Delivery In Singleton Pregnancies Research Articles

Assessment of utero-cervical angle and cervical length as predictors for threatened preterm delivery in singleton pregnancies.

The aim of this study was to evaluate the relationship between the cervix and the threat of preterm labor in singleton pregnancies between gestational weeks less than 37 and greater than 37 weeks in correlation with utero-cervical angle (UCA) and cervical length (CL) measurements. We conducted a prospective cohort study with UCA and CL measurements in patients with threatened preterm labor (TPL). Primary outcome was differences in UCA and CL measurements in relationship to maternal characteristics and perinatal outcome between groups. Secondary outcome evaluated measurement results and influencing factors for delivery within 7 days, between 1 and 4 weeks and beyond 4 weeks. Overall 152 patients were divided into as study/preterm group (<37 weeks; n = 56) and the control/term group (≥37 weeks; n = 96). Mean gestational age at admission was similar in both groups (30.98 ± 2.83 vs. 30.36 ± 2.63 weeks, p = 0.149) with similar CL (33.9 ± 6.34 vs. 32.02 ± 8.88 mm, p = 0.132), but wider UCA in the preterm group (81.65 ± 16.81° vs. 99.21 ± 22.33°, p < 0.001). Multivariate logistic regression analysis for preterm delivery was significant for nulliparity and UCA measurement. The factor for delivering before 37 gestational weeks within 7 days was the gestational week at admission (p = 0.046). UCA and CL measurements were statistically significant for distinguishing patients for delivery within 7 days and beyond 4 weeks (p = 0.001 for CL and p = 0.0001 for UCA). NPV was found 92.5, 92.2, and 92.3 for UCA >105°, CL ≤30 mm, and Bishop score >3, respectively. Combined measurement of TV UCA and CL represents stronger predictors for sPTB ultrasonographically, demonstrating the uterocervical sub-segment maturation before the active onset of labor.

Cervical Pessary for Prevention of Preterm Birth in Individuals With a Short Cervix

A short cervix as assessed by transvaginal ultrasound is an established risk factor for preterm birth. Study findings for a cervical pessary to prevent preterm delivery in singleton pregnancies with transvaginal ultrasound evidence of a short cervix have been conflicting. To determine if cervical pessary placement decreases the risk of preterm birth or fetal death prior to 37 weeks among individuals with a short cervix. We performed a multicenter, randomized, unmasked trial comparing a cervical pessary vs usual care from February 2017 through November 5, 2021, at 12 centers in the US. Study participants were nonlaboring individuals with a singleton pregnancy and a transvaginal ultrasound cervical length of 20 mm or less at gestations of 16 weeks 0 days through 23 weeks 6 days. Individuals with a prior spontaneous preterm birth were excluded. Participants were randomized 1:1 to receive either a cervical pessary placed by a trained clinician (n = 280) or usual care (n = 264). Use of vaginal progesterone was at the discretion of treating clinicians. The primary outcome was delivery or fetal death prior to 37 weeks. A total of 544 participants (64%) of a planned sample size of 850 were enrolled in the study (mean age, 29.5 years [SD, 6 years]). Following the third interim analysis, study recruitment was stopped due to concern for fetal or neonatal/infant death as well as for futility. Baseline characteristics were balanced between participants randomized to pessary and those randomized to usual care; 98.9% received vaginal progesterone. In an as-randomized analysis, the primary outcome occurred in 127 participants (45.5%) randomized to pessary and 127 (45.6%) randomized to usual care (relative risk, 1.00; 95% CI, 0.83-1.20). Fetal or neonatal/infant death occurred in 13.3% of those randomized to receive a pessary and in 6.8% of those randomized to receive usual care (relative risk, 1.94; 95% CI, 1.13-3.32). Cervical pessary in nonlaboring individuals with a singleton gestation and with a cervical length of 20 mm or less did not decrease the risk of preterm birth and was associated with a higher rate of fetal or neonatal/infant mortality. ClinicalTrials.gov Identifier: NCT02901626.

