Change In Cervical Length Research Articles

269: Can sonographic measurements and changes in cervical length during pregnancy predict a preterm delivery?

269: Can sonographic measurements and changes in cervical length during pregnancy predict a preterm delivery?

Association between change in cervical length and spontaneous preterm birth in twin pregnancies

There is a lack of consensus on the optimal transvaginal cervical length for determining risk for spontaneous preterm birth in twin pregnancies. Change in transvaginal cervical length over time may reflect early activation of the parturition process, as has been demonstrated in singleton pregnancies. The association between change in transvaginal cervical length and the risk for spontaneous preterm birth has not yet been described in the population of women with diamniotic twin pregnancies. Our primary objective is to determine whether rate of change in transvaginal cervical length in the midtrimester is associated with spontaneous preterm birth in twin gestations. Our secondary objective is to describe parameters for identifying patients at increased risk for spontaneous preterm birth based on change in transvaginal cervical length over time. This is a retrospective cohort of serial transvaginal cervical length performed for twin pregnancies at a single institution from 2008 through 2015. Women with diamniotic twin pregnancies who had transvaginal cervical length measurements at 18 and 22 weeks' gestation and outcome data available were included. Logistic regression was used to determine the relationship between the rate of change in transvaginal cervical length and the risk for the primary outcome of spontaneous preterm birth <35 weeks as well as spontaneous preterm birth <32 weeks. In all, 527 subjects met inclusion criteria for this study. The average rate of change in transvaginal cervical length for patients with spontaneous preterm birth <35 weeks was -0.21 cm/wk (SD 0.27) vs -0.10 cm/wk (SD 0.24) for patients who delivered ≥35 weeks (P < .01). The rate of change in transvaginal cervical length was associated with spontaneous preterm birth <35 weeks when controlling for initial transvaginal cervical length and other important risk factors for spontaneous preterm birth. Results for spontaneous preterm birth <32 weeks were similar. This association remained significant when the rate of weekly change was treated as a dichotomous variable based on an apparent inflection point in the risk for spontaneous preterm birth: women with rapid change in transvaginal cervical length, ≥-0.2 cm/wk, had 3.45 times the odds of spontaneous preterm birth as those with less rapid change (95% confidence interval, 2.15-5.52) when controlling for initial transvaginal cervical length. Change in transvaginal cervical length in the midtrimester is associated with spontaneous preterm birth, and therefore protocols for serial transvaginal cervical length measurement can provide the clinician with information to identify at-risk patients. A decrease of ≥0.2 cm/wk of transvaginal cervical length identifies patients at increased risk for spontaneous preterm birth <35 weeks.

P26.07: Second trimester cervical length change and the risk of preterm birth in triplet pregnancy

P26.07: Second trimester cervical length change and the risk of preterm birth in triplet pregnancy

High Maternal BMI Associated With Cervical Shortening in Women With Short Cervix on Second Trimester Anatomy Scan [27K

INTRODUCTION: Identify variables associated with cervical length (CL) changes in women with a short CL at time of second trimester anatomy scan. METHODS: Retrospective analysis of patients diagnosed with short CL at time of routine anatomy scan, between 16–26 weeks from October, 2012–June, 2015. Short CL was defined as <25 mm in high risk (HR) or <20 mm in low risk (LR) patients. Patients with history of spontaneous preterm delivery or 1+ 2nd trimester spontaneous abortions defined as HR. Change in CL calculated using difference between initial CL and subsequent measurement. Regression analysis performed with stepwise selection of variables, to assess for variables that are predictive of cervical change. RESULTS: 404 (4.6%)/8,732 scanned found to have short CL. Data incomplete for 208 were excluded from the analysis. Mean maternal age 28.7 and mean gestational age at diagnosis 21w1d. Mean Body Mass Index (BMI) 29.7 kg/m2 (14–57) and mean pregnancy weight gain 19.6 lbs (0–54). 25% were HR and 75% LR. The most common interventions were vaginal progesterone (38%) and cerclage (16%), with 40% expectant. Mean change in CL for this cohort between both scans was a decrease by 14 mm. Using regression analysis, BMI was predictive of CL shortening (P=.052). For every 10 BMI points, the cervix shortened by 1.8 mm. CONCLUSION: In this cohort of patients with short CL identified at time of routine anatomy scan, the BMI was predictive of further CL shortening. These results may imply a need for closer CL surveillance in patients with higher BMI who are found to have a short CL.

