post-cerclage group compared with the pre-cerclage group, but the relative abundance of Sneathia was significantly reduced. In addition, the volcano plot revealed that a total of 19 metabolites [including alpha-hydroxyalprazolam, LPE (18:1(9Z)/0:0), PS(16:0/15:0), N-acetylhistamine, carnitine, pseudouridine, and allopregnanolone] were significantly changed during pregnancy after cervical cerclage. Pathway analysis based on the Kyoto Encyclopedia of Genes and Genomes (KEGG) database showed that the changes in the vaginal microbiota and its metabolites mainly involved purine metabolism and amino acid metabolism. The alteration in the vaginal microbiota and its metabolites induced by cervical cerclage is associated with the therapeutic efficacy of cervical cerclage. Further studies are needed to explore how the vaginal microbiota affects the outcomes of pregnancy.

299-POS

ObjectiveThis study aimed to evaluate the predictive efficacy of combining serum soluble fms-like tyrosine kinase-1/placental growth factor (sFlt-1/PlGF) ratio with uterine artery Doppler ultrasound for early-onset preeclampsia (PE) before 34 weeks’ gestation.MethodsA retrospective cohort analysis was conducted on 148 singleton pregnancies (control group: n = 76; early-onset PE group: n = 72) who delivered at our institution between July 2023 and June 2024. At 24–28 weeks, serum sFlt-1 and PlGF levels were quantified via electrochemiluminescence immunoassay (Roche Elecsys®), and uterine artery pulsatility index (PI), resistance index (RI), and systolic/diastolic ratio (S/D) were measured by Doppler ultrasound (M22 system, standardized settings). Logistic regression and receiver operating characteristic (ROC) curves assessed predictive performance.ResultsCompared to controls, PE patients exhibited significantly elevated sFlt-1 (24.02 ± 6.68 vs 16.38 ± 7.47 μg/L; P < 0.001), reduced PlGF (1.22 ± 0.14 vs 1.54 ± 0.30 μg/L; P < 0.001), and higher sFlt-1/PlGF ratio (20.76 ± 7.71 vs 10.11 ± 4.10; P < 0.001). Doppler indices were markedly increased in PE: PI (1.34 ± 0.26 vs 0.82 ± 0.11; P < 0.001), RI (0.78 ± 0.12 vs 0.51 ± 0.07; P < 0.001), and S/D (3.89 ± 0.97 vs 2.11 ± 0.41; P < 0.001). Multivariate analysis confirmed all parameters as independent predictors (P < 0.05), with sFlt-1/PlGF ratio having the highest odds ratio (OR = 1.332, 95% CI: 1.128–1.573). The combined model achieved superior predictive performance: area under curve (AUC)=0.954 (95% CI: 0.92–0.99) vs sFlt-1/PlGF alone (AUC = 0.887; P = 0.003) or PI alone (AUC = 0.821; P < 0.001), with sensitivity 82.2%, specificity 96.7%, and accuracy 94.7%.ConclusionIntegration of sFlt-1/PlGF ratio and uterine artery Doppler parameters (particularly uterine artery PI and RI) significantly enhances early-onset PE prediction, providing a robust tool for clinical risk stratification.

ObjectiveTo assess the maternal demographic characteristics and uterine artery (UA) Doppler parameters at first and second trimesters of pregnancy as predictors for hypertensive disorders (HDs) and adverse perinatal outcomes.MethodsThis prospective cohort study comprised 162 singleton low-risk women undergoing routine antenatal care. The left and right UA were assessed by color and pulsed Doppler and the mean pulsatility and resistance indices as well as the presence of a bilateral protodiastolic notch were recorded at 11 to 14 and 20 to 24 weeks' gestation. Multilevel regression analysis was used to determine the effects of maternal characteristics and abnormal UA Doppler parameters on the incidence of HD, small for gestational age newborn, cesarean section rate, Apgar score <7 at 1st and 5th minute, and admission to the neonatal intensive care unit.ResultsFifteen women (9.2%) developed HD. UA mean resistance index (RI), UA mean pulsatility index, and parity were independent predictors of HD. Compared to the pregnancies with a normal UA mean RI at the first and second trimesters, pregnancies with UA mean RI >95th percentile only at the first trimester showed an increased risk for HD (odds ratio, 23.25; 95% confidence interval, 3.47 to 155.73; P<0.01). Similar result was found for UA mean pulsatility index >95th percentile (odds ratio, 9.84; 95% confidence interval, 1.05 to 92.10; P=0.05). The model including maternal age, maternal and paternal ethnicity, occupation, parity and UA mean RI increased the relative risk for HD (area under receiver operating characteristics, 0.81).ConclusionA first-trimester screening combining maternal characteristics and UA Doppler parameters is useful to predict HD in a low-risk population.

Association of second trimester uterine artery Doppler parameters with maternal hypertension 2–7 years after delivery

Objective:Prophylactic or emergency type cervical cerclage procedures are being used for treatment of cervical insufficiency. The aim was to review and compare the outcomes of these cerclage types and identify factors affecting outcomes.Material and Methods:Retrospective review of seventy-five patients in whom transvaginal cervical cerclage procedures were performed over a seven-year period in a tertiary referral center.Results:Twenty seven of 75 (36%) patients were in the emergency cerclage group and 48 (64%) of them were in the prophylactic group. Mean body mass index (BMI), hospitalization time and gestational week at cerclage were significantly higher, whereas latency period was significantly shorter for the emergency group. Mean gestational ages at delivery were 35.6±4.5 and 33.6±5.9 weeks in the prophylactic and emergency groups, respectively (p=0.117). Delivery rates under 34th gestational week were 20.8% and 37.0% in the prophylactic and emergency groups, respectively (p=0.175). Birthweight, and delivery ≥34th gestational week was higher in the prophylactic group, whereas complication rate was higher in the emergency group, but these differences were not significant. High BMI was associated with more deliveries before 34-week in the prophylactic group. Pre-cerclage cervical length was shorter in patients who delivered before 34 gestational weeks at delivery.Conclusion:Prophylactic and emergency cerclage procedures have comparable results regarding gestational week at delivery. High BMI and low pre-cerclage cervical length may have adverse effects on success of cerclage procedures.

OP 33 Correlation between uterine artery Doppler parameters and sFlt-1/PlGF ratio in different types of hypertensive pregnancy disorders