Investigating the Shape and Strength of the Relationship Between Maternal Weight Gain and Gestational Age at Delivery in Twin and Singleton Pregnancies.

Both inadequate and excessive maternal weight gain are correlated with preterm delivery in singleton pregnancies, yet this relationship has not been adequately studied in twins. We investigated the relationship between time-varying maternal weight gain and gestational age at delivery in twin pregnancies and compared it with that in singletons delivered in the same study population. We used serial weight measurements abstracted from charts for twin and singleton pregnancies delivered during 1998-2013 in Pittsburgh, Pennsylvania. Our exposure was time-varying weight gain z score, calculated using gestational age-standardized and prepregnancy body mass index-stratified twin- and singleton-specific charts, and our outcome was gestational age at delivery. Our analyses used a flexible extension of the Cox proportional hazards model that allowed for nonlinear and time-dependent effects. We found a U-shaped relationship between weight gain z score and gestational age at delivery among twin pregnancies (lowest hazard of delivery observed at z score= 1.2), which we attributed to increased hazard of early preterm spontaneous delivery among pregnancies with low weight gain and increased hazard of late preterm delivery without labor among pregnancies with high weight gain. Our findings may be useful for updating provisional guidelines for maternal weight gain in twin pregnancies.

The role of the PLGF in the management of pregnancies complicated with fetal microsomia.

To explore the contribution of maternal and fetal parameters in predicting the time interval between diagnosis and development of adverse events leading to delivery in singleton pregnancies complicated with fetal microsomia. Prospective study on singleton pregnancies referred to a tertiary center because of suspicion of fetal smallness in the third trimester. The study cohort included cases with fetal abdominal circumference (AC) ≤ 10th centile or estimated fetal weight ≤ 10th centile or umbilical artery pulsatitlity index ≥ 90th centile. Development of pre-eclampsia, fetal demise, and fetal deterioration diagnosed by fetal Doppler studies or fetal heart rate monitoring and leading to delivery were considered as adverse events. Maternal demographics, obstetric history, blood pressure, serum PLGF, and fetal Doppler studies were explored as predictors of the time interval between the first visit to the clinic and the diagnosis of complications. In 59 women, the median incubation period from presentation to the clinic to an adverse event was 6, 2weeks, whereas half of the pregnancies (52.5%) did not develop any adverse event. PLGF was the strongest predictor of adverse events. Both PLGF in raw values and PLGF MOM had equally good predictive ability (AUC 0.82 and 0.78 respectively). Optimal cut-off points were 177.7pg/ml for PLGF raw values (sensitivity 83% and specificity 66.7%) and 0.277 MoM (sensitivity 76% and specificity 86.7%). On multiple Cox regression analysis, maternal systolic blood pressure, PLGF, fetal increased umbilical artery PI, and reduced CP ratio were independently associated with adverse events. Half of the pregnancies with low PLGF and only one in ten with high PLGF were delivered within two weeks after the initial visit. Half of the pregnancies carrying a small fetus in the third trimester will not develop maternal or fetal complications. PLGF is a strong predictor of adverse events that can be used to customize antenatal care.

