Length In Women Research Articles

Anterior Cruciate Ligament Tibial Footprint Size as Measured on Magnetic Resonance Imaging: Does It Reliably Predict Actual Size?

Background: Measuring the size of the anterior cruciate ligament (ACL) tibial footprint on magnetic resonance image (MRI) is common for preoperative planning of ACL reconstruction. However, the accuracy of such measurement has not been well documented. Purpose: To investigate whether the actual size of the ACL tibial footprint could be predicted by its measurement on MRI and to develop equations to improve the accuracy of predicting the actual size based on MRI measurement. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 164 patients with normal visualized ACL in gross evaluation and MRI were included (mean ± SD age, 67.3 ± 8.3 years). Cases with ACL tear, severe mucoid degeneration, osteophyte around the ACL tibial insertion, or intervals >12 months between MRI and actual measurement were excluded. The ACL tibial footprint was carefully dissected and measured during total knee arthroplasty. The length of the ACL tibial footprint on MRI was measured on a sagittal image, while the width was measured on an oblique coronal image. For the ACL tibial footprint, the association between measurement on MRI and actual measurement of length and width was analyzed via univariable and multivariable regression analyses. Reliability of measurements on MRI was also evaluated. Results: The length and width of the ACL tibial footprint as measured on MRI showed strong correlation with the actual length and width (coefficients: ρ = 0.904 and ρ = 0.808, respectively). There were differences between ACL size on MRI and its actual size: length, 12.4 mm (range, 9.7-15.3 mm) vs 13.8 (10.6-17.8) (P < .001); width, 8.8 mm (range, 7.0-12.1 mm) vs 7.2 (5.8-10.4) (P < .001). Based on sex, there were also differences between the size per MRI and the actual size (P < .001 for all): length in men, 12.6 mm (range, 10.9-15.3 mm) vs 14.2 (12.3-17.8); length in women, 12.4 mm (range, 9.7-14.5 mm) vs 13.7 (10.6-15.8); width in men, 9.3 mm (range, 8.0-12.1 mm) vs 7.6 (5.8-10.4); width in women, 8.7 mm (range, 7.0-10.4 mm) vs 7.2 (5.8-9.7). The actual length of the ACL tibial footprint could be predicted by its length on MRI and sex (R2 = 0.83, P < .001). Similarly, actual width could be predicted by the width on MRI and sex (R2 = 0.75, P < .001). All intraclass correlation coefficients were >0.8, indicating good reliability. Conclusion: Measurements of the size of the ACL tibial footprint on MRI showed strong correlation with its actual size. Prediction equations showed good concordance correlation coefficients.

Hairline Restoration: Difference in Men and Woman—Length and Shape

Hair restoration has become increasingly popular in recent years with both men and women. New technologies such as follicular unit extraction and grafting have made it possible for patients to get a natural looking result with minimal downtime. Men usually experience hairline recession as a result of androgenic alopecia, while women most commonly experience thinning of the crown and vertex, with the preservation of the hairline. However, there is a growing population of women who wish to advance their hairline forward because of congenital high hairline, traction alopecia, or previous facial cosmetic surgery. There are several key differences between the female and male hairline. Understanding such differences and following certain guidelines will help the facial plastic surgeon to obtain beautiful and natural appearing results.

The Effect of Resistance Training on Telomere Length in Women Recovering from Breast Cancer

The purpose of this exploratory analysis was to examine the effects of resistance training (RT) on leukocyte telomere length in breast cancer survivors. Samples from 33 breast cancer survivors were analysed following a 16-week RT or usual care intervention (RT: n = 19, control: n = 14). The RT group performed supervised exercise three times per week. Leukocyte telomere length was assessed before and after training using quantitative PCR. Changes in telomere length were analysed using ANCOVA, with the change score being the dependent variable, and the baseline value the covariate. Effect sizes (ES) were calculated via partial eta squared. We found a non-statistically significant change in telomere length, and a small associated ES in the RT group compared to the control group for change in telomere length (p = 0.78, ES = 0.003). Our exploratory study demonstrates that a 16-week RT intervention does not have a significant effect on telomere length in women recovering from breast cancer. Therefore, RT is a safe intervention that does not accelerate biological ageing.

Menstrual characteristics in Korean women with endometriosis: a pilot study.

