Prediction Of Preterm Delivery Research Articles

MP50-01 UROLITHIASIS IN PREGNANCY: DOES AN ANTEPARTUM STONE ADMISSION INCREASE THE RISK OF PRETERM DELIVERY?

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II1 Apr 2018MP50-01 UROLITHIASIS IN PREGNANCY: DOES AN ANTEPARTUM STONE ADMISSION INCREASE THE RISK OF PRETERM DELIVERY? Max Drescher, Robert Blackwell, Parth Patel, Spencer Hart, Alexander Kandabarow, Paul Kuo, Ahmer Farooq, Thomas Turk, and Kristin Baldea Max DrescherMax Drescher More articles by this author , Robert BlackwellRobert Blackwell More articles by this author , Parth PatelParth Patel More articles by this author , Spencer HartSpencer Hart More articles by this author , Alexander KandabarowAlexander Kandabarow More articles by this author , Paul KuoPaul Kuo More articles by this author , Ahmer FarooqAhmer Farooq More articles by this author , Thomas TurkThomas Turk More articles by this author , and Kristin BaldeaKristin Baldea More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1612AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The impact of antepartum stone formation and subsequent interventions on obstetric outcomes are debated in the literature. Antepartum urolithiasis can result in the need for ureteral stent or nephrostomy tube placement; however, in recent years, definitive management with flexible ureteroscopy has increased in popularity. In this study we assess current management of antepartum stone events and evaluate the risk of UTI and preterm labor. METHODS A retrospective review of the Healthcare Cost and Utilization Project State Inpatient Database including all pregnant women admitted for a delivery to participating hospitals in California and Florida during 2008-2011. Antepartum stone admissions were identified, as were retrograde intervention (ureteral stenting/ureteroscopy) or percutaneous nephrostomy tube (PCNT) placement. Descriptive statistics were performed, as was multivariable logistic regression to identify predictors of UTI and preterm delivery. RESULTS Antepartum urolithiasis admissions were experienced by 3,904 (0.14%) of the 2,750,776 included deliveries. Stone related admissions occurred predominantly during the second (30.0%) and third trimesters (65.0%). The majority of stone patients were managed conservatively (71.4%), while 803 (20.6%) underwent retrograde intervention and 312 (8.0%) underwent PCNT placement. Preterm delivery rates increased from a baseline 7.0% for patients without a stone, to 9.1% for conservatively managed, 11.2% for retrograde intervention, and 19.6% for PCNT patients. On multivariable analysis after controlling for relevant clinical variables, conservative management (adjusted odds ratio (aOR) 1.3), retrograde intervention (aOR 1.5), and PCNT placement (aOR 2.3) each independently increased the risk of preterm delivery (all p<0.001). The presence of UTI at the time of delivery was the strongest predictor of preterm delivery (aOR 3.2). Compared to patients without a stone admission, we identified an increased incidence of UTI for patients undergoing a retrograde procedure (aOR 9.3); the risk of UTI was highest among patients who underwent PCNT placement (aOR 21.2). CONCLUSIONS Antepartum urolithiasis is a condition that affects 1 in 714 women and is associated with increased risk of UTI and preterm labor. UTI at delivery was the strongest predictor of preterm delivery in our study. Intervention with ureteral stent or nephrostomy tube placement independently increase these risks, however our analysis demonstrates that PCNT placement is associated with the greatest risk of UTI and preterm delivery. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e675 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Max Drescher More articles by this author Robert Blackwell More articles by this author Parth Patel More articles by this author Spencer Hart More articles by this author Alexander Kandabarow More articles by this author Paul Kuo More articles by this author Ahmer Farooq More articles by this author Thomas Turk More articles by this author Kristin Baldea More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Risk for adverse pregnancy outcome in axial spondyloarthritis and rheumatoid arthritis: disease activity matters.