The greater risk of preterm birth in triplets is mirrored by a more rapid cervical shortening along gestation

The risk of preterm birth increases with plurality. However, data are limited about the role of cervical length in triplet pregnancies and how the greater predisposition for preterm birth in triplet pregnancies, compared with twin pregnancies, is reflected by cervical length. Specifically, it is unclear whether the greater predisposition of triplet pregnancies for preterm birth is reflected by a more rapid cervical shortening during gestation compared with twin pregnancies (and therefore a shorter cervical length at any given gestational age), by a greater risk for preterm birth per given cervical length at any given gestational age, or both. The purpose of the study was to compare the rate of cervical shortening during gestation and the correlation between cervical length and gestational age at birth in asymptomatic women with triplet vs twin pregnancies. This was a retrospective study of women with triplet or twin pregnancies who were who were observed in a tertiary center who underwent serial sonographic measurement of cervical length from 16-32 weeks gestation. Change in cervical length during gestation and relationship of cervical length with gestational age at birth were compared between the triplets and twins groups. A total of 431 measurements of cervical length from 86women with triplets was analyzed and compared with 2826 measurements of cervical length from 441 women with twins. The rate of cervical shortening among triplet pregnancies was higher than among twin pregnancies starting from 18 weeks of gestation (slope of regression line, -1.297 vs -0.907; P < .001). Similarly, the proportion of women with cervical length of <25 mm or 15 mm was higher among triplet pregnancies than among twin pregnancies (34.0% vs 21.0% [P < .001] and 16.7% vs 8.4% [P = .001]), respectively. For any given cervical length measured after 22 weeks of gestation, the associated gestational length at birth in triplet pregnancies was lower by 2.7 weeks on average compared with twin pregnancies (P < .001). The higher rate of preterm birth in triplet pregnancies, compared with twin pregnancies, is reflected by both a more rapid cervical shortening during gestation and a lower gestational age at birth per any given cervical length.

Serial Change in Cervical Length for the Prediction of Emergency Cesarean Section in Placenta Previa.

PurposeTo evaluate whether serial change in cervical length (CL) over time can be a predictor for emergency cesarean section (CS) in patients with placenta previa.MethodsThis was a retrospective cohort study of patients with placenta previa between January 2010 and November 2014. All women were offered serial measurement of CL by transvaginal ultrasound at 19 to 23 weeks (CL1), 24 to 28 weeks (CL2), 29 to 31 weeks (CL3), and 32 to 34 weeks (CL4). We compared clinical characteristics, serial change in CL, and outcomes between the emergency CS group (case group) and elective CS group (control group). The predictive value of change in CL for emergency CS was evaluated.ResultsA total of 93 women were evaluated; 31 had emergency CS due to massive vaginal bleeding. CL tended to decrease with advancing gestational age in each group. Until 29–31 weeks, CL showed no significant differences between the two groups, but after that, CL in the emergency CS group decreased abruptly, even though CL in the elective CS group continued to gradually decrease. On multivariate analysis to determine risk factors, only admissions for bleeding (odds ratio, 34.710; 95% CI, 5.239–229.973) and change in CL (odds ratio, 3.522; 95% CI, 1.210–10.253) were significantly associated with emergency CS. Analysis of the receiver operating characteristic curve showed that change in CL could be the predictor of emergency CS (area under the curve 0.734, p < 0.001), with optimal cutoff for predicting emergency cesarean delivery of 6.0 mm.ConclusionsPrevious admission for vaginal bleeding and change in CL are independent predictors of emergency CS in placenta previa. Women with change in CL more than 6 mm between the second and third trimester are at high risk of emergency CS in placenta previa. Single measurements of short CL at the second or third trimester do not seem to predict emergency CS.

552: Distribution of change in cervical length in an unselected cohort of twin pregnancies across gestational ages

552: Distribution of change in cervical length in an unselected cohort of twin pregnancies across gestational ages

542: Cervical length change as a predictor of preterm birth in symptomatic patients

542: Cervical length change as a predictor of preterm birth in symptomatic patients

Do the levels of tumor makers or proinflammatory cytokines in mid-trimester cervical fluid predict early-stage cervical shortening?

