Cervical assessment in women with threatened preterm labor

Objective.?The aim of the study was to examine the clinical value of cervical assessment by transvaginal ultrasonography in women with symptoms of preterm labor.

Methods.?We prospectively evaluated 172 women with singleton pregnancies and symptoms of preterm labor. Seventy of them were nulliparas, while 102 were multiparas. Gestational age ranged between 24 and 34 wks. All women underwent cervical assessment with transvaginal ultrasonography and were given intravenous tocolytics. The only parameter evaluated was cervical length. Women with multiple pregnancies, gestational age <?24 wks or >?34 wks, cervical dilatation >?2?cm, placenta praevia, premature rupture of membranes, or cervical cerclage were excluded from the study. The outcome measure was delivery before 34 wks gestation.

Results.?The preterm delivery rate before 34 wks was 37%. The sensitivity and the specificity of a cervical length of less than 20?mm was 60 and 53.8% and 97.7 and 95.2% for nulliparas and multiparas, respectively. A cervical length <?20?mm was also 93.7% predictive of preterm delivery in nulliparas and 87.5% in multiparas, while the corresponding numbers for its negative predictive value (NPV) were 81.4 and 76.9%, respectively.

Conclusions.?Cervical assessment in women with symptoms of preterm labor can distinguish those at high risk for preterm delivery. Cervical sonography can be a valuable adjunct to the clinical evaluation of these patients.     

Increased level of granulocyte elastase in cervical secretion is an independent predictive factor for preterm delivery

OBJECTIVE: The objective of this study was to explore whether increased levels of granulocyte elastase in cervical secretion is an independent predictive factor for preterm delivery before 34 weeks of gestation in the patient with preterm labor. METHODS: One hundred and sixty-one women with preterm labor at 22-28 weeks of gestation were enrolled prospectively. The level of granulocyte elastase in cervical secretions was measured by immunoassay, vaginal secretions were collected for the microscopic evaluation of Gram-stained smears, and the uterine cervix was assessed by transvaginal ultrasonography. RESULTS: Nineteen of 161 patients (12%) delivered before 34 weeks of gestation. Granulocyte elastase assessment had a sensitivity, specificity, positive predictive value, and negative predictive value for preterm delivery of 53, 75, 22 and 92%, respectively. A positive elastase assessment was associated with a relative risk for preterm delivery of 2.9 (95% CI 1.3-6.6), whereas a positive bacterial vaginosis assessment and shorter cervical length less than 25 mm demonstrated a relative risk of 1.9 (95% CI 0.8-4.6) and 1.5 (95% CI 0.6-5.0), respectively. CONCLUSION: The present study demonstrates that the risk of spontaneous preterm delivery before 34 weeks of gestation is increased in the women with preterm labor who are found to have an increased level of granulocyte elastase in cervical secretions.     

The short and funneling cervix: when to use cerclage?

PURPOSE OF REVIEW: The diagnosis of cervical incompetence remains extremely difficult because there is no diagnostic test available prior to, during or after pregnancy. This review will summarize the latest publications on the use of transvaginal ultrasonography to identify women at high risk of preterm delivery and the use of cervical cerclage in these women. RECENT FINDINGS: Cervical length is not only inversely related to the risk of preterm delivery but also inversely related to the risk of intrauterine infection in women with preterm labor. Furthermore, previous history of preterm delivery is related to the risk of preterm delivery. Cerclage trials on women with short cervical length present conflicting results both in low and high-risk populations. Assessment of risk factors and obstetric history remain important in the diagnosis of cervical incompetence. Women at high risk of preterm delivery due to cervical incompetence should be followed-up with transvaginal measurements of cervical length. Only a minority of these women will develop a short cervical length and will consequently be at high risk of preterm delivery. SUMMARY: A combination of assessment of risk factors, obstetric history and follow-up of cervical length enables us to identify women who benefit from a cervical cerclage.     