To analyse pregnancy outcome and delivery mode in patients with RA and axial spondyloarthritis (axSpA) in relation to disease activity and anti-rheumatic drugs. Patients with RA and axSpA were compared with age-matched healthy controls (HCs) with respect to pregnancy outcome and delivery mode. Disease activity (DAS28, ASDAS, CRP) and medication use of patients was assessed once at each trimester. ORs with 95% CI were calculated with univariate and multivariate regression models. We analysed 244 pregnancies, of which 96 occurred in patients with RA, 78 in patients with axSpA and 70 in HCs. The adjusted analysis showed that pregnant women with RA and axSpA had a higher risk of pregnancy complications (gestational diabetes, preeclampsia, infection, preterm premature rupture of membranes), small for gestational age infants and preterm deliveries (all P < 0.05). Active disease was a predictor for preterm delivery in both RA [odds ratio (OR) = 3.9, 95% CI: 1.25, 12.15] and axSpA (OR = 13.8, 95% CI: 1.33, 143.94). Regarding delivery mode, most patients had vaginal deliveries. However, women with RA revealed an increased risk of caesarean section compared with HC (P < 0.05), which was not seen in patients with axSpA. Our findings show that disease activity of RA and axSpA during pregnancy influences pregnancy outcome. To allow for successful pregnancy a treatment strategy that targets inactive disease beyond conception should be followed.

Інтерлейкін 6 та інтегративний індекс анамнезу, вихідного стану здоров'я, перебігу вагітності як предиктори передчасних пологів у жінок із багатопліддям

Інтерлейкін 6 та інтегративний індекс анамнезу, вихідного стану здоров'я, перебігу вагітності як предиктори передчасних пологів у жінок із багатопліддям

Labor estimation by informational objective assessment (LEIOA) for preterm delivery prediction.

To introduce LEIOA, a new screening method to forecast which patients admitted to the hospital because of suspected threatened premature delivery will give birth in < 7days, so that it can be used to assist in the prognosis and treatment jointly with other clinical tools. From 2010 to 2013, 286 tocographies from women with gestational ages comprehended between 24 and 37weeks were collected and studied. Then, we developed a new predictive model based on uterine contractions which combine the Generalized Hurst Exponent and the Approximate Entropy by logistic regression (LEIOA model). We compared it with a model using exclusively obstetric variables, and afterwards, we joined both to evaluate the gain. Finally, a cross validation was performed. The combination of LEIOA with the medical model resulted in an increase (in average) of predictive values of 12% with respect to the medical model alone, giving a sensitivity of 0.937, a specificity of 0.747, a positive predictive value of 0.907 and a negative predictive value of 0.819. Besides, adding LEIOA reduced the percentage of incorrectly classified cases by the medical model by almost 50%. Due to the significant increase in predictive parameters and the reduction of incorrectly classified cases when LEIOA was combined with the medical variables, we conclude that it could be a very useful tool to improve the estimation of the immediacy of preterm delivery.

Spontaneous prematurity in fetuses with congenital diaphragmatic hernia: a retrospective cohort study about prenatal predictive factors

BackgroundTo evaluate possible predictive factors of spontaneous prematurity in fetuses with congenital diaphragmatic hernia (CDH).MethodsA retrospective cohort study was performed. Inclusion criteria were presence of CDH; absence of fetoscopy; absence of karyotype abnormality; maximum of one major malformation associated with diaphragmatic hernia; ultrasound monitoring at the Obstetrics Clinic of Clinicas Hospital at the University of São Paulo School of Medicine, from January 2001 to October 2014. The data were obtained through the electronic records and ultrasound system of our fetal medicine service. The following variables were analyzed: maternal age, primiparity, associated maternal diseases, smoking, previous spontaneous preterm birth, fetal malformation associated with hernia, polyhydramnios, fetal growth restriction, presence of intrathoracic liver, invasive procedures performed, side of hernia and observed-to- expected lung to head ratio (o/e LHR). On individual analysis, variables were assessed using the Chi-square test and the Mann-Whitney test. A multiple logistic regression model was applied to select variables independently influencing the prediction of preterm delivery. A ROC curve was constructed with the significant variable, identifying the values with best sensitivity and specificity to be suggested for use in clinical practice.ResultsEighty fetuses were evaluated, of which, 21 (26.25%) were premature. O/e LHR was the only factor associated with prematurity (p = 0.020). The ROC curve showed 93% sensitivity with 48.4% specificity for the cutoff of 40%.ConclusionO/e LHR was the only predictor of prematurity in this sample.

