Short Cervical Length Research Articles

Prediction of pregnancy duration up to 34 weeks gestation after ultrasound-indicated cerclage placement

Ultrasound (US)-indicated cerclage is an intervention that has been shown to significantly improve neonatal survival in pregnancies complicated by a history of spontaneous preterm birth (sPTB) with cervical length (CL) < 25mm, and may also reduce risk for those without a history of sPTB when CL is < 10-15mm. Our aim is to evaluate factors associated with cerclage placement for short CL in these two groups and pregnancy duration up to 34 weeks gestational age (GA).

Screening vs. no screening for preterm delivery in low-risk singleton pregnancies: comparison by propensity score analysis

PurposeTo compare the effect of a policy of screening for spontaneous preterm delivery (SPD) by transvaginal cervical length (CL) measurement versus a no screening policy in the prevention of severe prematurity.MethodsRetrospective study on low-risk singleton pregnancies examined at 20–24 weeks. Two cohorts, one with SPD screening and the other without screening, were matched using propensity analysis to create the study groups. Women with short CL were treated with vaginal progesterone and/or cervical cerclage/pessary. The outcomes examined were SPD < 32 weeks (SPD 32) and SPD between 20 and 32 weeks (SPD 20–32).ResultsScreening for SPD was associated with a significant reduction in the rate of SPD at less than 32 weeks (0.3 vs. 0.8%, p = 0.001 in the screened and no screened pregnancies, respectively) and in the rate of SPD 20–32 (0.3 vs. 0.9%, p = 0.005 in the screened and no screened pregnancies, respectively). After adjusting for maternal age, parity, body mass index, smoking and mode of conception, the screening group had significantly lower hazard for SPD 20–32 (HR = 0.36, 95% CI: 0.18–0.75, p = 0.006) and SPD32 (HR = 0.39, 95% CI: 0.19–0.82, p = 0.013).ConclusionScreening for SPD by transvaginal CL measurement in mid-pregnancy may reduce the incidence of severe prematurity in low-risk singleton pregnancies.

Preterm Birth: An Overview.

Birth order has a significant impact on perinatal and long-term outcomes. Preterm birth rates, ranging from 5% to 18%, are regrettably still high in industrialized and developing countries, making them the main contributor to infant mortality and morbidity. Infection, cervical pathology, uterine overdistension, progesterone deficiency, stress on the mother and fetus, allograft reaction, allergic phenomena, and likely more unknown factors are just a few of the causes of preterm birth syndrome. These several causes may improperly stimulate the usual pathway between the decidua and the fetal membranes, resulting in cervical ripening, membrane rupture, and uterine contractility. Some of the mechanisms underpinning these actions include receptors, chemokines, and inflammatory cytokines. For early identification, treatment, and avoidance of negative consequences, it is essential to understand the cellular and metabolic mechanisms that cause preterm labor. Clinicians and researchers are crucial to improving our knowledge of the biochemistry of preterm delivery, identifying risk factors, and creating treatments for this challenging condition. Intrauterine growth restriction and pre-eclampsia or eclampsia are frequent causes of suspected preterm births. "Spontaneous preterm births" occur after preterm labor that develops without warning with an early membrane rupture. It is thought that the condition that may cause these births may have several causes, such as uterine overdistension, vascular disease, infection, or inflammation. Unplanned preterm births have several reasons, including the black race, periodontal disease, low mother body mass index (BMI), and previous preterm births. A short cervical length and a high cervical-vaginal fetal fibronectin concentration are the two best signs of premature birth.

Could Maternal Vitamin D Concentration Affect Cervical Length in Mid-Pregnancy? A Report From an Iranian Tertiary Center.

