Cervical Length In Patients Research Articles

Comparison between Fetal Fibronectin Versus Ultrasonographic Assessment of The Cervical Length in Patients with Unfavourable Cervix in Prediction of Successful Induction of Labor

Comparison between Fetal Fibronectin Versus Ultrasonographic Assessment of The Cervical Length in Patients with Unfavourable Cervix in Prediction of Successful Induction of Labor

Postpartum cervical length as a predictor of subsequent preterm birth—novel insights on an old enigma

Preterm birth poses one of the biggest challenge in modern obstetrics. Prediction of preterm birth has previously been based on patient history of preterm birth, short cervical length around midtrimester, and additional maternal risk factors. Little is known about cervical length and physiology during the postpartum period and any associations between postpartum cervical features and subsequent preterm birth. This study aimed to determine the feasibility and utility of postpartum cervical length measurements in prediction of subsequent spontaneous preterm birth. This was a prospective cohort study in a single tertiary center, conducted during a 5-year period (2017-2021). We evaluated the mean postpartum cervical length in patients after both preterm birth and term deliveries at 4 time periods: 8, 24, and 48 hours, and 6 weeks postpartum, with follow-up in their subsequent pregnancies to evaluate gestational age at delivery. The mean postpartum cervical length in different populations stratified by gestational age at delivery was assessed in phase 1 of the study, and the gestational age at subsequent delivery was assessed in phase2. A total of 1384 patients participated in phase 1. Mean postpartum cervical length was significantly shorter in the preterm birth (<34 weeks' gestation) group than in the term group at 8 hours (8.4±4.2 vs 22.3±3.5 mm; P<.0001), 24 hours (13.2±3.8 vs 33.2±3.1 mm; P<.0001), and 48 hours (17.9±4.4 vs 40.2±4.2 mm; P<.0001) postpartum. There was no significant difference in mean postpartum cervical length between the preterm birth group and the term group at 8, 24, and 48 hours postpartum. Cervical length was similar between the groups at 6 weeks postpartum. A total of 891 patients participated in phase 2. The area under the curve was higher for preterm birth screening based on a history of a short postpartum cervix alone than for a history of spontaneous preterm birth alone (0.66 [95% confidence interval, 0.63-0.69] vs 0.57 [95% confidence interval, 0.54-0.61]; P<.0001). Combining both a history of spontaneous preterm birth and a short postpartum cervix resulted in additional benefit, with an area under the curve of 0.74 (95% confidence interval, 0.73-0.84; P<.0001). Postpartum cervical length measurements may assist in detecting the group of patients at higher risk of subsequent spontaneous preterm birth. It may be beneficial to consider an increased follow-up regimen and earlier interventions in this group to reduce adverse perinatal outcomes.

Effect of intra‐amniotic fluid pressure from polyhydramnios on cervical length in patients with twin–twin transfusion syndrome undergoing fetoscopic laser surgery

To determine the relationship between intra-amniotic pressure and cervical length (CL) in patients with twin-twin transfusion syndrome (TTTS) undergoing fetoscopic laser photocoagulation (FLP), and to identify pre- or intraoperative factors associated with increased intra-amniotic pressure in this population. This was a prospective cohort study of patients undergoing FLP for TTTS. Exclusion criteria were triplet or higher-order gestation and prior cervical cerclage, amnioreduction or FLP procedure. CL was assessed using preprocedure transvaginal ultrasound. Intra-amniotic pressure measurements were obtained on initial placement of the trocar into the amniotic cavity, using a direct hydrostatic pressure gauge. The relationship between intra-amniotic pressure and CL was assessed using multivariate linear regression analysis, including relevant preoperative and intraoperative variables. In total, 283 pregnancies met the inclusion criteria. Quintero stage of TTTS was I in 33 pregnancies, II in 88, III in 150 and IV in 12. Mean gestational age (GA) at FLP was 20.7 ± 3 weeks. Mean intra-amniotic pressure was 23.1 ± 9 mmHg. On unadjusted linear regression analysis, there was no significant association between intra-amniotic pressure and preoperative CL (P = 0.24) or GA at delivery (P = 0.22). On multivariate analysis, the factors associated significantly with intra-amniotic pressure were: number of prior term deliveries (P = 0.03), recipient maximum vertical pocket (P < 0.0001), Quintero stage IV (P = 0.01) and type of anesthesia (sedation vs general anesthesia; P = 0.01). In pregnancies with TTTS, intra-amniotic pressure is not associated with CL or GA at delivery. This novel finding suggests that cervical shortening in this population is not mechanically driven. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Transvaginal Sonographic Cervical Length Measurement as Predictor of Preterm Delivery