阴道超声测量子宫颈长度及宫颈管宽度对预测早产的价值

目的　探讨阴道超声测量正常孕妇宫颈长度及宫颈管宽度对先兆早产孕妇发生早产的预测价值。方法　对无任何合并症和并发症的 1 54例正常单胎初产妇 ,于妊娠 1 6～ 35周经阴道超声测量宫颈长度和宫颈管宽度 ,记录宫颈内口有无开大。按孕周不同分成 5组 ,观察不同孕周组孕妇的宫颈变化。同时对 58例有先兆早产症状的孕妇进行宫颈长度及宫颈宽度的超声测量 ,并追踪其妊娠结局。结果　 (1 )正常单胎孕妇各不同孕周组间宫颈长度及宫颈管宽度无明显不同 ,宫颈长度平均为(36± 5)mm ,宫颈管宽度为 (4± 1 )mm ,均无宫颈内口开大。 (2 ) 58例先兆早产孕妇中发生早产的 1 1例为早产组 ,未发生早产的 47例为非早产组。两组孕妇年龄、孕次、出现先兆早产的孕周、保胎的方法及指检宫颈长度比较 ,差异均无显著性 (P >0 0 5)。以宫颈长度 > x - 2s(2 6mm)为界值 ,早产组孕妇的宫颈长度均≤ 2 6mm ,平均为 (1 8± 6)mm ,显著短于非早产组的 (32± 6)mm。两组比较 ,差异有极显著性 (P <0 0 0 1 )。 (3)以宫颈长度≤ 2 6mm为界值 ,预测先兆早产孕妇发生早产的敏感性为1 0 0 % ,特异性为 81 % ,阳性预测值为 55 % ,阴性预测值为 1 0 0 %。结论　经阴道超声检测宫颈长度 ,对先兆早产孕妇发生早产有一定的预测价值 ,先兆早     

Transvaginal ultrasonographic cervical assessment for the prediction of preterm delivery

To determine the usefulness of transvaginal ultrasonographic cervical assessment for the prediction of preterm delivery in an apparently normal population, 729 pregnant women (between 15 and 34 weeks' gestation) were randomly enrolled in the study in ten tertiary perinatal centers in Japan. Cervical parameters, including cervical length, internal os dilatation, and funneling depth, were measured by transvaginal ultrasound. The predictive values of these measurements for preterm delivery were investigated in a prospective fashion. Among various cervical parameters, cervical length showed the best correlation with pregnancy outcome. Cervical length (mm) was gradually decreased as the gestational age progressed, the regression line being y = 41.21 – 0.22x. When the mean cervical length minus 1 standard deviation at each gestational age was chosen as a cut-off value, the group with a shortened cervix showed a significantly high preterm delivery rate exclusively in the primigravidae (odds ratio: 4.86, 95% CI: 1.85–12.72). Internal os dilatation, in contrast, was a useful predictor in multiparous women (odds ratio: 6.00, 95% CI: 1.65–21.71). It was concluded that tranvaginal ultrasonographic cervical assessment, especially the measurement of cervical length, was effective for the prediction of preterm delivery in the primigravidae.     

Cervical incompetence: a reappraisal of an obstetric controversy

Cervical incompetence is not a categoric but rather a continuous variable, meaning that there are various degrees in the competency of the cervix. Furthermore, a certain degree of competency of the cervix can be expressed differently in subsequent pregnancies. Women with risk factors for cervical incompetence in their gynecological/obstetric history should be followed by transvaginal ultrasonography. History alone is not an indication for a prophylactic cerclage. Although transvaginal ultrasonography identifies women at high risk of preterm delivery, it does not discriminate between different underlying pathologies. Short cervical length alone is not an indication for a therapeutic cerclage. Serial transvaginal ultrasonographic measurements of cervical length in women with risk factors can identify those women truly at high risk of preterm delivery. A transvaginal cervical cerclage with bed rest reduces preterm delivery and improves perinatal outcome in women with a short cervical length and risk factors for cervical incompetence. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will be able to define cervical incompetence, explain the role of transvaginal ultrasonography in the prediction of preterm delivery, and summarize the data on the use of transvaginal cervical cerclage.     