This descriptive-analytic cross-sectional study aimed to figure out whether maternal serum vitamin D concentration correlates with cervical length measurement in mid-gestation or not. During Jun-Jan 2021, 213 pregnant women at 18-22 weeks of gestation were investigated. First, demographic features were obtained then, maternal serum vitamin D concentration was measured by enzyme-linked immunoassay and cervical length was measured via transvaginal sonography according to fetal maternal foundation guideline and appropriate statistical test was used to analyze the correlation between maternal vitamin D level and cervical length in mid-pregnancy. It was shown that 29.6% and 25.4% of participants had vitamin D deficiency and insufficiency, respectively. Spearman's test found no significant correlation between maternal vitamin D level and cervical length in mid-pregnancy. Moreover, cervical length and maternal vitamin D level had no association with maternal BMI. Although maternal vitamin D level and its sufficiency status was not associated with cervical length in mid-pregnancy, as a trend toward decreased maternal serum vitamin D level by advancing gestational age was observed. It may be concluded that it is prolonged vitamin D deficiency during gestation that may lead to cervical length shortening and subsequent preterm delivery later in gestation.

Incidentally Found Midtrimester Shortened Cervical Length: Practice Patterns among American Maternal-Fetal Medicine Specialists.

The management of incidentally found short cervical length (CL) without prior spontaneous preterm birth (PTB) can vary. While most agree on starting vaginal progesterone, management after CL shortens <10 mm varies. The purpose of this study was to elucidate current practice patterns amongst maternal-fetal medicine (MFM) specialists. We conducted an online survey of MFM attending physicians and fellows in the United States from May 2019 to April 2020. The primary outcome was management of varying CL based on gestational age. Variations in management were assessed descriptively. There were 236 respondents out of 400 eligible surveyed, with a response rate of 59.2%. Universal CL screening was reported by 93.6% (49.6% abdominal and 44.1% transvaginal). Management of short CL varied based on CL measurement, rather than gestational age at presentation. At CL <10 mm, management included cerclage (17.4-18.7%), vaginal progesterone (41.3-41.7%), or cerclage plus vaginal progesterone (43.4%). Between CL of 10 to 20 mm, the majority (77.4-91.9%) would start vaginal progesterone. At CL 21 to 25 mm, management varied between expectant management (45.5-48.5%) or vaginal progesterone (51.1-52.8%). Suture material used was ethylene terephthalate (47.4%) or polypropelene (31.2). Preoperative antibiotic use was reported by 22.3%, while 45.5% used them only if the amniotic membranes were exposed, and 32.2% reported no antibiotic use. Postoperative tocolytic use varied with 19.3% reporting no use, 32.6% using it always, 8.2% only after significant cervical manipulation, 22.7% after the patient is experiencing symptoms, and 17.6% using it only if the cervix is dilated on exam. After cerclage placement, 44.5% continued CL surveillance. Substantial differences of opinion exist among MFM physicians regarding management of incidentally found short CL in patients without history of PTB. The differences in responses obtained highlight the need for evidence-based guidelines for managing this clinical scenario. · There is lack of consensus on the management of incidentally found shortened CL.. · The purpose of this study was to elucidate current trends in CL screening and management.. · Substantial differences of opinion exist regarding management of incidentally found short CL..

STUDY OF SECOND TRIMESTER CERVICAL LENGTH AS A PREDICTOR OF PRETERM LABOUR-A PROSPECTIVE STUDY IN A TERTIARY CARE HOSPITAL

Introduction:- Cervical dysfunction either due to disruption of intact cervical epithelial barrier or mechanical incompetence of the cervix has been associated as one of the risk factors for preterm premature rupture of membranes and preterm birth. Our aim was to study second trimester cervical length as a predictor of preterm labour in our population. Methodology:-This hospital based prospective study was conducted in a tertiary care hospital over a period of one and a half year (2019-2021). The relationship of cervical length between the 16th and 24th week of pregnancy and preterm delivery was evaluated for the 82 women after inclusion and exclusion criteria. Data was analyzed using SPSSversion 11.0. Results:- The mean age of study patients was 29.3±2.52 years, with 52.4% (most common) being in the age group of 28-31 years. 26.8% patients had a cervical length of ≤2.5 cm while 73.2% had cervical length of &gt;2.5 cm at the time of examination. 45.1% women delivered at &lt;37 weeks of gestation while 54.9% delivered at term. Most of the patients i.e., 64.6% delivered by normal vaginal delivery and 35.4% delivering by Cesarean section. 72.7% patients with short cervical length delivered at &lt;37 weeks while only 35% of those with normal cervical lengths delivered at &lt;37 weeks. This difference was statistically signicant (p&lt;0.0002). Conclusion:- We concluded that a short cervical length of&lt; 2.5 is a risk factor for development of spontaneous preterm labour and that ≤ 2.5mm is an optimum threshold for it.