The present study entitled, “Transvaginal Sonographic cervical length measurement as predictor of Preterm delivery” was carried out on 150 cases of primiparas who attended the Govt. Medical College, Hospital, Nagpur. The transvaginal ultrasonographic cervical length was measured at 18 -20 weeks. These cases were followed at 24 weeks and 28 to 30 weeks for pregnancy outcome as abortion, preterm labour or full term delivery. The study was carried out to correlate the outcome of pregnancy (preterm delivery) with the transvaginal cervical length measured serially at 18-20 wks, 24 wks & 28-30 wks. The mean cervical length was 41.9 at 18-20 weeks, 40.09 at 24 weeks and 37.41 at 28 to 30 weeks. The mean cervical length in patients who had preterm delivery was 22.67 at 18 to 20 weeks, 24 at 24 weeks and 18.50 at 28-30 weeks compared to 42.03, 40.3 and 32.41 respectively in those who had full term delivery. This difference was significant. The cervical length of

Cervical Length in Patients at Risk for Placenta Accreta.

To evaluate cervical length measurements in women with placenta accreta compared to women with a nonadherent low-lying placenta or placenta previa and evaluate this relationship in terms of vaginal bleeding, preterm labor, and preterm birth. We conducted a retrospective cohort study between 1997 and 2011 of gravidas with more than 1 prior cesarean delivery who had a transvaginal ultrasound examination between 24 and 34 weeks for a low-lying placenta or placenta previa. Cervical length was measured from archived images in accordance with national guidelines by a single investigator, who was blinded to outcomes and ultrasound reports. The diagnosis of placental accreta was based on histologic confirmation. For study purposes, preterm birth was defined as less than 36 weeks, and cervical lengths of 3 cm or less were considered short. Standard statistical analyses were used. A total of 125 patients met inclusion criteria. The cohort was divided into patients with (n = 43 [34%]) and without (n = 82 [66%]) placenta accreta and stratified by gestational age at the ultrasound examinations. Women with placenta accreta had shorter cervical length measurements during their 32- to 34-week ultrasound examinations (mean ± SD, 3.23 ± 0.98 versus 3.95 ± 1.0 cm; P < .01) and were more likely to have a short cervix of 3 cm or less (P = .001). However, these findings did not correlate with the degree of invasion (P = .3), or higher rates of vaginal bleeding and preterm labor (P = .19) resulting in preterm birth before 36 weeks (P = .64). Women with placenta accreta had shorter cervical lengths at 32 to 34 weeks than women with a nonadherent low-lying placenta or placenta previa, but this finding did not correlate with a higher risk of vaginal bleeding or preterm labor resulting in preterm birth before 36 weeks.

262: Further shortening in cervical length in patients diagnosed with short cervix on midtrimester anatomy ultrasound is associated with higher risk of preterm birth

262: Further shortening in cervical length in patients diagnosed with short cervix on midtrimester anatomy ultrasound is associated with higher risk of preterm birth

178: Proximal cervical length in patients with a cerclage is a better predictor of spontaneous preterm birth

178: Proximal cervical length in patients with a cerclage is a better predictor of spontaneous preterm birth

516: Cervical length in patients at risk for placental invasion

516: Cervical length in patients at risk for placental invasion

Clinical implications of pregestational cervical length in patients undergoing IVF

The correlation between shortened sonographic cervical length (CL) in 2nd or 3rd trimester and preterm delivery has been well established. Correlations between pregestational and pregnant CL have yet to be investigated. The aim of this study was to determine whether sonographic pregestational CL and uterine dimensions in patients undergoing IVF correlated with midtrimester CL, gestational age at delivery and neonatal birthweight.

Utilización de la longitud cervical para la reducción de la estancia hospitalaria en pacientes ingresadas por amenaza de parto pretérmino

Objective To evaluate the impact of ultrasound cervical length measurement on length of hospital stay in patients admitted for preterm labor. Material and methods We performed a prospective longitudinal study of a sample of patients with preterm labor admitted to two admission wards (units 1 and 2). In unit 1, the patients were managed according to the routine protocol, based on Bishop's index and the presence of uterine activity confirmed by monitoring. In unit 2, the protocol was modified according to cervical length measured by ultrasound and early discharge was planned if cervical length was 25 mm or more. The characteristics of both groups, mean length of hospital stay and delivery rates within 7 days and before 34 and 37 weeks’ gestation were analyzed. Results One hundred thirty-eight patients were included in the study. Delivery rates within 7 days and before 34 and 37 weeks’ gestation and the incidence of readmission were similar in both groups. However, length of hospital stay was significantly reduced in unit 2 (6.14 days vs 3.86; p < 0.001), where cervical length was used as a criterion for discharge. Conclusions Routine use of ultrasound assessment of cervical length in patients admitted for preterm labor may reduce length of hospital stay without increasing preterm delivery rates or the percentage of readmissions.