ObjectiveThis study aimed to determine whether the menstrual characteristics are different in Korean women with or without ovarian endometrioma.MethodsWe selected 95 premenopausal women aged below 39 years who underwent laparoscopic surgery for ovarian endometrioma (n=46) or other benign ovarian tumors (n=49) between April 2016 and February 2017. We excluded those with uterine diseases that could potentially affect the menstrual characteristics and those on anticoagulants or hormonal medication. At admission, menstrual characteristics such as cycle length, cycle regularity, and menstrual duration, were collected. In addition, amount of menstrual bleeding and severity of dysmenorrhea were recorded using a pictorial blood loss assessment chart (PBAC) and visual analogue scale, respectively.ResultsAge and parity were similar in both women with ovarian endometrioma and women with other benign ovarian tumors. Body mass index (BMI) was significantly lower (median, 20.9 vs. 22.1 kg/m2; P=0.031) in women with ovarian endometrioma. The amount of menstrual bleeding (median PBAC score, 183 vs. 165), menstrual duration (median, 6 vs. 6 days), and cycle length in women with regular cycle (median, 29.0 vs. 29.2 days) were not different between the 2 groups. Pain score was significantly higher (median, 4 vs. 3; P=0.005) in women with ovarian endometrioma.ConclusionWe found that the menstrual characteristics between women with ovarian endometrioma and women with other benign ovarian tumors were similar. We also observed that low BMI may be one of the risk factor for endometriosis.

Progress in Endovascular Aortic Repair for Women.

The diagnosed prevalence of abdominal aortic aneurysm (AAA) in women is approximately 20% of that in men.1–3 Therefore, women are underrepresented in epidemiologic studies and trials in which screening and therapeutic methods are evaluated. Consequently, central issues related to AAA in women have not been fully investigated.First, screening recommendations provide inadequate guidance for women. The United States Preventive Services Task Force has concluded that insufficient evidence exists for screening women with a history of smoking and has advised against screening women who have never smoked.4 The only prospective studies of ultrasound screening in women yielded no difference in mortality rates at 10 years.3,5 Subsequent efforts to identify women at high risk of AAA have been more promising.6,7Female sex is associated with a more rapid aneurysmal growth rate and earlier rupture.8,9 These findings suggest that women might benefit more from earlier AAA repair than do men. In addition, AAAs in women are more likely to have complex features.10 The median infrarenal aortic neck length in women is 12 mm, compared with 16 mm in men. The degree of neck angulation is greater in women (45° vs 36°), and iliac vessel caliber is smaller (11 vs 14 mm). Thus, approximately 60% of women are not eligible for endovascular aortic repair (EVAR) with use of conventional devices.11Recent advances in device design, including smaller delivery systems and modifications to accommodate shorter neck lengths and greater angulation, can be expected to increase EVAR eligibility in women. For instance, the Endurant® II AAA Stent Graft System (Medtronic, Inc.; Minneapolis, Minn) and the TriVascular Ovation Prime® device (TriVascular, an Endologix company; Santa Rosa, Calif) can accommodate neck lengths as short as 10 mm and 7 mm, respectively. The Zenith® Fenestrated AAA Endovascular Graft (Cook Medical Inc.; Bloomington, Ind), which is uniquely manufactured to conform to patients' aortic anatomy, can be used in necks as short as 4 mm. Extreme neck angulation is accommodated by the Aorfix™ Endovascular Stent Graft (Lombard Medical, Inc.; Irvine, Calif). These devices can also be used in patients who have iliac vessel diameters as narrow as 8 mm and as wide as 25 mm. The TriVascular Ovation® provides the lowest-profile delivery system at 14F.The ongoing LIFE Study seeks to show benefits associated with the low-profile TriVascular Ovation Prime device in conjunction with the Fast-Track EVAR Protocol, which includes percutaneous access, conscious sedation, and next-day discharge from the hospital.12 Thirty-day results include low rates of adverse events, high procedural success rates, freedom from endoleak, and hospital readmission rates 5 times lower than those in contemporary EVAR reports (1.6% vs 8.2%).13 Patients assigned to the fast-track approach showed a trend toward more greatly improved quality of life. Whether the predicted benefits of the Ovation Prime device will specifically translate into improved outcomes in female patients will be determined in the forthcoming LUCY Study.14The underrepresentation of women in clinical trials related to AAA has resulted in a lack of guidance for patients and physicians in the central issues of natural history, screening, and treatment threshold. Technical advances in stent-grafts, which are now lower-profile and more compatible with complex aneurysmal features, are likely to increase eligibility for EVAR in women. In addition to procedural advances, future study should focus on improved screening algorithms and defining the optimal treatment threshold in women.