Comparison of cervical volume and cervical length to predict preterm delivery by transvaginal ultrasound

The objective of this study was to evaluate predictive value of cervical volume and length measurement for preterm delivery in low-risk pregnancies by transvaginal ultrasound. Two hundred fifty pregnant women were underwent ultrasound examination at 22 weeks of gestation by transvaginal route. Cervical length, width, and anteroposterior diameters were measured and cervical volume was calculated. All subjects were observed until term. Predictive values of cervical length and cervical volume were calculated and compared with predict preterm delivery. Preterm delivery occurred in 18 patients (7.2%). Mean cervical length and volume were statistically different between term and preterm delivered patients ( P = 0.001). Areas under curves were 0.913 for cervical volume and 0.923 for cervical length; this difference was not statistically significant ( P = 0.289). Sensitivity of cervical volume was 73.3% for 32-mL cut-off value with 12.85% false-positive rate and cervical length had 80% sensitivity at the 33.15-mm cut-off value with 12.7% false-positive rate. Cervical volume measurement by two-dimensional ultrasound did not add any benefit compared with the cervical length measurement for prediction of preterm delivery.     

Prediction of preterm delivery with transvaginal ultrasonography of the cervix in patients with high-risk pregnancies: does cerclage prevent prematurity?

OBJECTIVES: We sought to determine the predictive accuracy for preterm delivery of transvaginal ultrasonography of the cervix between 14 and 24 weeks' gestation in high-risk patients and to determine whether cerclage prevents preterm delivery in patients with ultrasonographic cervical changes. STUDY DESIGN: Patients with asymptomatic singleton pregnancies at high risk for preterm delivery were followed prospectively from 14 weeks' to 23 weeks 6 days' gestation with transvaginal ultrasonography of the cervix. The subgroup of patients with either a cervical length of <25 mm or funneling of >25% or both was offered McDonald salvage cerclage, which was performed at the discretion of the patient and the obstetrician. The 2 groups (with and without cerclage) were compared for the primary outcome of preterm delivery at <35 weeks' gestation. RESULTS: One hundred sixty-eight women were followed, including 97 (58%) with >/=1 prior 14- to 34-week preterm deliveries. Of 63 (37. 5%) patients identified as having cervical changes, 23 (37%) had preterm delivery; of 105 patients with no cervical changes, 8 (8%) had preterm delivery (relative risk, 4.8; 95% confidence interval, 2. 3-10.1). The sensitivity, specificity, and positive and negative predictive values of either a short cervix of <25 mm or funneling of >25% or both were 74%, 70%, 37%, and 92%, respectively. Of 63 pregnancies in which there were cervical changes, 39 underwent cerclage and 24 did not. These 2 groups were similar for demographic characteristics, risk factors, and transvaginal ultrasonographic cervical length and funneling but dissimilar for gestational age at identification of cervical changes (18.3 vs 21.2 weeks' gestation in the groups with and without cerclage, respectively; P <.001). Multivariate logistic regression analysis after adjustment for gestational age at cervical changes showed no difference in the rate of preterm delivery between the groups with and without cerclage (odds ratio, 1.1; 95% confidence interval, 0.3-4.6). Stratified analysis of patients identified between 18 and 24 weeks revealed 22 pregnancies with cerclage and 22 pregnancies without cerclage, which was similar for all characteristics studied. The incidence of preterm delivery remained similar (27% vs 23%, respectively; P =.7), as did days from cervical changes to delivery (111 vs 96, respectively; P =.2). CONCLUSIONS: Transvaginal ultrasonography of the cervix between 14 and 24 weeks' gestation is a good predictor of preterm delivery in high-risk pregnancies. Cerclage may not prevent preterm delivery in patients identified to be at high risk for this outcome by transvaginal ultrasonography.     

Predictive value of transvaginal ultrasonography for determining the response to tocolytic therapy in cases with preterm labour.