154: Predictors of preterm birth after physical exam indicated cerclage in singleton pregnancy

To evaluate the predictors of preterm birth <32 weeks in women that underwent physical-exam indicated cerclage (PEIC) in singleton pregnancy. Multicenter retrospective study of asymptomatic singleton pregnancies with cervical dilation ≥1cm and visible membranes between 16 0/7 to 23 6/7 weeks who underwent PEIC from 2003-2017. Cases with abnormal karyotype, major fetal anomalies, chorioamnionitis and revision of a history-indicated cerclage were excluded. Primary outcome: delivery <32 weeks. Analysis: t-test, Fisher’s exact test and multivariable logistic regression. Kaplan-Meyer survival curve. 198 women underwent PEIC. Demographic characteristics stratified by delivery <32weeks vs. ≥32weeks. Demographics were significantly different between the two groups: women that delivered <32 weeks had cervical dilation at earlier gestational age (GA), more women had cervical dilation ≥ 2cm and prolapsed membranes at the external os. The incidence of preterm birth <37, <34, <32, <28 and < 24 weeks were 57.5%, 42.9%, 35.8%, 29.3% and 18.7% respectively. The interval from cerclage to delivery was 12.2±6.9 weeks. Premature preterm rupture of membranes (PPROM) was present in 54 women (27.3%). Perinatal mortality was 17%, half of them associated with PPROM before 24 weeks. Prolapsed membranes to external os was significantly associated with PTB <32 weeks: 43/71 (60.5%) vs 37/127 (29.1%) [aOR 4.2, 95% confidence interval 2.5-7.2]. After adjusting for confounders, prolapsed membranes to external os was the strongest predictor of preterm delivery <32weeks In women with singleton pregnancy and ≥1cm of cervical dilation between 16 to 24 weeks that were candidates for PEIC, prolapsed membranes to external os was the strongest predictor of preterm delivery <32weeks.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

712: Beyond preterm birth history and cervical length: analysis of routinely collected clinical data improves prediction of preterm delivery

A history of preterm delivery and shortened cervical length are widely recognized risk factors for preterm birth (PTB) and have been used as inclusion criteria for trials of therapies to prevent PTB. We sought to determine if other readily accessible clinical or demographic variables could improve risk stratification or identification of pregnancies at increased risk for PTB. This is a secondary analysis of the MFMU-sponsored Singleton Preterm Prediction Study, a prospective observational study to identify risk factors for PTB conducted from 1992-1994. Participants were not selected based on risk factors for PTB, had extensive demographic and clinical data collected and, amongst other tests, underwent sonographic cervical length (CL) measurement around 24 weeks. We used cervical length measured between 23w0d and 25w0d, PTB history and other data readily accessible in a clinical setting (final predictors: age, race, reported family income, chronic hypertension history, prior full term delivery, prior miscarriage, vaginal bleeding prior to 25 weeks and pre-pregnancy BMI) to predict spontaneous PTB (<37 weeks). We compared 4 logistic regression models for prediction of PTB using the following predictors: 1) PTB history (PTB only); 2) Cervical length (CL only); 3) Listed clinical variables and PTB history (Clinical only); and 4) PTB history, CL and clinical variables (Clinical+CL). The area under the curve (AUC) for the receiver operating characteristic (ROC) curve was compared across the 4 models. In the study population of 2,796, there were 402 spontaneous preterm births (14.4%). The Clinical+CL model predicted PTB best, followed by the Clinical only model (Figure). The CL only and PTB only models performed worst, with no significant difference between their AUC. Amongst the 280 participants predicted to be in the top decile of risk for PTB by the Clinical+CL model (Probability of PTB >0.283), 63 (22.5%) had no history of PTB and 232 (82.9%) had a cervical length >20mm. Beyond PTB history and CL, clinical variables that are available at essentially no cost significantly improve risk-stratification for PTB. Clinical trials of PTB prevention strategies in this easily identified and potentially overlooked population are warranted.

Cytokines in Preterm Delivery: Proposal of a New Diagnostic Algorithm.