Vitamin D and menstrual cycle length in women with proven fecundity

Vitamin D and menstrual cycle length in women with proven fecundity

Higher adherence to the ‘vegetable-rich’ dietary pattern is related to longer telomere length in women

Increasing evidence suggests a role of nutrition in aging process measured by telomere length (TL). However, data from Chinese are scarce. Moreover, the potential mechanism underlying diet and aging is not clear. Although inflammation has been hypothesized as one of the main factors, direct evidence is lacking. We examined whether dietary patterns were associated with TL in Chinese adults, with particular attention paid to body fat (excessive accumulation of body fat is a state of high-systematic oxidative stress and inflammation) and C-reactive protein (CRP, a marker of inflammation). Principal components analysis was used to identify dietary patterns from a 66-item food frequency questionnaire. TL was measured by Southern blots-based assay (Telomere restriction fragments, TRF). Data on sociodemographic characteristics, lifestyle behaviors, anthropometry and metabolism were collected. Multivariate linear regressions were performed in 553 Chinese adults (50.8% men) aged 25-65 years. Four main dietary patterns were identified. After adjustment for potential confounders, only the 'vegetable-rich' pattern characterized by higher intake of fruits, whole grains, various vegetable groups, dairy products, nuts, eggs and tea, was positively related to TL in women (β=160.81, P for trend <0.05). The strength of this relation was almost identical with further adjustment for body fat (β=160.50, P for trend <0.05), but was attenuated slightly with additional adjustment for CRP (β=152.02, P for trend <0.05). No significant relations were observed in men between dietary patterns and TL. Chinese women with higher adherence to 'vegetable-rich' dietary pattern have a longer TL. This relation was partially explained by CRP but not by body fat.

Association between age at menarche and height and leg length in adult women: findings from survey in 10 areas in China

Objective: To describe the regional differences and secular trend in age at menarche, height and leg length in adult women aged 30-79 years in 10 areas included in China Kadoorie Biobank study (CKB), and evaluate the association between age at menarche and height and leg length in adult women in China. Methods: A total of 285 187 women, who had data on age at menarche and who had their menarche at the age between 9-18 years, were included in the analysis. Multiple linear regression models were used to assess the association between age at menarche and height and leg length. Subgroup analyses were performed for different birth cohorts and living areas (urban area or rural area). Results: The overall means (standard deviation) of age at menarche, height and leg length were 15.2 (±1.7) years, 154.2 (±6.0) cm and 71.0 (±3.7) cm, respectively. A significant increasing trend was observed in the mean height and leg length in different birth cohorts(trend: all P<0.001), while a decreasing trend was observed in the mean age at menarche, except for a slight increase in women born in 1940s (trend: P<0.001). Adjusted for age, study area, educational level and hip circumference (only for models for leg length), the average height and leg length in women increased by 0.17 cm and 0.20 cm, respectively, for each later age at menarche (both P<0.001). The positive associations between age at menarche and both height and leg length were stronger in younger birth cohorts (interaction: both P<0.001). Conclusion: Age at menarche was positively associated with height and leg length in women in 10 areas included in CKB study.

Repeat Measurement of Cervical Length in Women with Threatened Preterm Labor.

To examine the value of a repeat measurement some days after the first cervical length measurement done at the time of preterm contractions. Retrospective study involving women with singleton pregnancies who presented with preterm contractions at 24 to 33 + 6 weeks of gestation. The cervical length was measured at the time of presentation and some days afterwards. The study population consisted of 17 cases with a preterm delivery within 14 days and 288 uneventful pregnancies. Univariate logistic regression analysis indicated a significant correlation between delivery within 14 days and both, the first and second cervical length measurements as well as the difference between the two measurements. Up to a false positive rate of 20 %, ROC curve analysis showed an improved detection rate for preterm delivery by inluding both measurements. At a false positive rate of 10 % - which corresponds to a first and second cervical length of 10 and 9 mm - the detection rate was 17.6 % with the first cervical length measurement, 47.0 % with the second and 52.9 % if the difference between both measurements was added. Our results indicate that in women with symptoms of preterm labor it is worth to repeat the measurement some days later and to take into account the difference between both measurements.

