Predictors of preterm birth |
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| Institution: | 1. Université Paris Descartes, EHU-PACT, Department of Obstetrics and Fetal Medicine, Hôpital Necker Enfants-Malades, 149 rue de Sèvres, 75015, Paris, France;2. Université Versailles Saint-Quentin, Department of Obstetrics and Gynecology, Hôpital Intercommunal de Poissy, France;1. Department of Reproductive Biology, Case Western Reserve University, Cleveland, OH, USA;2. Department of Obstetrics and Gynecology, University Hospitals of Cleveland, Cleveland, OH, USA;1. Department of Obstetrics and Gynecology, Washington University in St. Louis, MO, USA;2. Department of Biology, Washington University in St. Louis, MO, USA;3. Department of Biology, University of Rochester, NY, USA;4. Washington University School of Medicine, St. Louis, MO, USA;1. Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands;2. Department of Obstetrics and Gynaecology, University Medical Center, Utrecht, The Netherlands;3. Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia;2. Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI;3. Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI |
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| Abstract: | Cervical length (CL) measured by transvaginal ultrasound examination (TVUE) best identifies the risk for preterm birth (PTB). It identifies women at risk who can benefit from corticosteroids or in utero transfer. Early screening improves effectiveness of tocolysis. It reduces iatrogenicity and cost. In preterm premature rupture of membranes (PPROM), CL is devoid of infectious risk and predicts duration of the latency phase but not the risk of perinatal sepsis.Asymptomatic women at risk should be screened at a 2-week interval starting from 16 to 18 weeks, up to 24 weeks. CLs <10th centile are at risk of PTB, especially with decrease in CL after 16 weeks. Repeat ultrasound improves predictive values. Stable CL calls for term delivery. Funneling does not improve predictivity of CL. In twin pregnancies, CL reduces unnecessary interventions. In symptomatic women, fetal fibronectin performs less than CL. Its combination with inconclusive CL has not emerged productive through randomized controlled trials (RCTs), and studies with homogeneous management for preterm labor (PTL) suggest that up to 15% of unjustified hospitalizations and treatment could be avoided. |
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| Keywords: | Preterm delivery Preterm labor Cervical length Transvaginal ultrasound Prediction Fetal fibronectin |
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