Analysis of Delivery in Singleton Pregnancies Achieved by In Vitro Fertilization

BACKGROUND: Birth after IVF is increasingly observed in modern obstetrics, so knowledge of its features is of paramount importance for clinical practice. &#x0D; AIM: The purpose of our study was to compare IVF and spontaneous singleton pregnancies in terms of cesarean section rate, operative vaginal birth rate, induction of labor, manual removal of the placenta in vaginal births, severe PPH and need for blood transfusion after delivery.&#x0D; &#x0D; MATERIAL AND METHODS: We conducted a retrospective study at "Maichin Dom" University Hospital in Sofia, Bulgaria for the period from January 2013 to December 2017 and analyzed 402 singleton IVF pregnancies and compared them with 523 spontaneous singleton pregnancies &#x0D; &#x0D; RESULTS: We found a significantly higher rate of cesarean sections in IVF compared to spontaneous pregnancies [OR 1.73; 95% CI 1.4-2.14; p&lt;0.001]. Vaginal delivery after IVF is associated with a higher incidence of operative vaginal delivery than spontaneous pregnancies [OR 2.27; 95% CI 1.14 - 4.52; p=0.018]. No statistical differences in rates of labor induction and manual removal of the placenta between two groups were estimated (p&gt;0.05). Severe PPH and blood transfusions were three times higher in patients after IVF undergoing a cesarean section than in those with spontaneous singleton pregnancies [OR 3.0; 95% CI 1.11 - 8.11; p=0.018].&#x0D; &#x0D; CONCLUSION: IVF singleton pregnancies are associated with a higher risk of cesarean section as well as some obstetric complications. Obstetricians should treat these pregnancies with caution in order to reduce cesarean section rate and improve the outcome.

Risk Factors Associated with Preterm Delivery in Singleton Pregnancy in a Tertiary Care Hospital in South India: A Case Control Study.

BackgroundPreterm delivery is a major obstetric complication and a leading cause of neonatal mortality and morbidity. It is also associated with significant costs in terms of psychological and financial hardship, to the families.ObjectiveThe primary objective of this study was to determine the risk factors associated with all preterm deliveries in singleton pregnancy in a tertiary care hospital and the secondary objective was to determine the fetal outcomes among women with preterm delivery.Materials and MethodsA case control study was conducted between January 2019 and June 2019 in the Department of Obstetrics and Gynecology of a tertiary care center in Central Kerala, India. Women who delivered before 37 completed weeks of gestation were taken as cases and those who delivered at or after 37 weeks were considered as controls in a 1:1 ratio, approximately. Data regarding 191 cases and 200 controls were taken from delivery room records of the years 2016 to 2018 with the help of a predesigned checklist. Univariate and multivariate analysis were done to determine the magnitude of association between the exposure factors and preterm delivery.ResultsThe mean age of study participants among the cases was 29.3 ± 5.1 years and controls was 28.1 ± 4.4. Pregnancy induced hypertension (aOR = 14.60; 95% CI 4.8, 44.1; p<0.001), abnormal amniotic fluid volume (aOR = 10.68; 95% CI 3.46, 32.98; p<0.001), premature rupture of membranes (PROM) (aOR = 10.27; 95% CI 4.82, 21.86; p<0.001), previous history of preterm delivery (aOR = 4.12; 95% CI 1.22, 13.85; p<0.002), history of urinary tract infection (UTI) during pregnancy (aOR = 3.67; 95% CI 1.39, 9.68; p<0.002), systemic diseases (aOR = 2.78; 95% CI 1.28, 6.39; p<0.001), anaemia (aOR = 2.54; 95% CI 1.28, 5.03; p<0.004) were found to be the independent risk factors for preterm delivery. On analyzing the fetal outcomes, the average birth weight of preterm babies was 2 ± 0.6 kg compared to 3.1kg among term babies.ConclusionEarly detection and adequate treatment of various conditions like anaemia, pregnancy induced hypertension, UTI and systemic illness can help in reduction of the prevalence of preterm delivery.

The Feasibility of Cervical Elastography in Predicting Preterm Delivery in Singleton Pregnancy with Short Cervix Following Progesterone Treatment.