VAGINAL PROGESTERONE IN RISK REDUCTION OF PRETERM BIRTH IN WOMEN WITH SHORT CERVIX IN MID TRIMESTER OF PREGNANCY

Background: Preterm labour is a major health challenge in obstetrics. Many risk factors being identified, the most common one is short cervical length, can be diagnosed by transvaginal ultrasound scan after 13 weeks of pregnancy. Vaginal progesterone is the most bioavailable form of progesterone that have effect on uterine and cervix. Progesterone is found to inhibit the production of proinflammatory cytokines and prostaglandins within the uterus and to inhibit myometrial contractility Aim:To evaluate the efficacy of vaginal progesterone administration for preventing preterm birth and decrease perinatal morbidity and mortality in asymptomatic women with a singleton gestation and a mid-trimester sonographic cervical length (CL) ≤ 25 mm. Materials And Methods:This is a prospective study of asymptomatic women with a singleton pregnancy and a sonographic short cervix (&lt;25mm) at 19 + 0 to 23 + 6 weeks of gestation. Women were allocated randomly to receive vaginal progesterone or placebo daily starting from 19 + 0 to 23 + 6 weeks until 36 + 6 weeks, rupture of membranes or delivery, whichever occurred first. Randomization sequence was stratified by centre and history of a previous preterm birth. The primary endpoint was preterm birth before 33 weeks of gestation. Analysis was by intention to treat. Results:Out of 100 patients for whom study was done, 20 lost to followup and remaining divided into two groups: 40 Singleton pregnant women with CL&lt;25mm between 19 + 0 to 23 + 6 weeks of gestation with no sign and symptoms were given daily vaginal progesterone for up to 36 + 6 weeks, rupture of membranes or delivery, whichever occurred first. The dose is 200 mg once daily and a group of 40 women with cervical length of &lt;25 mm between 19 + 0 to 23 + 6 weeks of pregnancy were given no treatment, Maximum distribution belongs to age of 19-24 years followed by 30-34 years. Most of women in this study have no history of preterm labour. In those who received vaginal progesterone 5 women had history of previous preterm labour and five women in no treatment group. It was found that there was statistically significant reduction in preterm labour in women with short cervix &lt;2.5cm with 200mg vaginal progesterone. Conclusions:This updated systematic review and meta-analysis reaffirms that vaginal progesterone reduces the risk of preterm birth and neonatal morbidity and mortality in women with a singleton gestation and a mid-trimester CL ≤ 25 mm, without any deleterious effects on neurodevelopmental outcome. Clinicians should continue to perform universal transvaginal CL screening at 19 + 0 to 23 + 6 weeks of gestation in women with a singleton gestation and to offer vaginal progesterone to those with a CL ≤ 25 mm.

Prediction of Preterm Delivery From the Endocervical Length at 11 to 14 Weeks

Background and Objectives Premature delivery is called delivery before 37 weeks. It is estimated that every year, about 15 million babies are born with preterm delivery worldwide, which is approximately equal to 11% of the total number of deliveries. In this study, a number of pregnant women with 11-14 weeks of pregnancy were evaluated in order to evaluate the value of cervical length at the end of the first trimester of pregnancy in predicting preterm delivery. Subjects and Methods In this cohort study, 156 asymptomatic pregnant women with a gestational age of 11-14 weeks were randomly selected and evaluated. Cervical length was measured by transvaginal ultrasound using a standard method. Cervical length and gestational age at delivery were recorded in a computer database along with demographic information, clinical history, and pregnancy information. Results The mean length of the cervix in women with preterm delivery was 31.32±6.71 mm and in women with term delivery was 38.96±5.80 mm. Data analysis showed that shorter cervical length was significantly associated with preterm delivery. With a threshold of 34.5 mm, the length of the cervix from 3rd month to 6th month could predict preterm delivery with a sensitivity of 76% and a specificity of 81%. Conclusion Measuring cervical length with transvaginal ultrasound in the second trimester can predict preterm delivery.