This study was performed prospectively on 144 randomly selected women carrying singleton uncomplicated pregnancies of 20 to 36 gestational weeks and 60 women with preterm labour matched for gestational age to determine the predictive value of transvaginal cervical measurements for evaluation of the response to tocolytic therapy. Cervical length and width and width of the cervical canal were measured and funnelling of internal os of the cervical canal was evaluated by transvaginal ultrasonography in each case. These measurements did not reveal any change depending on the gestational age in the control group. The mean values for cervical length and width, and width of cervical canal were 45.05+/-6.52 mm, 38.75+/-4.11 mm, 7.01+/-2.76 mm, respectively. Mean cervical length+/-standard deviations of the control group were used as cut-off values for the prediction of preterm delivery in the preterm labour group. When the cut-off value of the cervical length was accepted as 38.53 mm (-1 SD of the control group), the sensitivity, specificity, positive and negative predictive values for prediction of preterm delivery were 80.9%, 72.2%, 87.2%, 61.9%, respectively; whereas when this cut-off value was used in combination with the funnelling of the internal cervical os, the sensitivity and negative predictive value decreased to 40.5% and 41.9%, respectively; but the positive predictive value and specificity became 100.0% and 100.0%, respectively.     

Ultrasonographic measurement of cervical length in twin pregnancies with preterm labor: comparison with singleton pregnancies

OBJECTIVE: Our purpose was to assess the utility of ultrasonographic measurement of cervical length for predicting preterm delivery in pregnant women with twin pregnancy and preterm labor. PATIENTS AND METHOD: Prospective study in 192 singleton and 66 twin pregnancies with preterm labor before 34 weeks. Vaginal sonography for measurement of cervical length, and screening for fetal fibronectin in vaginal smears were performed at admission. The incidence of delivery before 34 weeks was compared with cervical length and the presence of fetal fibronectin. RESULTS: In singleton pregnancies, delivery before 34 weeks was significantly more frequent in women with a cervical length <30 mm (26.6 vs. 2.0%; P = 0.0004), or presence of fetal fibronectin (27.5 vs. 6.0%; P = 0.001). The corresponding negative predictive values (NPV) were 98% and 94%, respectively. In twin pregnancies, receiver characteristic curve analysis showed that a cervical length of 20 mm had the highest diagnostic performance in predicting preterm delivery. The corresponding NPV was 63%. In this group, delivery before 34 weeks showed no significant difference in women with a cervical length < 30 mm (43.7 vs. 38.8%), cervical length < 20 mm (52.0 vs. 36.6%, P = 0.219), or presence of fetal fibronectin (47.6 vs. 21.7%, P = 0.0705). DISCUSSION AND CONCLUSION: Ultrasonographic measurement of cervical length does not predict preterm delivery in twin pregnancies with preterm labor.     

Ultrasonographic cervical length measurement at 10-14 and 20-24 weeks gestation and the risk of preterm delivery

OBJECTIVE: To compare cervical length measurements at 10-14 and 20-24 weeks gestation in asymptomatic women with singleton pregnancies and to assess the measurements as a predictor of preterm delivery. STUDY DESIGN: In this prospective study, cervical length was measured in 152 asymptomatic women with singleton pregnancies using transvaginal ultrasonography at 10-14 and 20-24 weeks gestation. The primary outcome measure was spontaneous preterm delivery before 35 weeks of gestation. The mean cervical length was calculated at both stages, and lengths were compared between the term and preterm groups. RESULTS: The rate of spontaneous preterm deliveries was 10.5%. The mean cervical length at 10-14 and 20-24 weeks was 40.5 and 37.1mm, respectively. The cervical length at 10-14 weeks was not significantly different between those who delivered at term (40.9 mm) and those who delivered preterm (38.6 mm). By contrast, the cervical length at 20-24 weeks was significantly shorter in the group that had preterm deliveries (28.4 mm) than in those who had term deliveries (37.8 mm) (P < 0.001). The cervical shortening was more apparent in the group that delivered prematurely (from 38.6 to 28.4 mm) than in that which delivered at term (from 40.9 to 37.8 mm). CONCLUSION: Cervical length measurement used to predict preterm delivery was found to be more predictive at 20-24 weeks. Cervical length measurement at 10-14 weeks was not reliable for predicting preterm delivery. The mean cervical length tapered gradually from the first to the second scan, and the more rapid cervical shortening was found to be associated with increased risk for preterm delivery.     