Predicting preterm delivery within 7 days is very important for the proper timing of glucocorticosteroid administration. If within 7 days after glucocorticosteroid administration, the delivery does not occur, it remains questionable if repeated glucocorticosteroid therapy results in improved infant respiratory function. Therefore, differentiation of preterm delivery from false preterm delivery is clinically significant. The aim of this study was to create a diagnostic algorithm to distinguish preterm delivery from false preterm delivery on the basis of concentrations of selected cytokines. The study group (n = 622) were patients hospitalized due to threatened preterm delivery. To assess the concentration of cytokines in the serum, we used a multiplex method, which allows simultaneous determination of 13 cytokines. The sets consist of the following cytokines: IGFBP-1, IGFBP-2, BDNF, L-Selectin, E-Selectin, ICAM-1, PECAM, VCAM-1, MIP-1d, MIP-3b, Eotaxin-1, Eotaxin-2, and BLC. In the study group, 67.8% patients had preterm delivery and 32.2% had false preterm delivery. Based on the analysis of cytokine concentrations, a classification tree to distinguish between preterm delivery and false preterm delivery was created. Our findings show the possibility of prediction of preterm delivery with the use of a classification and regression tree of selected cytokine concentration.

A study of cervical length measured ultrasonographically in prediction of preterm delivery

A study of cervical length measured ultrasonographically in prediction of preterm delivery

Cervical gland area as an ultrasound marker for prediction of preterm delivery: A cohort study

Preterm labor is a major cause of perinatal morbidity and mortality and it might be predicted by assessing the cervical change. To assess the association between absence of cervical gland area (CGA) and spontaneous preterm labor (SPTL). This prospective cohort study was performed on 200 singleton pregnant women with a history of SPTL, second-trimester abortion in the previous pregnancy or lower abdominal pain in current pregnancy. Each patient underwent one transvaginal ultrasound examination between 14-28 wk of gestation. Cervical length was measured and CGA was identified and their relationship with SPTL before 35 and 37 wk gestation was evaluated using STATA software version 10. The mean of cervical length was 36.5 mm (SD=8.4), the shortest measurement was 9 mm, and the longest one was 61 mm. Short cervical length (≤18mm) was significantly associated with SPTL before 35 and 37 wk gestation.Cervical gland area (the hypoechogenic or echogenic area around the cervical canal) was present in 189 (94.5%) patients. Absent of CGA had a significant relationship with SPTL before 35 and 37 wk gestation (p=0.01 and p<0.001, respectively). Cervical length was shorter in women with absent CGA in comparison with subjects with present CGA: 37±10 mm in CGA present group and 23±9 mm in CGA absent group (p<0.001). Our study showed that cervical gland area might be an important predictor of SPTL which should be confirmed with further researches.

Detection and risk stratification of women at high risk of preterm birth in rural communities near Nagpur, India

BackgroundPresently, preterm birth is globally the leading cause of neonatal mortality. Prompt community based identification of women at high risk for preterm births (HRPB) can either help to avert preterm births or avail effective interventions to reduce neonatal mortality due to preterm births. We evaluated the performance of a package to train community workers to detect the presence of signs or symptoms of HRPB.MethodsPregnant women enrolled in the intervention arm of a cluster randomized trial of Antenatal Corticosteroids (ACT Trial) conducted at Nagpur, India were informed about 4 directly observable signs and symptoms of preterm labor. Community health workers actively monitored these women from 24 to 36 weeks of gestation for these signs or symptoms. If they were present (HRPB positive) the identified women were brought to government health facilities for assessment and management. HRPB positive could also be determined by the provider if the woman presented directly to the facility. Risk stratification was based on the number of signs or symptoms present. The outcome of preterm birth was based on the clinical assessment of gestational age < 37 weeks at delivery or a birth weight of <2000 g.ResultsBetween July 1, 2012 and 30 November, 2013, 686 of 7050 (9.7%) pregnant women studied, delivered preterm. 732 (10.4%) women were HRPB positive, of whom 333 (45.5%) delivered preterm. Of the remaining 6318(89.6%) HRPB negative women 353 (5.6%) delivered preterm. The likelihood ratio (LR) of a preterm birth in the HRPB positives was 8.14 (95% confidence interval 7.16–9.26). The LR of a preterm birth increased in women who had more signs or symptoms of HRBP (p < 0.00001). More signs or symptoms of HRPB were also associated with a shorter time to delivery, lower birth weight and higher rates of stillbirths, neonatal deaths and postnatal complications. Addition of risk stratification improved the prediction of preterm delivery (Integrated Discrimination Improvement 17% (95% CI 15–19%)).ConclusionsThe package for detection of signs and symptoms of HRPB is feasible, promising and likely to improve management of preterm labor.Trial registrationNCT01073475 on February 21, 2010 and NCT01084096 on March 9, 2010.