Association between paraben exposure and menstrual cycle in female university students in Japan.

Parabens have been known to have estrogenic activity in many in vivo and in vitro studies and biomonitoring data indicated ubiquitous exposure in general populations. However, there are few human studies on reproductive effects of parabens. In this study, menstrual cycle length and its intra-individual variation were investigated by bleeding record over the period of 5 months and urinary concentrations of parabens were measured for 128 female Japanese university students. We found significantly negative relationships between menstrual cycle length and urinary estrogen-equivalent total paraben (odds=0.73, 95% CI 0.56-0.96) and butyl paraben concentrations (odds=0.83, 0.70-0.99), which indicated shortened cycle length in women with high urinary paraben concentrations. This study indicated that paraben exposure at not excessive levels is associated with menstrual cycle length or its variability among general female subjects. These results suggest a possibility that parabens exposure is one of the environmental causes of human reproductive problem.

Study of Prolapse-Induced Cervical Elongation.

The cervix often appears to be elongated in women with pelvic organ prolapse (POP). This can pose surgical challenges. MRI evidence has suggested that prolapsed cervices are significantly longer than those in normal controls. Our objective was to compare cervical length in surgical hysterectomy specimens from women with symptomatic POP with the length in specimens from women with other benign gynaecological conditions. In this pilot, prospective, case-control study, hysterectomy specimens were collected at St. Paul's Hospital, Vancouver, BC, between 2013 and 2015. Recorded patient demographics were age at the time of hysterectomy, any prior history of cervical dysplasia, and reason for hysterectomy. Specimens from women in whom the indication for hysterectomy was POP were compared with the specimens from women with other benign gynaecological conditions. Specimens were excluded if there was a history of cervical dysplasia because we could not verify whether women had undergone previous procedures resulting in cervical shortening. After bivalving each uterus, cervical and total uterine lengths were measured by staff pathologists, and the ratios of cervical length to total uterine length were calculated. Measurements in the two hysterectomy groups were compared using linear regression. Seventy-seven specimens were collected, 52 from women with POP and 25 from women without POP. The most common indication for hysterectomy in women without POP was uterine fibroids. Women with POP were on average older than women without POP (mean 58.5 years vs. 47.8 years, P < 0.001). The ratio of cervical length to total uterine length in women with POP was 0.10 higher (95% CI 0.03, 0.16; P= 0.005) than in women without POP. Women with symptomatic POP have significantly higher ratios of cervical length to total uterine length than women without POP.

Abstract P3-08-01: Randomized controlled trial of weight loss vs. usual care on telomere length in women with breast cancer: The lifestyle, exercise and nutrition (LEAN) study

Abstract PURPOSE: Some studies suggest that telomere shortening due to repeated cell divisions may be associated with increased breast cancer risk and mortality. Obesity is also associated with increased breast cancer risk and mortality. Few studies have examined telomere length as a potential mechanism/biomarker mediating the obesity-breast cancer association. One study published of a diet, physical activity and support intervention in prostate cancer patients found a positive association between lifestyle changes and relative lengthening of telomeres, and another study of weight loss in healthy postmenopausal women observed no effect of weight loss on leukocyte telomere length. The purpose of our study was to examine the effect of a 6-month diet- and exercise-induced weight loss intervention vs. usual care on telomere length in 100 breast cancer survivors. METHODS: 100 breast cancer survivors with BMI≥25 kg/m2 were randomly assigned to a weight loss counseling intervention with either telephone or in-person counseling (n = 67) or usual care group (n=33). Weight loss counseling included eleven 30-minute counseling sessions over 6 months, focusing on reducing caloric intake, increasing physical activity and behavioral therapy. Body composition (height, weight, and DEXA scans), physical activity and diet were measured at baseline and 6-months. Fasting blood samples were also collected at baseline and 6 months. Relative telomere length (T/S: telomere length/single copy of gene albumin) was measured by quantitative-polymerase chain reaction (qPCR) done on buffy coat extracted genomic DNA. Mean baseline to 6-month changes were compared between groups (intent-to-treat) using generalized estimating equations and Pearson correlation coefficients. RESULTS: Baseline characteristics were similar for women randomized to each group. Women were 59±7 years, with BMI 33.1±6.6 kg/m2 and were 2.9±2.1 years from diagnosis; 91% were non-Hispanic white, and 51% were diagnosed with Stage I breast cancer. Average 6-month weight loss was 6.2% and 2.0% for weight loss and usual care groups, respectively (p=0.0004). At baseline, higher % body fat was associated with shorter T/S (r = -0.31, P=0.012). After 6 months, women randomized to weight loss experienced a 4% T/S lengthening compared to a 5% T/S shortening in the usual care group (P=0.10) (Table 1). Effect of weight loss vs. usual care on leukocyte telomere lengthLEAN VariableUsual Care Weight Loss Group TelomereNMeanSDNMeanSDBaseline330.850.26630.750.216 Month Change26-0.040.21540.030.18 (-5%) (+4%)p=.10SD=Standard Deviation CONCLUSION: Our results indicate that higher % body fat is associated with shorter leukocyte telomere length, and weight loss was associated with an increase in leukocyte telomere length, suggesting that telomere length may be a mechanism mediating the relationship between obesity and breast cancer risk and mortality. Citation Format: Sanft T, Lu L, Harrigan M, Cartmel B, Zhou Y, Chagpar A, Pusztai L, Irwin M. Randomized controlled trial of weight loss vs. usual care on telomere length in women with breast cancer: The lifestyle, exercise and nutrition (LEAN) study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-08-01.