Value of cervical phosphorylated insulinlike growth factor binding protein-1 in the prediction of preterm labor

OBJECTIVE: To determine the value of cervical phosphorylated insulinlike growth factor binding protein-1 (IGFBP-1) in the prediction of preterm labor. STUDY DESIGN: In this prospective study, 77 pregnant women, gestational age 24-36 weeks, were enrolled in the study. Twenty women with completely healthy pregnancies formed the control group. Fifty-seven women with signs and symptoms of preterm labor formed the study group. Phosphorylated IGFBP-1 in cervical secretions was assessed in all patients by using a qualitative, immunochromatographic, 1-step dipstick test. Cervical length was measured by transvaginal sonography. RESULTS: The IGFBP-1 test was negative in all patients in the control group (n = 20), and all of them delivered after 37 weeks, while the test was positive in 15 of 45 (33.3%) patients in the study group. The correlation between cervical length and gestational age at the time of delivery in patients with a positive phosphorylated IGFBP-1 test (n = 15) was significant (r = .553, P = .03). The sensitivity, specificity, positive predictive value and negative predictive value for the phosphorylated IGFBP-1 test were 78%, 87%, 73% and 90%, respectively. CONCLUSION: Use of a 1-step dipstick test for detecting phosphorylated IGFBP-1 in cervical secretions is of value in the prediction of preterm labor. The high negative predictive value of the test may be useful in avoiding unnecessary medical interventions.     

阴道超声监测先兆早产孕妇的宫颈预测其妊娠结局

目的　评价阴道超声监测宫颈对早产的预测价值。　方法　采用阴道超声对 5 2例先兆早产患者进行宫颈监测以预测保胎治疗后的妊娠结局。超声监测指标为 :宫颈长度、漏斗形成、漏斗长度、漏斗宽度及宫颈指数 [(漏斗长度 1) /宫颈长度 ]。　结果　 5 2例先兆早产患者中 14例发生早产 ,早产的发生率为 2 6 .92 % (14/ 5 2 )。各项超声监测指标均与先兆早产预后显著相关 (P均 <0 .0 0 1) ,而宫颈长度是预测早产的最佳超声指标。制作 ROC曲线 ,结果显示宫颈长度 17mm为最佳临界值 ,预测早产的敏感性为 78.5 7% ,特异性为 86 .84% ,准确性为 84.6 2 %。　结论　应用阴道超声监测宫颈 ,可客观、准确地预测早产。     

Transvaginal sonography in prediction of preterm delivery in patients presenting with signs and symptoms of preterm labor

OBJECTIVE: The purpose of the study was to assess the clinical value of transvaginal sonography in the group of women presenting with preterm contractions and cervical changes. MATERIAL AND METHODS: We prospectively evaluated 82 patients between 23-34 weeks of gestation presenting in our department with signs and symptoms of preterm labor, intact membranes and cervical dilatation < 3 cm. In all cases transvaginal sonography was performed. The following parameters were assessed: functional canal length, funneling, cervical diameter and the length of the vaginal portion of the cervix. The primary outcome was delivery < or = 28 days from examination. RESULTS: The rate of preterm delivery (< 37 weeks) was 25.6% (21/82) and 17.1% (14/82) of the patients delivered < or = 28 days from the examination. Among the analyzed parameters, the significant difference between patients delivered < or = 28 and > 28 days from examination, was noticed only for the functional canal length (21.6 mm vs 30.1 mm; p < 0.001). The analysis of ROC curves showed that functional canal length had the highest diagnostic capability. Two important thresholds were found--20 mm and 31 mm. For predicting delivery < or = 28 days the functional canal length < or = 20 mm had sensitivity of 57.1%, specificity of 92.6%, PPV of 61.5% and NPV of 91.3%. The cutoff value of 31 mm had sensitivity of 100%, specificity of 47.1%, PPV of 28% and NPV of 100%. In multiple logistic regression analysis only FCL < or = 20 mm (OR 8.18; p = 0.027) was independently associated with PTD. CONCLUSIONS: 1. The shortening of the functional canal length (< or = 20 mm) is predictive of impending preterm delivery and the functional canal length > 31 mm is the indicator of the absence of labor. 2. Cervical sonography can be a valuable adjunct to the clinical assessment of patients with signs and symptoms of preterm labor.     