In the present study, we aimed to assess the biomarkers in mid-trimester cervical fluid that can predict early stage cervical shortening. We obtained cervical swab specimens from 96 gravidas, after which the cervical length was measured, at approximately 20 weeks of gestation. Cervical length was measured again at 4 weeks after the initial examination. Cervical shortening was noted in 20 women between 20 and 24 weeks of gestation (group A), whereas no cervical shortening was noted in 76 women (group B). We evaluated the use of the levels of tumor markers, proinflammatory cytokines, and matrix metalloproteinase-8 (MMP-8) as candidate biomarkers. CA-125 and carcinoembryonic antigen levels were determined by using an automatic immunoassay system in both groups. Furthermore, IL-1β, IL-8, tumor necrosis factor-α, and MMP-8 levels were measured using an enzyme-linked immunosorbent assay. The levels of inflammatory cytokines and MMP-8 did not differ between the two groups, and were not correlated with cervical length or the change in cervical length. Although CA-125 and carcinoembryonic antigen levels were higher in group A, they were not statistically significant (P = 0.304 and 0.092, respectively). Early stage cervical shortening in mid-trimester was not associated with an increase in the levels of tumor markers or proinflammatory cytokines in cervical fluid.

Serial change in cervical length and the risk of emergent cesarean delivery in placenta previa

Serial change in cervical length and the risk of emergent cesarean delivery in placenta previa

EP01.09: Consecutive change of cervical length in placenta previa for the prediction of emergent Caesarean delivery

EP01.09: Consecutive change of cervical length in placenta previa for the prediction of emergent Caesarean delivery

Cervical Length and Maximum Vertical Pocket as Predictors of Gestational Age at Delivery in Pregnancies Treated With Selective Fetoscopic Laser Photocoagulation for Severe Twin–Twin Transfusion Syndrome [94

OBJECTIVE: To evaluate the effect of polyhydramnios on cervical length and whether cervical length recovery after amnioreduction during selective fetoscopic laser photocoagulation is associated with a greater gestational age at delivery in pregnancies complicated by severe twin–twin transfusion syndrome. METHODS: Retrospective study of pregnancies complicated by severe twin–twin transfusion syndrome treated by selective fetoscopic laser photocoagulation performed between March 2010 and October 2013 at a single center. Preoperative maximum vertical pocket and preoperative and postoperative cervical lengths were measured. The cervical length difference was calculated with a difference of ±3 mm considered no change. Data were analyzed with Spearman and Pearson correlation coefficients calculated for gestational age at delivery. RESULTS: Thirty-nine women were included in the study population. Preoperative (ρ=0.352; P=.035) and postoperative (ρ=0.332, P=.044) cervical lengths were found to have significant positive correlations with gestational age. A subgroup analysis excluding iatrogenic deliveries less than 34 weeks of gestation (n=22) showed a similar correlation with postoperative cervical length, but only a trend toward significance (ρ=0.379; P=.06). Change in cervical length and preoperative maximum vertical pocket were not statistically correlated with gestational age at delivery. The overall survival rate was 74.3% (57/78). There were two fetal survivors in 56.4% (22/39) and at least one survivor in 89.7% (35/39). CONCLUSION: Selective fetoscopic laser photocoagulation remains an effective therapy for pregnancies complicated by severe twin–twin transfusion syndrome. This study is concordant with prior research indicating that cervical length before and after treatment has a significant correlation with gestational age at delivery. However, severity of polyhydramnios and change in cervical length postprocedure were not found to be statistically significant.

Corticosteroid Use in the Face of Threatened Preterm Labor [165

BACKGROUND: Patients presenting with a shortened cervix and uterine contractility between 24 and 34 weeks of gestation are at risk for preterm delivery and candidates for administration of corticosteroids to abate associated neonatal mortality and morbidity. Our observations indicate that many patients treated with aggressive tocolytic agents deliver well beyond the 7-day steroid effectiveness, giving rise to concerns that such patients are receiving corticosteroids unnecessarily. The goal of this investigation was to determine the number of such cases. METHODS: One hundred six singleton pregnancies, with cervical lengths less than 25 mm, at risk of preterm labor, who subsequently delivered, were reviewed. Patients were stratified by delivery gestational age, ranging from less than 28 weeks of gestation to full term. Variables included maternal demographics, gestational age, and cervical lengths at admission and delivery, time of steroid administration, and neonatal outcomes. RESULTS: No differences were noted between admission cervical length (mean 11.4±9.7) and delivery. Likewise, admission cervical length at less than 34 weeks of gestation compared with deliveries at greater than 34 weeks of gestation were found to be nonsignificant (P=.27). Nor were dynamic changes in cervical length between groups significant (P=.15). Prior steroidal administration (days) to delivery was significant with those greater than 34 weeks of gestation receiving the earliest predelivery doses (mean 71.3±45.2, P<.001). This cohort encompassed 40.8% of the entire steroid group, thus nullifying treatment indications. All other factors were found to be nonsignificant. CONCLUSION: Careful assessment of several factors in women presenting in preterm labor must be taken into consideration before providing a regimen of care that may or may not be beneficial to the fetus or neonate.