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.

Role of Cervical Length in Predicting the Premature Labour: A Prospective Observational Study

Background: Over the last decade, little progress has been made in understanding and preventing preterm birth, and the incidence of spontaneous preterm birth has continued to rise, even in low risk women. One of the key predictors of premature birth is cervical length. Methods: This was a hospital based prospective study conducted at the postgraduate department of obstetrics and gynecology, Government Lalla Ded Hospital, Srinagar for a period of one and a half year (2019-2021). Out of the 140 women, 36 were removed from the research owing to rescue or emergency cerclage, and 22 women were lost to follow-up. For the 82 remaining women, the association between cervical length between the 16th and 24th week of pregnancy and premature birth was examined. Results: We observed that 2.5 cm cervical length was the ideal cut-off with sensitivity, specificity, positive predictive, negative predictive, and accuracy values of (68.7%), (75.7%), (77.5%), (66.7%), and (71.9%), respectively. The average cervical length of patients with gestational age at delivery fewer than 37 weeks was significantly smaller compared to those with gestational age more than 37 weeks at delivery (2.75 vs 3.92, p-value &lt; 0.001). Conclusion: We concluded that a short cervical length of &lt;2.5cm is a risk factor for development of spontaneous preterm labour and that ≤ 2.5mm is an optimum threshold for it. Our findings imply that the cervix's length is a reliable predictor of its competence and should be seen as a continuous rather than a binary characteristic. Preterm birth is more likely to occur if the cervix is shorter than normal. The length of the cervix strongly correlates with the length of pregnancy. Keywords: Cervical length, Preterm, Pregnancy

Cervical length distribution among Brazilian pregnant population and risk factors for short cervix: A multicenter cross-sectional study

Since there are populational differences and risk factors that influence the cervical length, the aim of the study was to construct a populational curve with measurements of the uterine cervix of pregnant women in the second trimester of pregnancy and to evaluate which variables were related to cervical length (CL) ≤25 mm. This was a multicenter cross-sectional study performed at 17 hospitals in several regions of Brazil. From 2015 to 2019, transvaginal ultrasound scan was performed in women with singleton pregnancies at 18 0/7 to 22 6/7 weeks of gestation to measure the CL. We analyzed CL regarding its distribution and the risk factors for CL ≤25 mm using logistic regression. The percentage of CL ≤ 25mm was 6.67%. Shorter cervices, when measured using both straight and curve techniques, showed similar results: range 21.0-25.0 mm in straight versus 22.6-26.0 mm in curve measurement for the 5th percentile. However, the difference between the two techniques became more pronounced after the 75th percentile (range 41.0-42.0 mm straight x 43.6-45.0 mm in curve measurement). The risk factors identified for short cervix were low body mass index (BMI) (OR: 1.81 CI: 1.16-2.82), higher education (OR: 1.39 CI: 1.10-1.75) and personal history ([one prior miscarriage OR: 1.41 CI: 1.11-1.78 and ≥2 prior miscarriages OR: 1.67 CI: 1.24-2.25], preterm birth [OR: 1.70 CI: 1.12-2.59], previous low birth weight <2500 g [OR: 1.70 CI: 1.15-2.50], cervical surgery [OR: 4.33 CI: 2.58-7.27]). By contrast, obesity (OR: 0.64 CI: 0.51-0.82), living with a partner (OR: 0.76 CI: 0.61-0.95) and previous pregnancy (OR: 0.46 CI: 0.37-0.57) decreased the risk of short cervix. The CL distribution showed a relatively low percentage of cervix ≤25 mm. There may be populational differences in the CL distribution and this as well as the risk factors for short CL need to be considered when adopting a screening strategy for short cervix.