Cervicovaginal fibronectin improves the prediction of preterm delivery based on sonographic cervical length in patients with preterm uterine contractions and intact membranes

The purpose of this study was to examine the diagnostic performance of ultrasonographic measurement of the cervical length and vaginal fetal fibronectin determination in the prediction of preterm delivery in patients with preterm uterine contractions and intact membranes. Ultrasound examination of the cervical length and fetal fibronectin determination in vaginal secretions were performed in 215 patients admitted with preterm uterine contractions (22-35 weeks) and cervical dilatation of </=3 cm. Outcome variables were the occurrence of preterm delivery within 48 hours, 7 days, and 14 days of admission, delivery </=32 and </=35 weeks, as well as the admission-to-delivery interval. Statistical analysis included chi-square test, receiver-operator characteristic (ROC) curve analysis, logistic regression, and survival analysis. The overall prevalence of preterm delivery </=35 weeks was 20% (43/215). The prevalence of spontaneous preterm delivery within 48 hours, 7 days, and 14 days of admission, and delivery </=32 and </=35 weeks were 7.9% (17/215), 13.0% (28/215), 15.8% (34/215), 8.9% (9/101), and 15.8% (34/215), respectively. ROC curve analysis and contingency tables showed a significant relationship between the occurrence of preterm delivery and both cervical length and fetal fibronectin results ( P < .01 for each). Both tests performed comparably in the prediction of spontaneous preterm delivery. However, when fetal fibronectin results were added to those of cervical length (<30 mm), a significant improvement in the prediction of preterm delivery was achieved. Fetal fibronectin adds prognostic information to that provided by sonographic measurement of the cervical length in patients with preterm uterine contractions and intact membranes.

Prediction of the latency period by cervical length in preterm premature rupture of membranes

PREMATURE RUPTURE OF MEMBRANES ACQUINONETTE BRYANT, TAMMY SINCLAIR, AMY MURTHA, Duke University Medical Center, Obstetrics and Gynecology, Durham, North Carolina OBJECTIVE: Preterm premature rupture of membranes (PPROM) remains a leading cause of preterm delivery. The interval from rupture of membranes to delivery is important in optimizing neonatal outcomes. However, predicting the latency period remains a challenge in obstetric practice. The objective of this study is to determine if the cervical length in pregnant women diagnosed with (PPROM) is associated with a decrease in latency period. The secondary objective is to determine if cervical length is associated with an increase in the incidence of funisitis. STUDY DESIGN: The ultrasound reports of women, whom were previously recruited in the PPROM Infection & Inflammation study, were reviewed; and data regarding the cervical length and the mode of ultrasound was collected. All subjects admitted with the diagnosis from 22-34 weeks were approached for enrollment. All subjects received an ultrasound as part of their routine care. The latency period was defined in hours from the time of rupture to the time of delivery. The cervical lengths were divided into two groups: > or %2.5 cm. The latency period between the two groups was compared using the Mann-Whitney U test. The cervical length and incidence of funisitis was compared using the t test. RESULTS: Of the 112 patients enrolled 24% had cervical length %2.5 cm. A cervical length of %2.5 cm was associated with a significant decrease in the median latency compared to those >2.5 cm (142.8 hours versus 290.9 hours, P = .002). 37% (37/102) of the patients enrolled had a histological diagnosis of funisitis. The mean cervical length in patients with funisitis was 3.44 cm compared to 3.05 cm in those without funisitis (P = .64). CONCLUSION: In women with PPROM the latency period appears to be shorter in patients with a cervical length %2.5 cm. Preliminary analysis suggests that cervical length may not predict funisitis. S104 SMFM Abstracts

P03.03: Transvaginal ultrasound assessment of cervical length in patients with antepartum haemorrhage of unknown origin

P03.03: Transvaginal ultrasound assessment of cervical length in patients with antepartum haemorrhage of unknown origin

The prognostic value of funneling and upper cervical length in patients with a cerclage

The prognostic value of funneling and upper cervical length in patients with a cerclage