Is Midtrimester Cervical Length Associated with Preterm Birth in Women Evaluated for Preterm Labor?

This article aims to evaluate whether midtrimester cervical length (CL) is associated with improved prediction of preterm delivery in women presenting with preterm labor. This is a retrospective cohort study of women with a singleton gestation who underwent routine CL screening between 18 and 24 weeks of gestation between 2010 and 2014 who were later evaluated for preterm labor. Women were stratified by midtrimester CL quartile. Bivariable and multivariable analyses were performed to identify factors independently associated with preterm birth <37 weeks, <34 weeks, and delivery within 7 days of evaluation. Receiver operating characteristic (ROC) curves were created for multivariable equations with and without CL quartile to determine whether addition of CL improved the predictive capacity of the model for predicting preterm birth. A total of 460 women were evaluated for preterm labor and had midtrimester CL measurements available. When CL quartile was incorporated into a regression model including demographic and clinical characteristics associated with preterm birth, the area under the ROC curve was not improved (0.775 vs. 0.786, p = 0.20). While a shorter midtrimester CL quartile is associated with an increased incidence of preterm delivery in women evaluated for preterm labor, the addition of this variable to an existing model does not improve prediction of preterm birth.

EP18.11: Addition of cervical elastography may increase preterm delivery prediction performance in pregnancies with short cervix: a prospective study

EP18.11: Addition of cervical elastography may increase preterm delivery prediction performance in pregnancies with short cervix: a prospective study

Cervix elastography: a bibliometric analysis

Introduction: The aim of this study was to assess the global contribution to cervical elastography research in PubMed, Scopus, and Web of Science databases. Materials and Methods: PubMed, Scopus, and Web of Science databases were queried without language restrictions for records present up to January 2016. All indexed publications under cervix elastography were retrieved. All meta-informations present in the databases were locally stored and used for the analyses. Results: The absolute number of publications included was 107. The top four countries to publish on the argument were USA (23 publications), UK (16 publications), Germany (5), and Poland (5). Finally the most researched areas were cervical ripening in labor induction, pre-term delivery prediction, and cervical cancer analysis. Conclusions: Although interest in this field has greatly increased in recent years, original articles on this topic are still limited.

Use of cervicovaginal PAMG-1 protein as a predictor of delivery within seven days in pregnancies at risk of premature birth

BackgroundTo investigate the utility of vaginal placental alpha microglobulin-1 (PAMG-1) protein as a predictor of preterm delivery within 7 days in pregnancies at risk of premature birth.MethodsThis prospective study was performed in women at risk of premature birth. The levels of vaginal PAMG-1 and foetal fibronectin (fFN) and the transvaginal cervical length measurement (CLM) were investigated and compared.ResultsSeventy-two pregnant women were included in this study. The sensitivities of PAMG-1, fFN and CLM were 73.3, 73.6%, and 52.9%, respectively, while the specificities of PAMG-1, fFN and CLM were 92.9%, 94.3%, and 90.9%, respectively. The positive predictive values of PAMG-1, fFN and CLM were 73.3%, 82.3%, and 64.2%, respectively, and the negative predictive values of PAMG-1, fFN and CLM were 92.9%, 90.9%, and 86.2%, respectively.ConclusionThe diagnostic accuracy of PAMG-1 is similar to that of fFN in terms of preterm labour detection within 7 days.

Transvaginal Sonographic Cervical Length Measurement as Predictor of Preterm Delivery

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

Neutrophil to lymphocyte ratio &amp; cervical length for prediction of spontaneous preterm delivery in threatened preterm labour

Background: Being able to predict preterm birth is important, as it may allow a high-risk population to be selected for future interventional studies. As inflammation represents a crucial pathogenic process of preterm delivery, the aim of this study is to define the role of serum inflammatory markers in the prediction of spontaneous preterm delivery &amp; to combine these markers with cervical length to increase the diagnostic accuracy.Methods: Eighty pregnant women with threatened preterm labour (group I) were compared with 40 women at term (group II (, subdivided into 2 subgroups (20 of them were not in labour &amp; the other 20 were in labour). Neutrophils to lymphocytes ratio (NLR) &amp; C-reactive protein (CRP) level were measured &amp; compared for all study subjects. For group I, transvaginal cervical length was measured &amp; combined marker (defined as NLR divided by the cervical length) was estimated &amp; they were subdivided into: (group Ia) who delivered before 37 weeks (n=30) &amp; (group Ib) who delivered at term (n=50.)Results: The levels of NLR (P&lt;0.001), CRP (P&lt;0.016) in group Ia were significantly different from those in group Ib &amp; they were also significantly higher in group IIa than in group IIb (P&lt;0.001). The cervix length (P&lt; 0.001) &amp; combined marker (P&lt;0.001) in group Ia were significantly different from those of group Ib. It has been shown that the combined marker has higher sensitivity (65%) &amp; specificity (87%) for prediction of preterm delivery, as compared to cervical length or systemic inflammatory markers each alone .Conclusions Combined marker is useful for identifying women at risk of preterm delivery in patients with threatened preterm labour .