Previous studies demonstrated an association between cervical strain and risk of spontaneous preterm delivery (sPTD). The present study aimed to assess the efficacy of elastography in predicting sPTD at <32 weeks of gestation in women with singleton pregnancies receiving progesterone for short cervix (≤2.5 cm) diagnosed between 16 and 28 weeks of gestation Among 115 participants eligible for analysis, nine had sPTD at <32 weeks. Preprogesterone (PP0) mean internal os strain (IOS), elasticity contrast index (ECI), hardness ratio (HR), one-week postprogesterone (PP1) IOS, mean external os strain (EOS), ECI, and HR were significantly different between groups. Higher PP0 IOS, PP1 IOS, and PP1 EOS were associated with a 2.92, 4.39 and 3.65-fold increase in the risk of sPTD at <32 weeks, respectively (adjusted for cervical length (CL) at diagnosis; p = 0.04, 0.012 and 0.026, respectively). A combination of CL at diagnosis, PP0 IOS and PP1 EOS showed a significantly higher area under the receiver operating characteristic curve (0.858) than that of CL alone (p = 0.041). In women with singleton pregnancies receiving progesterone for short cervix, cervical elastography performed before and one week after progesterone treatment may be useful in predicting sPTD at <32 weeks of gestation.

Maternal History and First Trimester Biochemical and Biophysical Markers in the Prediction of Spontaneous Preterm Delivery in Singleton Pregnancies

Maternal History and First Trimester Biochemical and Biophysical Markers in the Prediction of Spontaneous Preterm Delivery in Singleton Pregnancies

Sonoelastographic Assessment of the Uterine Cervix in the Prediction of Imminent Delivery in Singleton Nulliparous Women Near Term: A Prospective Cohort Study.

To explore the role of newly developed software to assess cervical sonoelastography in predicting the onset of spontaneous delivery in singleton pregnancies at term and to compare its diagnostic performance with that provided by the cervical length (CL) and posterior cervical angle (PCA). This work was a prospective study including nulliparous singleton pregnancies at gestational ages of 37 weeks to 38 weeks 6 days. The CL, PCA, hardness ratio (HR), and mean strain from the internal os and external os were obtained by a transvaginal ultrasound approach using semiautomatic software (E-Cervix; Samsung Medison Co, Ltd, Seoul, Korea). Multivariate logistic regression and area under the curve analyses were used to test the strength of the association and the diagnostic performance of the variables considered in predicting delivery within 7 days. A total of 398 women were included, and 24.6% delivered within 7 days. The CL was shorter (19.5 versus 2 7 mm; P = .0001), PCA narrower (99° versus 102°; P = .02) HR lower (35.3 versus 40.7; P = .0001), mean strain from the external os higher (0.41 versus 0.35; P = .0001), and mean strain from the internal os higher (0.38 versus 0.33; P = .0001) higher in women who delivered within 7 days from the assessment. At the multivariable logistic regression analysis, the CL (adjusted odds ratio, 1.307) and HR (adjusted odds ratio, 1.227) were the only variables independently associated with delivery within 1 week. A model combining the CL and HR showed an area under the curve of 0.873 in predicting delivery within 7 days, higher than that obtained by using the CL and HR singularly (P ≤ .0001). The HR assessed by sonoelastography improves the efficacy of the CL in predicting imminent delivery in nulliparous women close to term.

Risk of preterm delivery in singletons conceived by in vitro fertilization

To evaluate the preterm delivery and other obstetrics complications similar in singleton pregnancies achieved through IVF compared to spontaneous pregnancies. Retrospective case-control study included 1663 women with singleton pregnancies following IVF-ICSI (study group) and 3326 women with singleton spontaneous pregnancies (control group) who delivered between January 2015 and January 2018 at the Peking University Third Hospital. The control group matched 1:2 by age, BMI, parity, and gravidity. Maternal outcomes included preterm delivery and complications. There was significantly higher incidence of gestational diabetes, hypertensive disorders, and placenta previa in IVF-ICSI pregnancies versus controls (p < .05). IVF-ICSI resulted in significantly higher rate of preterm birth than in spontaneous pregnancies (p < .05) and the difference remained significant for deliveries that occurred before 28, 32, and 34 weeks gestation (p < .05). Multivariate logistic regression analysis revealed that female-factor infertility, hypertensive disorder, placenta previa, and PROM were significant prognostic factors associated with increased risk of prematurity. IVF-ICSI is associated with increased risk of obstetric complications including preterm delivery in singleton pregnancies. Female-factor infertility is an independent prognostic factor for preterm birth. This information is important for patient counseling and helps to refine the recommendation to optimize maternal health before embarking on fertility treatments.