A Case of Umbilical Cord Prolapse With Intact Membranes Managed Successfully With Conservative Measures

Umbilical cord prolapse with ruptured membranes is an obstetric emergency with management consisting of delivery via emergent cesarean delivery. If the umbilical cord prolapses beyond the internal os with intact membranes, there is an opportunity to intervene and reduce the risk of fetal morbidity and mortality. A healthy 30-year-old, gravida 1 para 0 was incidentally found to have a short cervical length at 25 weeks five days on routine anatomy ultrasound evaluation. On evaluation via ultrasound by the maternal-fetal medicine service, the umbilical cord was noted to be prolapsing through the cervix with membranes intact. The cord prolapse with intact membranes resolved after placing the patient in the Trendelenburg position and nifedipine was administered for tocolysis given the uterus was noted to be contracting. For the remainder of the pregnancy, the patient underwent close follow-up and serial ultrasound scans with confirmation of the fetal head as the presenting part. The patient ultimately delivered vaginally at term. Cord prolapse with intact membranes, when identified via ultrasound, can be managed conservatively via Trendelenburg positioning and tocolysis to avoid premature cesarean delivery.

Suture choice for cervical cerclage

Preterm birth is a global health-care problem that leads to significant neonatal morbidity and mortality,1 results in suffering within families, and incurs considerable health-care costs.2 Cerclage is a surgical intervention in which the cervix is closed with the aim of preventing pregnancy loss or preterm birth. Indications for cerclage are varied, including short cervical length in a current pregnancy or history of preterm birth or cervical insufficiency.3

Correlation between Maternal Weight Gain in Each Trimester and Fetal Growth According to Pre-Pregnancy Maternal Body Mass Index in Twin Pregnancies.

Background andObjectives: This study aimed to determine the correlation between maternal weight gain in each trimester and fetal growth according to pre-pregnancy maternal body mass index in twin pregnancies. Materials and Methods: We conducted a retrospective review of the medical records of 500 twin pregnancies delivered at 28 weeks’ gestation or greater at a single tertiary center between January 2011 and December 2020. We measured the height, pre-pregnant body weight, and maternal body weight of women with twin pregnancies and evaluated the relationship between the maternal weight gain at each trimester and fetal growth restriction according to pre-pregnancy body mass index. Results: The overweight pregnant women were older than the normal or underweight pregnant women, and the risk of gestational diabetes was higher. The underweight pregnant women were younger, and the incidence of preterm labor and short cervical length during pregnancy was higher in the younger group. In normal weight pregnant women, newborn babies’ weight was heavier when their mothers gained weight, especially when they gained weight in the second trimester. Mothers’ weight gain in the first trimester was not a significant factor to predict fetal growth. The most predictive single factor for the prediction of small neonates was weight gain during 24–28 and 15–18 weeks, and the cutoff value was 6.2 kg (area under the curve 0.592, p < 0.001). Conclusions: In twin pregnancy, regardless of the pre-pregnant body mass index, maternal weight gain affected fetal growth. Furthermore, weight gain in the second trimester of pregnancy is considered a powerful indicator of fetal growth, especially in normal weight pregnancies.

Different effects for different questions: An illustration using short cervix and the risk of preterm birth.

To illustrate the difference between exposure effects and population attributable effects. We examined the effect of mid-pregnancy short cervical length (<25 mm) on preterm birth using data from a prospective cohort of pregnant women in Lusaka, Zambia. Preterm birth was live birth or stillbirth before 37 weeks of pregnancy. For estimation, we used multivariable regression and parametric g-computation. Among 1409 women included in the analysis, short cervix was rare (2.4%); 13.6% of births were preterm. Exposure effect estimates were large (marginal risk ratio 2.86, 95% confidence interval [CI] 1.80-4.54), indicating that the preterm birth risk was substantially higher among women with a short cervix compared with women without a short cervix. However, the population attributable effect estimates were close to the null (risk ratio 1.06, 95% CI 1.02-1.10), indicating that an intervention to counteract the impact of short cervix on preterm birth would have minimal effect on the population risk of preterm birth. Although authors often refer to "the" effect, there are actually different types of effects, as we have illustrated here. In planning research, it is important to consider which effect to estimate to ensure that the estimate aligns with the research objective.