Abstract P1-10-14: Meeting the information and psychosocial needs of young Jewish women at increased risk for or diagnosed with breast cancer

Abstract Background: Approximately 12% of women living in the United States will be diagnosed with breast cancer during their lifetimes. Although breast cancer survival rates are improving, there remain significant impacts upon women's length and quality of life. This includes women already diagnosed with the disease, as well as those who are at increased risk owing to hereditary breast cancer-causing mutations (e.g., BRCA1/2 genes). While all women face formidable challenges posed by the threat of living with or being at increased risk for breast cancer, those of Ashkenazi and Central or Eastern European Jewish descent face additional challenges owing to higher BRCA1/2 mutation prevalence in this population. Amidst calls for population-based screening for hereditary breast cancer risk, much can be learned from the experiences of young Jewish women at risk for and surviving with breast cancer about their information and psychosocial needs. Methods: The present study is a secondary analysis of survey data from 2010 to 2014 originally collected by Sharsheret, a non-profit organization dedicated to serving women of all Jewish backgrounds facing or at risk for breast cancer. The evaluation included measures and metrics of community referral practices, social service/program engagement and satisfaction, and resource needs among the target population (N=555). Only survey items administered across all data collection years were analyzed. Results: Respondents had a M age of 50 years and ∼90% identified as Jewish. Over 1/3 were referred to the organization by family or friends, most often after a breast cancer diagnosis. Within the surveyed population, 25% reported being at risk or confirmed carriers of a BRCA1/2 mutation. Of the education and support programs offered, the greatest level of engagement occurred in the 1-on-1 peer emotional support and health care symposia education programs. Women reported very high levels of satisfaction with the programs and services available, sought additional information and social support services, and noted a strong desire to give back to the community by participating as a peer supporter. Importantly for this high-risk population, women who participated in the organization's breast cancer genetics program were &amp;gt;98% satisfied (on average) with the various evaluated components of the program. Women identified genetic risk information as one of their top needs for future engagement. Conclusion: These data affirm success of the organization's programs, especially in educating Jewish women about breast cancer genetics. Genetic information is increasingly salient among members of the Jewish community, extending to their cultural needs and need for peer support. Women likely responded well to Sharsheret's peer support program as it connects women to those with similar backgrounds, including culture, lifestyle, and medical similarities. Implications of these findings assert that culturally-relevant information and psychosocial services for young Jewish women living with or at risk for breast cancer can be enhanced for larger dissemination to meet the expected growing demand in this high risk community. Citation Format: Silber E, Fleischmann AK, Shoretz R, Johnson AC, Murphy SE, Mays D, O'Neill SC, Tercyak KP. Meeting the information and psychosocial needs of young Jewish women at increased risk for or diagnosed with breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-10-14.

Cervical Length and Androgens in Pregnant Women With Polycystic Ovary Syndrome: Has Metformin Any Effect?