Cervical Length as a Predictor of Latency Interval in Twin Pregnancies With Preterm Prelabor Rupture of Membranes [35H

INTRODUCTION: Preterm prelabor rupture of membranes (PPROM) is a significant risk factor for preterm birth, carrying medical, financial and psychological burden. Predicting onset of labor after PPROM can result in timely interventions, including appropriate transfer to tertiary care centers. Ultrasound-measured cervical length can predict preterm delivery in singleton pregnancies with PPROM, but no data exists in twins. Therefore, we sought to determine whether cervical length could predict latency interval in twin pregnancies with PPROM. METHODS: Using the BORN Database, we performed a retrospective study identifying 43 twin pregnancies between 2012-2016 complicated by PPROM at McMaster University, Canada. Cervical length was determined by ultrasound measurement. We then compared our primary outcome, latency to labor in those pregnancies with cervical lengths less than 25 mm to those greater than 25 mm and results were analyzed by Mann-Whitney statistical analysis. Additional secondary measures compared the groups on length of stay, PPROM parameters and neonatal outcomes. RESULTS: We determined that the average latency interval in those twin pregnancies with cervical lengths less than 25 mm is statistically significantly shorter than in those with cervical lengths greater than 25 mm (49.2 vs. 196.0 hours, p=0.035). The average length of stay was also significantly greater in those with longer cervical lengths (5.52 vs. 11.05 days, p=0.03). Potential confounders such as parity, chorionicity, erythromycin or magnesium sulfate did not have any significant effect by ANCOVA regression analysis. CONCLUSION: In those twin pregnancies complicated by PPROM, cervical lengths less than 25 mm are associated with shorter latency intervals, which may prompt critical, timely intervention in this group.

Predictors of Caesarean Delivery in Preterm Premature Rupture of Membranes.

BACKGROUND:Preterm premature rupture of membranes (P-PROM) exerts a tremendous influence on pregnancy prognosis. Additionally, it is a major public health concern, as the cause of up to 40% of all preterm births.AIM:The objective of this study was to identify predictors of Caesarean Delivery in singleton pregnancies complicated by P-PROM.MATERIALS AND METHODS:This is a retrospective observational study of all consecutive singleton P-PROM deliveries (24-37 weeks) over an 18 months at a tertiary referral centre. Pertinent data was collected comprising demographics, obstetric history, pregnancy-associated pathology and delivery from electronic patient records. Univariate statistical analysis comprised Odds Ratio, 95% Confidence interval and Chi-square test with subsequent p-value with statistical significance set at p < 0.05.RESULTS:A total of 240 women delivered singletons following P-PROM over an 18-month period. Maternal age ranged between 12-41 years with an average age of 28 ± 6.27 years. Vaginal delivery (VD) was the predominant mode of delivery, accounting for 52.9% (n = 127) of deliveries. The following parameters were identified as predictors of Caesarean Section (CS) in P-PROM: vaginal infection (p = 0.04), previous CS (p < 0.0001), primiparity (p = 0.004), gravidity > 5 (p = 0.009), university education (p = 0.0006) and prenatal care (p < 0.0001).CONCLUSION:The advantage of CS over vaginal delivery is expedited delivery of the distressed fetus, while that of vaginal delivery entails avoiding postoperative morbidity. However, large multicentric randomised-controlled studies are needed to elucidate this dilemma definitively.

Can myometrial thickness/cervical length ratio predict preterm delivery in singleton pregnancies with threatened preterm labor? A prospective study.