The MRI estimations of placental thickness and cervical length correlate with postpartum hemorrhage (PPH) in patients with risk for placenta accreta spectrum (PAS) disorders

IntroductionThis study aims to identify whether placental thickness and cervical length measured by MRI correlate with postpartum hemorrhage (PPH) in patients at high risk for placenta accreta spectrum (PAS) disorders. MethodsThe placental thickness and cervical length of 200 patients from October 2017 to October 2021 were retrospectively measured. The mid-sagittal plane of the placentas was measured by 2 independent radiologists using MRI. Partial correlation analysis was used to characterize the correlation between placental thickness, cervical length and estimated blood loss during surgery. The correlation between clinical features, placental thickness, cervical length and PPH was evaluated with univariate and multivariate analyses. A nomogram was constructed based on the logistic regression. ResultsPlacental thickness was positively correlated with the estimated blood loss during delivery, while cervical length had a negative correlation with it, based on the adjustment for gestational age. Multivariate analyses revealed that prior cesarean section, placenta previa, increased placental thickness(≧4.35 cm) and short cervical length（< 3.05 cm） were independent risk factors for PPH. When the 4 risk factors were combined together, the AUC was the highest, 0.773 (95%CI 0.707–0.840). DiscussionPlacental thickness and cervical length correlated with PPH. The nomogram constructed based on prior cesarean section, placenta previa, placental thickness and cervical length can be used to recognize patients with a higher risk of PPH.

Screening for Low-Tract Genital Infections in Women with Threatened Preterm Labor: Which Role?

Objectives: The aim of this study was to evaluate the possible relationship between cultural specimens and preterm birth in women admitted for threatened preterm labor. Preterm birth is the leading cause of neonatal mortality and antenatal hospitalization; several risk factors including intrauterine infections have been identified, but its real causes remain poorly understood. Design: This is a retrospective, multicenter, cohort study including 250 women admitted for threatened preterm labor. Methods, Participants/Materials, Setting: All women admitted for threatened preterm labor, i.e., presenting with cervical changes and uterine activity before 37 weeks at the obstetrics unit of the hospitals of Modena, Monza, Carate, and Vimercate were included in the study. We excluded twin pregnancies and cases with preterm premature rupture of membranes at admission. Data about maternal history, pregnancy complications, cervical length, vaginal swabs, and urine culture at admission and gestational age at delivery were collected from clinical records in order to compare the incidence of preterm birth according to some known risk factors, cervical length, and microbiological test at admission. Results: 250 women were included in the study; preterm birth at less than 37 weeks occurred in 44.4% women admitted for threatened preterm labor. The incidence of preterm birth was not different between those with a positive or a negative vaginal swab (48.3 vs. 38.4%, p = 0.22) or positive versus negative urine culture (31.8 vs. 42.1%, p = 0.23) at admission. A shorter cervical length at admission was found in women with subsequent preterm birth (17 vs. 19.5 mm, p = 0.03). Cervical length <15 mm (OR 1.82, 95% CI: 1.03–3.23, p = 0.039) predicted the risk of preterm birth. Furthermore, only the history of a previous preterm birth (p = 0.02) and a previous uterine curettage (p = 0.045) was associated with preterm birth. Limitations: The observational and retrospective nature of the study and its small sample size are important limitations of the study. Moreover, women were not systematically or randomly assigned to the screening for vaginal or urinary infections. Conclusions: There is no evidence that the search for vaginal or urinary infections in women admitted for threatened preterm labor is helpful to identify those at increased risk of preterm birth. Although several studies have explored the role of screening for bacterial vaginosis in asymptomatic women and some studies evaluated vaginal or urinary infections in women with preterm birth, none of them focused on the possible role of microbiological specimens as a predictive tool in women admitted for threatened PTL. No association was found in our study, but prospective randomized controlled trials are required to confirm the results of this observation.