Effectiveness of delayed absorbable monofilament suture in emergency cerclage

ObjectiveTo determine the sustained effects of emergency cerclage using slowly absorbable monofilament sutures, changes in cervical length after cerclage were evaluated in six cases. Materials and methodsA delayed absorbable monofilament suture (1 PDS-Plus; Ethicon, Inc., Somerville, NJ, USA) has been used for emergency cerclage after 20 weeks of gestation at Juntendo University Hospital since January 2011. A retrospective chart review was conducted including all of the patients undergoing emergency cerclage between January 2011 and August 2013. The patients' characteristics, perinatal outcome, cervical length, and obstetric data were collected. ResultsSix cases were identified from our medical records. Their characteristics and perinatal outcomes are shown in Table 1. Of the six cases, four had an extremely short cervix, with an average cervical length of 7.85 ± 3.38 mm, and two had prolapsed membranes. Fig. 1 shows the cervical length and the time elapsed after cerclage. There were no cases with shortening of the cervical length below the levels at the cerclage. ConclusionThis absorbable monofilament suture appears useful for emergency cerclage.

P17.14: Rate of change in cervical length and the risk of Caesarean delivery

<scp>P</scp>17.14: Rate of change in cervical length and the risk of Caesarean delivery

OC23.04: Normal range and longitudinal change of cervical length as a function of gestational age in pregnant women with triplet gestations

<scp>OC</scp>23.04: Normal range and longitudinal change of cervical length as a function of gestational age in pregnant women with triplet gestations

Consideration of effect of the amount of mandibular setback on the submental region in the planning of orthodontic–orthognathic treatment

Aesthetic outcome has gained in importance in the treatment of patients with orthognathic problems. Historically, Class III malocclusions have historically been treated by isolated mandibular setback and maxillary advancement, whereas bimaxillary procedures have recently become the more common option. Functional outcome and stability have been discussed previously. The aim of this observational study was to evaluate the effect of mandibular setback (BSSO) on the cervical region. We studied 38 Class III patients (20 women and 18 men, mean (SD) age 25 (0.8) years) who we identified from our clinical records and who were treated between 1 January 2002 and 30 December2012 with mandibular setback procedures and followed up for 6 months. To study the effect of the amount of mandibular setback on the aesthetic outcome we have distinguished between patients with less than 5mm setback and those with 5mm or more. In patients whose mandibular setback was less than 5mm there was no significant change in cervical length. However, it decreased significantly in patients in whom the movement was 5mm or more. Postoperatively the lip–chin–throat angle (p=0.02), the length of the lower lip (p=0.002), and the length of the upper lip (p=0.003) from the aesthetic line also differed significantly between the 2 groups. Our observations strongly suggest that all these relations should be considered when treatment is being planned to avoid an unpleasant aesthetic impact on the chin region.

818: Activity restriction does not slow the rate of cervical shortening in pregnancy