Dedicated Entropy Measures for Early Assessment of Pregnancy Progression From Single-Channel Electrohysterography.

Preterm birth is a large-scale clinical problem involving over 10% of infants. Diagnostic means for timely risk assessment are lacking and the underlying physiological mechanisms unclear. To improve the evaluation of pregnancy before term, we introduce dedicated entropy measures derived from a single-channel electrohysterogram (EHG). The estimation of approximate entropy (ApEn) and sample entropy (SampEn) is adjusted to monitor variations in the regularity of single-channel EHG recordings, reflecting myoelectrical changes due to pregnancy progression. In particular, modifications in the tolerance metrics are introduced for improving robustness to EHG amplitude fluctuations. An extensive database of 58 EHG recordings with 4 monopolar channels in women presenting with preterm contractions was manually annotated and used for validation. The methods were tested for their ability to recognize the onset of labor and the risk of preterm birth. Comparison with the best single-channel methods according to the literature was performed. The reference methods were outperformed. SampEn and ApEn produced the best prediction of delivery, although only one channel showed a significant difference () between labor and nonlabor. The modified ApEn produced the best prediction of preterm delivery, showing statistical significance () in three channels. These results were also confirmed by the area under the receiver operating characteristic curve and fivefold cross validation. The use of dedicated entropy estimators improves the diagnostic value of EHG analysis earlier in pregnancy. Our results suggest that changes in the EHG might manifest early in pregnancy, providing relevant prognostic opportunities for pregnancy monitoring by a practical single-channel solution.

Optimising fertility outcomes for women with early-stage cervical cancer: when less is more.

Radical hysterectomy and pelvic lymphadenectomy is standard management for early-stage cervical cancer. Radical trachelectomy achieves equivalent oncological outcomes to hysterectomy thus providing an alternative for women who wish to preserve their fertility (Xu et al. Acta Obstet Gynecol Scand 2011; 90: 1200-09). Trachelectomy offers the potential for pregnancy but poor obstetric sequelae, including second trimester miscarriage, preterm premature rupture of membranes (PPROM) and preterm delivery are common, likely due to reduced mechanical support from a shortened cervix and ascending infection. In this issue of BJOG, Kasuga et al. report that mid-trimester residual cervical length of <13mm is a good predictor of preterm delivery <34 weeks in women who have undergone abdominal radical trachelectomy (ART). This article is protected by copyright. All rights reserved.

Positive vaginal culture at rescue cerclage predicts subsequent preterm delivery

Purpose: This retrospective case-control study is aimed to extract predictors of preterm delivery after rescue cerclage. Materials and methods: We collected the data from all the pregnant women who underwent rescue cerclage before 26+0 gestational weeks at our facility between July 2006 and July 2016. These women were divided into “delivery at <34 weeks” group (n = 12) and “delivery at ≥34 weeks” group (n = 12). Multiple factors that had been detected at the time of cerclage were compared between these two groups. Results: “Gestational weeks at cerclage ≥23” and “positive vaginal culture at cerclage” were significantly more prevalent in the “delivery at <34 weeks” group than in the “delivery at ≥34 weeks” group. “Prolapsed membranes at cerclage” tended to be more prevalent in the “delivery at <34 weeks” group than in the “delivery at ≥34 weeks” group. “Positive vaginal culture at cerclage” was the only independent risk factor associated with eventual preterm delivery before 34 gestational weeks. Conclusions: Simple aerobic bacterial culture of the vaginal swab sampled at the time of cerclage could be used as a reliable test to predict subsequent preterm delivery before 34 gestational weeks.