Sonographic measurement of cervical length in twin pregnancies in threatened preterm labor.

OBJECTIVE: To determine whether sonographic measurement of cervical length in twin pregnancies presenting with threatened preterm labor helps distinguish between true and false labor. METHODS: In 87 women with twin pregnancies presenting with regular and painful uterine contractions at 24-36 (median, 30) weeks of gestation, cervical length was measured by transvaginal ultrasound. Women presenting in active labor, defined by the presence of cervical dilation of 3 cm or more, with ruptured membranes and those who underwent a prior or subsequent cervical cerclage, were excluded from the study. The clinical management was determined by the attending obstetrician without taking into account the cervical length. Primary outcome of the study was delivery within 7 days of presentation. RESULTS: Delivery within 7 days of presentation occurred in 19/87 (22%) pregnancies and this was inversely related to cervical length, decreasing from 80% (4/5) at 1-5 mm, to 46% (6/13) at 6-10 mm, 29% (4/14) at 11-15 mm, 21% (4/19) at 16-20 mm, 7% (1/15) at 21-25 mm and 0% (0/21) at >25 mm. Logistic regression analysis demonstrated that significant independent contribution in the prediction of delivery within 7 days was provided by cervical length (odds ratio (OR) = 0.78, 95% CI 0.68-0.89, P < 0.001) and use of tocolytics (OR = 0.13, 95% CI 0.02-0.76, P = 0.024), with no significant contribution from gestation at presentation, chorionicity, ethnic origin, maternal age, body mass index, parity, previous history of preterm delivery, cigarette smoking, contraction frequency, vaginal bleeding or the administration of antibiotics or steroids. CONCLUSION: In women with twin pregnancies presenting with threatened preterm labor, sonographic measurement of cervical length helps distinguish between those who deliver within 7 days and those who do not.     

Sonographic measurement of cervical length in threatened preterm labor in singleton pregnancies with intact membranes.

OBJECTIVES: To predict when delivery will occur, within 48 h and 7 days of presentation and before 35 weeks' gestation in women presenting with threatened preterm labor. METHODS: Sonographic measurement of cervical length was carried out in 510 women with singleton pregnancies presenting with threatened preterm labor and intact membranes at 24 to 33 + 6 weeks of gestation. The measurement was not taken into account in the subsequent management of the pregnancies. The outcome measures were delivery within 48 h and 7 days of presentation and delivery before 35 weeks. RESULTS: The median gestation at presentation was 30 + 1 (range, 24 to 33 + 6) weeks and the median cervical length was 25 (range, 1-51) mm. Delivery within 48 h of presentation occurred in 21 (4.1%) cases, delivery within 7 days occurred in 43 (8.4%) and delivery before 35 weeks occurred in 76 (14.9%). Logistic regression analysis demonstrated that the only significant independent predictor of delivery within 48 h was cervical length (odds ratio (OR), 0.73; 95% CI, 0.65-0.81) and for delivery within 7 days the independent predictors were cervical length (OR, 0.69; 95% CI, 0.63-0.76) and vaginal bleeding (OR, 19.42; 95% CI, 3.87-97.4). In the subgroup of women who did not deliver within 7 days of presentation, the incidence of delivery before 35 weeks was 7.1% (33 of 467) and the only significant independent predictor of such delivery was cervical length (OR, 0.92; 95% CI, 0.88-0.96, P < 0.0001). There was no significant independent contribution to any of the outcome measures from ethnic group, maternal age, gestational age, body mass index, parity, cigarette smoking or use of tocolytics. CONCLUSIONS: In women with threatened preterm labor sonographic measurement of cervical length helps to distinguish between true and false labor and to predict early preterm delivery.     

Sonographic cervical length in threatened preterm labor in a South African population.

OBJECTIVE: In a previous study conducted in the UK we demonstrated that only 8% of women with threatened preterm labor deliver within 7 days. Furthermore, delivery within 7 days occurred in less than 1% of women presenting with a sonographically measured cervical length > or = 15 mm, compared to 37% in those with cervical length < 15 mm. In this study we investigate the potential value of cervical length in the prediction of outcome of threatened preterm labor in a South African population. METHODS: We examined 63 women with singleton pregnancies presenting with regular and painful uterine contractions at 24-36 (mean, 31) weeks of gestation. Women in active labor, defined by the presence of cervical dilatation > or = 3 cm, and those with ruptured membranes were excluded. On admission to the hospital a transvaginal scan was performed to measure the cervical length. The subsequent management was determined by the attending obstetrician. The primary outcome was delivery within 7 days of presentation. RESULTS: Delivery within 7 days of presentation occurred in 20/63 (32%) pregnancies, including 20 of the 30 (67%) cases with cervical length < 15 mm and none of the 33 cases with cervical length > or = 15 mm. Logistic regression analysis demonstrated that the only significant contributor in the prediction of delivery within 7 days was cervical length (odds ratio 0.67; 95% CI 0.54-0.85; P = 0.001) with no significant independent contribution from maternal age, gestational age, body mass index, parity, use of antibiotics, previous history of preterm delivery, cigarette smoking, contraction frequency or use of tocolytics. CONCLUSION: In this South African population, which had a high incidence of delivery within 7 days of presentation with threatened preterm labor, sonographic measurement of cervical length is equally effective as in a lower-risk population in distinguishing between true and false labor.     