Women with polycystic ovary syndrome (PCOS) have increased risk of preterm delivery. Shortening of the cervix is a sign of preterm delivery. This study aimed to investigate potential effect of metformin on cervical length and whether androgen levels correlate with cervical length in PCOS pregnancies. This was a sub-study of a randomized, placebo-controlled, multicenter study (The PregMet study) performed at 11 secondary or tertiary centers from 2005 to 2009. Two-hundred sixty-one pregnancies of 245 women with PCOS, age 18-42 years participated. Participants were randomly assigned to metformin or placebo from first trimester to delivery. We compared cervical length and androgen levels in metformin and placebo groups at gestational weeks 19 and 32. We also explored whether cervical length correlated with androgen levels. We found no difference in cervical length between the metformin and the placebo groups at gestational week 19 and 32. Dehydroepiandrosterone (DHEAS) tended to be higher in the metformin group. There were no correlations between androgens and cervical length at week 19. At gestational week 32, androstenedione (P = .02) and DHEAS (P = .03) showed a trend toward negative correlation to cervical length. High androstenedione level correlated with shortening of cervical length from week 19 to 32 when adjusted for confounders (P = .003). T (P = .03), DHEAS (P = .02), and free testosterone index (P = .03) showed a similar trend. Metformin in pregnancy did not affect cervical length in women with PCOS. High maternal androgen levels correlated with cervical shortening from the second to the third trimester of pregnancy, as a sign of cervical ripening.

Number of Children and Telomere Length in Women: A Prospective, Longitudinal Evaluation.

Life history theory (LHT) predicts a trade-off between reproductive effort and the pace of biological aging. Energy invested in reproduction is not available for tissue maintenance, thus having more offspring is expected to lead to accelerated senescence. Studies conducted in a variety of non-human species are consistent with this LHT prediction. Here we investigate the relationship between the number of surviving children born to a woman and telomere length (TL, a marker of cellular aging) over 13 years in a group of 75 Kaqchikel Mayan women. Contrary to LHT’s prediction, women who had fewer children exhibited shorter TLs than those who had more children (p = 0.045) after controlling for TL at the onset of the 13-year study period. An “ultimate” explanation for this apparently protective effect of having more children may lay with human’s cooperative-breeding strategy. In a number of socio-economic and cultural contexts, having more chilren appears to be linked to an increase in social support for mothers (e.g., allomaternal care). Higher social support, has been argued to reduce the costs of further reproduction. Lower reproductive costs may make more metabolic energy available for tissue maintenance, resulting in a slower pace of cellular aging. At a “proximate” level, mechanisms involved may include the actions of the gonadal steroid estradiol, which increases dramatically during pregnancy. Estradiol is known to protect TL from the effects of oxidative stress as well as increase telomerase activity, an enzyme that maintains TL. Future research should explore the potential role of social support as well as that of estradiol and other potential biological pathways in the trade-offs between reproductive effort and the pace of cellular aging within and among human as well as in non-human populations.

The maternal cervix: Why, when and how?

AbstractIntroductionThe incidence of preterm birth has continued to rise in most countries in the world during the last decade. There are many clinical risk factors that increase the risk of preterm birth. It has been shown that a sonographically shortened cervical length is a strong indicator of subsequent preterm birth in pregnancy.BackgroundIt has been established that women at an increased risk of preterm birth should have the cervical length recorded using a transvaginal approach. The sensitivity of a shortened cervical length to predict preterm birth is higher in women with a previous preterm birth, with reduced sensitivity in low risk women. The maternal cervix may be assessed using transabdominal, transperineal and transvaginal ultrasound approaches. This article discusses the available research into the use of these differing techniques and current guidelines for measuring maternal cervical length.SummaryMeasuring the maternal cervical length has become an important part of the mid trimester morphology examination. The appropriate technique to screen the cervical length in women at low risk of preterm birth is still debatable throughout the wider obstetric and ultrasound communities.