To investigate whether myometrial thickness (MT) to cervical length (CL) ratio could be used in the prediction of preterm birth (PTB) in singleton pregnancies presented with threatened preterm labor (TPL). After 48h of successful tocolysis, MT was measured transabdominally from the fundal, mid-anterior walls and the lower uterine segment (LUS) in 46 pregnancies presented with TPL. MT measurements were divided into CL, individually. The main outcome was PTB before 37weeks of gestation. The patients were divided into two groups as women delivered ≥ 37weeks (38.68 ± 1.01weeks) (n = 25) and those delivered < 37weeks (34.28 ± 2.53weeks) (n = 21). The mean ± SD CL in the preterm delivery group was significantly shorter than the term delivery group (23.77 ± 9.23 vs 29.91 ± 7.03mm, p < 0.05). Fundal, mid-anterior or LUS MT values were similar in both groups. However, in those who delivered preterm, the ratios of fundal MT-to-CL (p = 0.026) and mid-anterior MT-to-CL (p = 0.0085) were significantly different compared to those delivered at term. The optimal cutoff values for CL, fundal MT-to-CL and mid-anterior MT-to-CL ratios in predicting PTB were calculated as 31.1mm, 0.19 and 0.20, respectively. Fundal MT-to-CL ratio predicted preterm delivery with 71% sensitivity, 72% specificity, 68% positive and 75% negative predictive values. For mid-anterior MT-to-CL ratio, respective values were 76, 76, 73 and 79%. Measurement of MT along with CL may offer a promising method in the management of women presented with TPL.

Evaluation of umbilical cord pulsatility after vaginal delivery in singleton pregnancies at term

ObjectivesTo define the duration of umbilical cord pulsatility (UCP) after vaginal delivery and to evaluate its possible association with maternal characteristics and obstetric and neonatal variables. Study designProspective observational study on women with a singleton pregnancy at term who had a vaginal delivery and cord clamping at the cessation of pulsations. The collection of UCP duration was performed through a stopwatch and by manual palpation of the umbilical cord. Maternal (age, BMI, parity, antepartum hemoglobin), obstetric (pregnancy characteristics, gestational age at delivery, induction of labor, duration of the first, the second and the third stage of labor, post-partum blood loss, umbilical cord length) and neonatal (birthweight, Apgar score, hematocrit, hemoglobin) variables were then compared between two groups: long-term vs. short-term UCP. ResultsA total of 102 women were identified. The median duration of UCP after birth was 213 s (IQR 120, 420), corresponding to 3 min and 33 s. The long-term UCP group (n = 51) had a significantly longer duration of third stage of labor (median 12 vs. 8 min, p < 0.001) and a significantly higher birthweight (median 3530 g vs. 3250 g, p = 0.005) compared with the short-term UCP group (n = 51). No differences in the other variables were found between groups. ConclusionFor the first time we have reported the duration of UCP after vaginal delivery. An increased duration of UCP is associated with a prolonged duration of third stage of labor and a higher birthweight.

Associations between second-trimester amniotic fluid levels of ADAMTS4, ADAMTS5, IL-6, and TNF-α and spontaneous preterm delivery in singleton pregnancies.

Background We investigated the roles of inflammatory cytokines and the A disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) family in the etiopathogenesis of spontaneous preterm delivery by comparing the ADAMTS4, ADAMTS5, interleukin (IL)-6, and tumor necrosis factor-α (TNF-α) levels in second-trimester amniotic fluid between pregnant women with preterm birth and term controls. Methods All pregnant women who underwent second-trimester amniocentesis for genetic analysis between January 1, 2016, and January 1, 2018, were enrolled in this study. From this cohort, 22 patients who subsequently experienced spontaneous preterm delivery before 34 weeks of pregnancy formed the study group, and 22 age- and body mass index (BMI)-matched patients without preterm birth constituted the control group. Results No significant differences were observed between the preterm birth and control groups in terms of age, BMI, obstetric history of preterm delivery, gestational age at amniocentesis, or indication for amniocentesis. The mean amniotic fluid levels of ADAMTS4 and ADAMTS5 were significantly increased in the preterm birth group compared to the control group (248.3±22.6 and 182.4±19.8 pg/mL, P=0.012; and 198.6±21.6 and 159.1±21.7 pg/mL, P=0.035, respectively). Significantly increased IL-6 and TNF-α levels were also detected in the amniotic fluid of women who experienced spontaneous preterm delivery, relative to controls (142.1±16.2 and 95.8±16.4 pg/mL, P<0.001; and 139.4±12.5 and 89.6±11.2 pg/mL, P<0.001, respectively). Conclusion The results of this study imply that increased mid-trimester amniotic fluid levels of ADAMTS4, ADAMTS5, IL-6, and TNF-α play an important role in the pathophysiology of spontaneous preterm delivery.