Despite being prescribed commonly in prenatal care, activity restriction (AR) has not been demonstrated to reduce the rate of preterm birth. The objective of our study was to determine if there is a difference in cervical length shortening in women prescribed AR during pregnancy when compared with women reporting normal and increased activity (IA). This was a secondary analysis of data from the Maternal-Fetal Medicine Unit Network Preterm Prediction Study. Participants reported on their level of activity and the recommendation for AR at 2 study visits beginning at ≥22 weeks gestation. We defined subjects as having IA if they reported participating in ≥2/7 activities considered more strenuous than normal. Subjects were then categorized into 3 groups: AR, normal activity, and IA. We compared cervical lengths (CL) measured by ultrasound at approximately 24 and 28 weeks gestation between the 3 groups. We also compared activity group with preterm or term delivery. Information was available regarding activity and CL for 2740 subjects. Of these, 354 (13%) reported AR at some point during pregnancy, 776 (28%) were considered IA and 1610 (59%) reported normal activity. Of subjects prescribed AR, 22% delivered preterm and 78% delivered at term. Subjects prescribed AR had significantly greater change in CL between the 2 visits compared with the normal and IA groups (2.8±0.4mm v 1.4± 0.1mm, p=0.0004, and 1.3±0.2mm, p=0.0005), respectively (Figure). When stratified by preterm versus term deliveries, the group reporting AR who delivered at term had the greatest change in cervical length (3.6±7.8mm, p=0.008) when compared with other groups. Activity restriction did not slow the rate of CL change. Increased activity did not speed the rate of CL change. The greatest change in CL was noted in the AR group who subsequently delivered at term. These data provide further support to stop prescribing AR for the prevention of preterm birth.

The use of cervical length and change in cervical length for prediction of spontaneous preterm birth in asymptomatic twin pregnancies

ObjectiveTo assess the association between cervical length (CL) and change of CL over two measurements and preterm birth (PTB) at <32 weeks in asymptomatic twin pregnancies. Study designThis study was undertaken in the multiple pregnancy antenatal clinic at the Security Forces Hospital (SFH), a tertiary care hospital in Riyadh, Saudi Arabia, between November 2005 and October 2010. This study involved 420 women with asymptomatic twin gestations, but only 209 unselected patients completed the study and met the inclusion criteria. All patients had a CL measurement by transvaginal ultrasound at 20–23 weeks, and a second CL measurement was done within 3–5 weeks of the initial measurement. Patients were classified into two groups, group A with significant shortening of CL, and group B without significant shortening of CL. Comparisons between the groups were performed using a chi-square test or a Fisher exact test for categorical variables, whereas Student's t-test or Wilcoxon's rank-sum test was used for continuous variables. We employed ROC curves to compare the diagnostic accuracy of actual cervical length and percent change in cervical length in predicting preterm birth events. All analyses were performed using the SAS/STAT software. ResultsThere were 35 (16.7%) patients whose CL shortened by ≥25% (group A), and 174 (83.3%) whose CLs either did not shorten or shortened by <25% (group B). Preterm birth at <28, <30, <32, and <34 weeks gestation was higher in group A than in group B even if the CL was >25mm. The use of CL shortening was superior, but not statistically significantly, to the use of CL for the prediction of PTB at <32 (P=0.0524) and <34 weeks (P=0.281), but CL was preferred for the prediction of PTB at <28 (P=0.037) and <30 weeks (P=0.0457). ConclusionThe test of two CL measurements, the first between 20 and 23 weeks gestation and another CL measurement 3–5 weeks later, with a difference of ≥25%, is a good predictor for preterm birth in asymptomatic twin pregnancies, even if the CL is >25mm.

Rate of Change in Cervical Length in Women With Vaginal Bleeding During Pregnancy

To evaluate whether women with known risk factors for preterm birth will manifest different rates of cervical shortening preceding a spontaneous preterm birth. We conducted a secondary analysis of data from the Maternal--Fetal Medicine Units Network Preterm Prediction Study. Known risk factors for preterm birth were recorded. Cervical lengths were measured between 22+0 weeks and 24+6 weeks, and again 4 weeks later. Cervical slope was defined as the change in cervical length between these visits divided by time (millimeters per week). Preterm birth was defined as preterm premature rupture of membranes or spontaneous preterm labor leading to delivery before 37 weeks of gestation. We analyzed the data for 2,584 women using logistic regression and tested for interaction between risk factors in the model to determine whether cervical shortening preceded preterm births in all variable groups. Cervical slope was not significantly associated with preterm birth (P=.9) in women with vaginal bleeding. Cervical slope was significantly associated with preterm birth in women without a history of vaginal bleeding (odds ratio 1.2, 95% confidence interval 1.1-1.4). Pregnancies without vaginal bleeding have a 20% increase in the risk of preterm birth for each additional millimeter per week increase in cervical slope. Pregnancies with vaginal bleeding are at risk for preterm birth but do not appear to undergo progressive cervical shortening. This suggests that women with vaginal bleeding undergo a different mechanism leading to preterm birth. II.