Gender differences in life expectancy with and without disability among older adults in Ecuador

BackgroundKnowledge on disability's impact among older women and men in Ecuador is limited. This paper provides gender-specific estimates of disability prevalence, life expectancy with and without disability, and the factors associated with gender differences in disability at older age in Ecuador (2009–2010). MethodsData from the Health, Well-Being, and Aging Survey (SABE) Ecuador 2009 was used. Participants were 4480 men and women aged 60 and over. Life expectancy with and without disability was calculated using the Sullivan method. Logistic regression analyses were used to explore gender differences in disability prevalence. Two disability measures, indicating limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL), were used. Results60-year-old women in Ecuador can expect to live 16.3 years without ADL limitations compared to 16.9 years for men. Life expectancy without IADL limitations was 12.5 years for women and 15.5 years for men. At age 60, women's length of life with ADL and IADL disability was higher (7.9 years for women vs. 4.9 years for men with ADL, and 11.7 years for women vs. 6.3 years for men with IADL). After controlling for socioeconomic characteristics, chronic conditions and lifestyle factors, gender differences in ADL disability were not statistically significant. However, older women were 58% more likely (OR=1.58, 95% CI 1.27, 1.95) to report having IADL limitations than men, even after including control variables. ConclusionInterventions should tackle chronic disease, physical inactivity, and socioeconomic differences to reduce women's vulnerability to disability in older age.

A comparison of ultrasonic measurement techniques for the maternal cervix in the second trimester.

Introduction: The appropriate ultrasound technique to assess the maternal cervical length in women at low risk of preterm birth is yet to be established. This study aimed to determine the accuracy of different ultrasound approaches for measuring the maternal cervix in patients between 17 and 22 weeks gestation. Methods: The prospective study recruited 50 patients who were at a low risk of preterm birth. All measurements were acquired by one operator who was blind to the measurements being acquired in all approaches. The cervical length was registered using the transabdominal approach with a full and empty bladder, the transperineal approach and the transvaginal. The transvaginal approach was used as the reference measurement. Results: The transabdominal full bladder, post void, transperineal and transvaginal measurements were obtainable in 50, 49, 45 and 50 participants respectively. The transabdominal post void measurements showed a bias of −0.06 mm from perfect agreement with transvaginal. The transperineal measurements showed a bias of −0.16 mm. The transabdominal full bladder measurements were positively biased by 14.05 mm (p < 0.05). All transabdominal post void cervical lengths of 30 mm or greater registered a transvaginal cervical length greater than 25 mm in this study. Conclusion: The cervix should not be assessed in the transabdominal approach with a full maternal bladder due to overestimation of cervical length. Transvaginal cervical length can be reproduced accurately by post void transabdominal cervical length in most cases. Transperineal cervical length should be considered if transvaginal cervical length is contraindicated.

Predictive value of cervical length in women with twin pregnancy presenting with threatened preterm labor.

To assess the accuracy and determine the optimal threshold of sonographic cervical length (CL) for the prediction of preterm delivery (PTD) in women with twin pregnancies presenting with threatened preterm labor (PTL). This was a retrospective study of women with twin pregnancies who presented with threatened PTL and underwent sonographic measurement of CL in a tertiary center. The accuracy of CL in predicting PTD in women with twin pregnancies was compared with that in a control group of women with singleton pregnancies. Overall, 218 women with a twin pregnancy and 1077 women with a singleton pregnancy, who presented with PTL, were included in the study. The performance of CL as a predictive test for PTD was similar in twins and singletons, as reflected by the similar correlation between CL and the examination-to-delivery interval (r, 0.30 vs 0.29; P = 0.9), the similar association of CL with risk of PTD, and the similar areas under the receiver-operating characteristics curves for differing delivery outcomes (range, 0.653-0.724 vs 0.620-0.682, respectively; P = 0.3). The optimal threshold of CL for any given target sensitivity or specificity was lower in twin than in singleton pregnancies. However, in order to achieve a negative predictive value of 95%, a higher threshold (28-30 mm) should be used in twin pregnancies. Using this twin-specific CL threshold, women with twins who present with PTL are more likely to have a positive CL test, and therefore to require subsequent interventions, than are women with singleton pregnancies with PTL (55% vs 4.2%, respectively). In women with PTL, the performance of CL as a test for the prediction of PTD is similar in twin and singleton pregnancies. However, the optimal threshold of CL for the prediction of PTD appears to be higher in twin pregnancies, mainly owing to the higher baseline risk for PTD in these pregnancies.

Re: Predictive value of cervical length in women with twin pregnancy presenting with threatened preterm labor. N. Melamed, L. Hiersch, R. Gabbay-Benziv, R. Bardin, I. Meizner, A. Wiznitzer and Y. Yogev. Ultrasound Obstet Gynecol 2015; 46: 73-81.

Linked Comment: Ultrasound Obstet Gynecol 2015; 46: 73–81