Influence of Utero-cervical Angle and Cervical Length on Labor Induction

Background: Successful labor induction is clearly related to the state of the cervix. The utero-cervical angle and cervical length represent novel ultrasonographic markers. Aim: To assess the relationship between utero-cervical angle and cervical length and satisfactory response to labor induction. Methods: Prospective cohort study was conducted in Al-Elwyia Maternity Teaching Hospital for a period of six months; 100 cases were enrolled in the study, and a pre-labor induction measurement of utero-cervical angle and cervical length using transvaginal ultrasound scanning was followed up till the end of labor to estimate the rate of success of induction of labor. Results: 65 patients had successful induction of labor and 35 failed to do so. No differences were found in demographic data and previous obstetric history. Short cervical length and wide utero-cervical angle were found in successful induction of labor. A significant negative correlation was found between utero-cervical angle and labor duration. At the cutoff point of 97.5 degrees of utero-cervical angle, the sensitivity was 83.12%, specificity was 71.4%, positive predictive value was 84.38%, negative predictive value was 69.45% and the accuracy was 88%. At a cutoff point of less than 29.5 mm of cervical length, the sensitivity was 92.3%, specificity was 80%, positive predictive value was 89.55%, negative predictive value was 84.84% and the accuracy was 88%. Conclusion: Utero-cervical angle and cervical length may be independent predictors of successful induction of labor.

Midtrimester cervical elastography in pregnant women with a history of loop electrosurgical excision procedure (LEEP)

We aimed to compare cervical elastographic parameters based on a previous loop electrosurgical excision procedure (LEEP) and to determine whether they can predict preterm delivery in pregnant women with a history of LEEP. This multicenter prospective case–control study included 71 singleton pregnant women at 14–24 weeks of gestation with a history of LEEP and 1:2 gestational age-matched controls. We performed cervical elastography using E-cervix and compared maternal characteristics, delivery outcomes, cervical length (CL), and elastographic parameters between the two groups. The median mid-trimester CL was significantly shorter in the LEEP group. Most elastographic parameters, including internal os (IOS), external os (EOS), elasticity contrast index (ECI), and hardness ratio (HR), were significantly different in the two groups. In the LEEP group, the sPTD group compared to the term delivery (TD) group showed a higher rate of previous sPTD (50% vs. 1.7%, p < 0.001), higher IOS and ECI (IOS: 0.28 [0.12–0.37] vs. 0.19 [0.10–0.37], p = 0.029; ECI: 3.89 [1.79–4.86] vs. 2.73 [1.48–5.43], p = 0.019), and lower HR (59.97 [43.88–92.43] vs. 79.06 [36.87–95.40], p = 0.028), but there was no significant difference in CL (2.92 [2.16–3.76] vs. 3.13 [1.50–3.16], p = 0.247). In conclusion, we demonstrated that a history of LEEP was associated with a change in cervical strain measured in mid-trimester as well as with CL shortening. We also showed that cervical elastography can be useful in predicting sPTD in pregnant women with previous LEEP.

Does a cervical pessary reduce the rate of preterm birth in women with a short cervix?

To evaluate neonatal outcomes after the use ofa cervical pessary in Japanese women with short cervical length (CL) less than 25mm. This multicenter study involved women with singleton pregnancies between 20 and 29+6 gestational weeks and a CL of less than 25mm. The primary outcome was preterm birth (PTB) before 34weeks of gestation. This study was registered in the Japan Registry of Clinical Trials (JRCT: jRCTs042180102). Two hundred pregnant women were enrolled; 114 in the pessary group and 86 in the expectant management group as controls. In the pessary group, all 114 neonates were investigated for perinatal outcomes, and 112 pregnant women were investigated for primary, and secondary outcomes. In the control group, 86 pregnant women were investigated for primary and secondary outcomes and 86neonates were investigated for neonatal outcomes. There were no significant differences in PTB in≤34,≤37, and≤28weeks of gestation or in preterm rupture of membranes (PROM)≤34weeks between the groups. The gestational weeks at birth and birth weight were significantly higher in the pessary group. Regression analysis demonstrated that the CL decreased without a pessary, whereas the shortening rate was suppressed during the intervention. No significant differences were observed in adverse neonatal outcomes, chorioamnionitis, or preterm PROM. The cervical pessary effectively reduced CLshortening during pregnancy resulting in an average increased gestational age, however, did not reduced the rates of preterm birth.