The diagnostic value of cervicovaginal and serum ferritin levels in relation to spontaneous preterm delivery

Objective The objective of the study was to detect the diagnostic value of cervicovaginal and serum ferritin levels in 20–24 weeks of gestation in the prediction of spontaneous preterm delivery in singleton pregnancies with no well-known risk factors of preterm delivery. Background Preterm delivery is one of the most important health problems in the world that may lead to severe short-term and long-term medical and developmental problems in infants. Patients and methods Venous blood and cervicovaginal fluid samples are drawn from 100 women with singleton pregnancies within 20–24 weeks of gestation at the Department of Obstetric and Gynecologies, El Mehalla Hospital and then they were followed up and the term of delivery were noted. Results Spontaneous preterm delivery in singleton pregnancies with no well-known risk factors is associated with increased levels of cervicovaginal and serum ferritin when measured within 20–24 weeks of gestation and there is a strong positive correlation between both serum and cervicovaginal ferritin levels measuring 0.83. However, the only significant predictor is serum ferritin as an increase by one unit of its value increases the preterm risk by 1.277. About 85% of preterm deliveries can be predicted by serum ferritin. Conclusion It has been observed that 20–24 weeks of gestation serum ferritin level is a significant predictor of preterm delivery in singleton normal pregnancies.

The predictive value of ultrasound cervical measurements for obstetrical outcomes after history-indicated cerclage in singleton pregnancies with sonographic short cervix

Objectives To determine which transvaginal cervical sonographic measurements before and after a history-indicated cervical cerclage are associated with preterm delivery in singleton pregnancies with sonographic short cervix. Methods We conducted a case-control study of all women with a singleton gestation with sonographic short cervix and a history-indicated cerclage placed at a single center between January 1, 2015, and October 1, 2018. Cervical cerclage operations were performed between 12 and 16 weeks' gestation. Obstetrical outcomes were defined as women who delivered before 34 weeks' gestation and delivered at or after 34 weeks. Transvaginal cervical measurements of cervical length, funnel length, total cervical length, funnel diameter and measurement difference obtained before and after cervical cerclage were compared between the two groups. Bivariable, multivariable, and log rank analyses were performed. Results A total of 213 women met inclusion criteria, with 46 (21.6%) delivering before 34 weeks. Cervical length before cerclage of less than 1.0 cm, funnel diameter before cerclage of greater than 2 cm and a total cervical length difference before and after cerclage of less than 1.5 cm were associated with an increased odds of preterm birth before 34 weeks in the bivariable analysis [odds ratio (OR), 11.7 (95% confidence interval (CI), 2.5-52.9), 7.8 (95% CI, 1.9-31.7), and 6.9 (95% CI, 2.1-33.8), respectively], whereas funnel length before cerclage of less than 1 cm was not significantly associated with delivery before 34 weeks [OR, 1.7 (95% CI, 0.7-4.1)]. In multivariable analysis, only funnel diameter before cerclage of greater than 2 cm remained associated with preterm delivery before 34 weeks [adjusted OR, 9.8 (95% CI, 3.5-74.9)]. Conclusions In singleton pregnancies with sonographic short cervix who received a history-indicated cerclage, funnel diameter before cerclage of greater than 2 cm is the most predictive cervical measurement for cervical cerclage failure and the only independently significant sonographic finding associated with an increased risk of preterm birth before 34 weeks.