Charts for cervical length in singleton pregnancy.

OBJECTIVES: To construct charts for cervical length in a low risk population measured by transvaginal ultrasonography. METHODS: Pregnant women of an apparently normal population were seen in the ultrasound division of the University Women's Hospital Basel between 20 and 34 weeks of gestation and underwent once (one measurement per subject) a transvaginal ultrasound measurement of the cervix under standardized conditions. In order to establish normal values of the cervical length, finally only women who delivered spontaneously at term (>37 weeks of gestation) remained in the study. Exclusion criteria were preterm labor, multiple pregnancies, cerclage or surgical intervention prior to pregnancy. For statistical evaluation, regression analysis and calculation of 5th and 95th percentiles were performed. RESULTS: A total of 669 cervical measurements were recorded. The number of measurements differed from 22 measurements at 23 weeks of gestation to 86 at 31 weeks of gestation. Cervical length gradually and significantly decreased as the gestational age progressed (between 20 and 34 weeks of gestation). New charts with the 5th, 50th and 95th percentile are presented and compared with previously published data. CONCLUSIONS: Our charts for cervical length in a limited risk population can be used for observing patients at high risk of preterm delivery and for clearly identifying a significant deviation or decline in the percentile for these subjects.     

Prediction of preterm delivery in the second trimester

OBJECTIVE: The aim of this study was to estimate the probability of spontaneous delivery at 34 weeks or less according to cervical assessment by transvaginal scan associated with previous obstetric history. METHODS: Ultrasound transvaginal cervical length and presence of funneling were evaluated in 1,958 singleton pregnancies between 21 and 24 weeks of gestation. For the prediction of preterm delivery, the results of cervical assessment were analyzed in association with the previous obstetric history of preterm delivery, spontaneous miscarriage, and curettage. Sensitivity, specificity, and positive and negative predictive values for the various cutoff cervical lengths in the groups with or without previous history of preterm delivery were calculated. Multivariable regression analysis was used to identify the predictive factors for preterm delivery at 34 weeks or less. RESULTS: The incidence of spontaneous delivery at gestational age of 34 weeks or less was 3.4%. The mean cervical length was 30.1 mm (standard deviation 10.1 mm) in the group with previous history of prematurity (n = 180) and 35.8 mm (standard deviation 7.9 mm) in the group without previous history of prematurity (P < .001). The mean cervical length in the group of patients who delivered at or before 34 weeks was 23.8 mm, and for patients who delivered after 34 weeks it was 35.6 mm (P < .001). The mean gestational age at delivery was significantly lower in the group with funneling compared with the group without funneling (33.5 weeks versus 38.8 weeks, P < .001). Logistic regression analysis demonstrated that cervical length, funneling, and history of previous preterm delivery were independent contributors for preterm delivery. CONCLUSION: Ultrasound cervical assessment may be useful in the prediction of preterm delivery, but it should also be considered in association with the obstetric history of prematurity.     