Longitudinal change of sFlt-1/PlGF ratio in singleton pregnancy with early-onset fetal growth restriction.

To describe the evolution of soluble fms-like tyrosine kinase-1 to placental growth factor (sFlt-1/PlGF) ratio in the last 5 weeks prior to delivery in singleton pregnancy complicated by early-onset fetal growth restriction (FGR), with or without pre-eclampsia (PE). This was a prospective observational cohort study of early-onset FGR cases that underwent serial assessment of maternal serum sFlt-1/PlGF ratio from diagnosis to delivery. Measurements were made at weekly intervals and within the last 48 h before birth. Absolute values and percentage increase between time intervals were computed, and previously described cut-off values of 38 (suspicion of PE), 85 (aids diagnosis of PE) and 655 (high risk for imminent delivery) were used for analysis of the sFlt-1/PlGF ratio. We compared findings between cases with early-onset FGR only (n = 37) and those that additionally developed PE (n = 36). Overall perinatal survival was 63/73 (86.3%). A sFlt-1/PlGF ratio above 38 was observed 4 weeks before delivery in most FGR-only and FGR with PE cases (73% and 100%, respectively), but absolute values of sFlt-1/PlGF were significantly higher in FGR cases with PE. Extremely elevated values of the ratio (≥ 655) within the last 48 h before delivery were found in 65% of cases of FGR with PE, but in only 8% of isolated FGR cases (P < 0.001). Elevated sFlt-1/PlGF was observed in most early-onset FGR pregnancies from 4 weeks before delivery, and values were even higher if there was concurrent PE. However, serial measurements of the ratio were of limited value, being useful only to anticipate the need for imminent delivery in cases of FGR with PE when sFlt-1/PlGF values ≥ 655 were reached. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

937: Mode of delivery for malpresentation and maternal outcomes in low- and middle-income countries

To improve neonatal outcomes, most high-income countries have adopted cesarean as the primary mode of delivery for breech and other malpresentations. In some low- and middle-income countries, cesarean delivery is not as widely available, and concern exists over increased maternal risk in these settings. We examined maternal morbidity and mortality by mode of delivery for malpresentation in low- and middle-income countries. Using the NICHD Global Network’s prospective, multi-country, population-based maternal-newborn registry of pregnancy outcomes from 2010-2016, we performed a cohort study of maternal outcomes by mode of delivery in singleton pregnancies with malpresentations. We examined rates of cesarean delivery for malpresentation and compared rates of maternal morbidity and mortality between cesarean and vaginal delivery by geographic region. Of 436,112 women enrolled at seven sites in six countries over the study period, 8,872 (2%) deliveries had malpresentation and were included. The rate of cesarean for malpresentation differed significantly by study site, ranging from 22% in Zambia to 87% in Napgur, India (Figure). When maternal complications and mortality rates were compared for cesarean and vaginal deliveries, higher rates of postpartum hemorrhage were seen in the vaginal delivery group across all geographic regions (Table). After adjusting for region, the relative risk for postpartum hemorrhage associated with cesarean delivery was 0.20 (95% CI 0.14, 0.28). Aggregate maternal mortality was also higher in the vaginal delivery group, although the direction of the risk estimates was inconsistent across regions and the number of maternal deaths was overall small. Women enrolled in study sites in Africa had lower rates of cesarean for malpresentation compared to those at study sites in India and Guatemala. We found that cesarean delivery for malpresentation is associated with decreased maternal risk for postpartum hemorrhage in this cohort of deliveries in low- and middle-income countries. Further research is needed to understand this association.

Difficulty of embryo transfer does not predict failed attempt at vaginal delivery in singleton pregnancies

Difficulty of embryo transfer does not predict failed attempt at vaginal delivery in singleton pregnancies