Transvaginal ultrasonography of the cervix length and the prediction of preterm delivery

OBJECTIVE: To determine if cervical shortening between 12 and 28 weeks gestation predicts risk of spontaneous preterm birth or cervical funneling requiring cerclage. STUDY DESIGN: We reviewed retrospectively all the patients who had transvaginal cervical ultrasound assessment during one year. 43 patients who had a second and early third trimester delivery or cerclage placement were chosen for the study. The control group consisted of 78 patients without signs of preterm labor and cervical shortening as assessed by transvaginal ultrasound. The results of the last ultrasound cervical length measurement were correlated with the likelihood of preterm delivery or cervical funneling requiring cerclage. RESULTS: 26 of 121 patients studied delivered preterm and 15 required cervical cerclage because of cervical shortening and funneling. The mean cervical length assessed by ultrasound was 23.22 +/- 3.07 mm in the group with preterm contractions and delivery and 21.99 +/- 7.05 mm in the group with cervical incompetence. In the normal pregnancy group mean cervical length was 35.59 +/- 3.07 mm. CONCLUSIONS: Cervical length of < 3.0 cm and further shortening of the cervix is predictive of preterm delivery or cervical incompetence requiring cerclage.     

Transvaginal sonographic assessment of the cervix and preterm labor

OBJECTIVE: The purpose of the study was to assess the accuracy of cervical measurements by transvaginal ultrasonography during the 1st and 2nd trimester in the prediction of preterm labor. STUDY DESIGN: Five hundred high-risk pregnant women in preterm labor were studied retrospectively. RESULTS: A significantly higher percentage rate of preterm delivery was found in women with abnormal cervical length compared to those with normal cervical length (54.6% [118 of 216 women] vs 16.5% [47 of 284 women], p < 0.001). Also in women with abnormal dilatation of the internal cervical os the percentage was significantly higher compared to those with normal findings (78.7% [133 of 216 women] vs. 9.7% [32 of 284 women], p < 0.001). For women with cervical funneling the incidence of preterm delivery was significantly higher compared to the rest of the women (94.3% [33 of 35] vs 28.4% [132 of 465], p = 0.015). CONCLUSION: Our data confirm that sonographic assessment between the 9th and 12th week is the best cut-off period for predicting preterm labor.     

Monocyte chemotactic protein-1 in cervical and amniotic fluid: relationship to microbial invasion of the amniotic cavity, intra-amniotic inflammation, and preterm delivery

OBJECTIVE: The purpose of this study was to evaluate the role of monocyte chemotactic protein-1 in cervical and amniotic fluid in women in preterm labor and with preterm premature rupture of membranes. STUDY DESIGN: Women with singleton pregnancies (相似文献   

Prediction of the latency period by cervical ultrasonography in premature rupture of the membranes before term

OBJECTIVE: To assess the value of ultrasonographic measurement of cervical length for predicting the duration of the latency period from admission to delivery in women with preterm premature rupture of the membranes (PROM). METHOD: Prospective study in 88 women with preterm PROM before 34 weeks of amenorrhea. The median gestational age at admission was of 30.1 weeks. The clinical management included: no digital examination of the uterine cervix, antenatal corticosteroids, antibiotics (amoxicillin & clavulanic acid) for 7 days, and hoding back until 34 weeks. Cervical length at admission was determined with transvaginal ultrasonography. The duration of the latency period was studied in relation with cervical length, serum C-reactive protein (CRP) level and white blood cell (WBC) count at admission. RESULTS: The median latency period was longer in women with a cervical length > or = 25 mm (10 vs 5 days; p = 0.04), but this was not associated with a significant increase in birth weight. The median latency period was also longer in women with CRP < 20 mg/l (10 vs 3 days; p < 0.001) and this was associated with a significant increase in birth weight (1716 +/- 549 vs 1201 +/- 485 g; p < 0.01). Moreover, increased CRP levels were more frequent in women with a cervical length < 25 mm, and cervical length was no more predictive of the duration of the latency period in the subgroup of women with CRP < 20 mg/l and WBC < 20,000 cells/mm3. CONCLUSION: In women with preterm PROM, the latency period from admission to delivery is shorter when cervical length is < 25 mm. However, the clinical value of transvaginal ultrasonography is limited in comparison with serum CRP.