Sonographic cervical length in singleton pregnancies with intact membranes presenting with threatened preterm labor.

OBJECTIVE: Less than 10% of women presenting with preterm contractions progress to active labor and delivery. This study investigates whether cervical length measurements by ultrasound can discriminate between true and false labor in women presenting with threatened preterm labor. METHODS: Cervical length was measured by transvaginal ultrasound in 253 women with singleton pregnancies presenting with painful uterine contractions at a median age of 31 (range, 24-35) weeks of gestation. Women presenting in active labor, defined by the presence of cervical dilatation of >or = 3 cm, those with ruptured membranes and those that underwent prior or subsequent cervical cerclage were excluded from the study. The clinical management was determined by the attending obstetrician without taking into account the cervical length. Primary outcome of the study was delivery within 7 days of presentation based on the results of randomized studies on the use of tocolytics in women with preterm labor that reported a prolongation of pregnancy by 7 days. RESULTS: Delivery within 7 days of presentation occurred in 21/253 (8.3%) pregnancies and this was inversely related to cervical length. Receiver-operating characteristics (ROC) curves established a cervical length of 15 mm as the most relevant cut-off level for the prediction of preterm delivery within 7 days. In 217 cases the cervical length was > or = 15 mm and only four of these (1.8%) delivered within 7 days. In the 36 women with cervical length < 15 mm, delivery occurred in 17 (47.2%) within 7 days. Logistic regression analysis demonstrated that significant independent contribution in the prediction of delivery within 7 days was provided by cervical length, contraction frequency at presentation, previous history of preterm delivery and vaginal bleeding. There was no significant contribution from gestation at presentation, ethnic origin, maternal age, parity, cigarette smoking or the administration of tocolysis, antibiotics or steroids. Similar results were shown in a subanalysis of 162 patients presenting at a gestational age below 32 weeks: 9/19 patients (47.4%) with a cervical length below 15 mm delivered within 7 days compared to 3/143 (2.1%) with a cervical length > or = 15 mm. Univariate as well as multivariate analyses confirmed cervical length to be a significant independent predictor of delivery within 7 days in this population. CONCLUSIONS: Sonographic measurement of cervical length helps to avoid overdiagnosis of preterm labor in women with preterm contractions and intact membranes.     

Ultrasound assessment of cervical length in threatened preterm labor.

OBJECTIVE: More than 70% of women presenting with threatened preterm labor do not progress to active labor and delivery. The aim of this study was to investigate the hypothesis that in women with threatened preterm labor, sonographic measurement of cervical length helps distinguish between true and false labor. METHODS: We examined 216 women with singleton pregnancies presenting with regular and painful uterine contractions at 24-36 (mean, 32) weeks of gestation. Women in active labor, defined by the presence of cervical dilatation > or = 3 cm, and those with ruptured membranes were excluded. On admission to the hospital a transvaginal scan was performed to measure the cervical length. The subsequent management was determined by the attending obstetrician. The primary outcome was delivery within 7 days of presentation. RESULTS: In 173 cases the cervical length was > or = 15 mm and only one of these women delivered within 7 days. In the 43 cases with cervical length < 15 mm delivery within 7 days of presentation occurred in 16 (37%) including 6/14 (42%) treated with tocolytics and 10/29 (35%) managed expectantly. Logistic regression analysis demonstrated that the only significant contributor in the prediction of delivery within 7 days was cervical length < 15 mm (odds ratio = 101, 95% CI 12-800, P < 0.0001) with no significant contribution from ethnic group, maternal age, gestational age, body mass index, parity, previous history of preterm delivery, cigarette smoking, contraction frequency or use of tocolytics. CONCLUSIONS: In women with threatened preterm labor, sonographic measurement of cervical length helps distinguish between true and false labor.     

Sonographic measurement of cervical length in preterm prelabor amniorrhexis.

OBJECTIVE: To determine whether sonographic measurement of cervical length in pregnancies complicated by preterm prelabor amniorrhexis helps distinguish between those women who deliver within 7 days and those who do not. METHODS: In 101 women with singleton pregnancies presenting with preterm prelabor amniorrhexis at 24-36 (median, 32) weeks of gestation cervical length was measured by transvaginal ultrasound. Exclusion criteria were active labor defined by the presence of cervical dilatation of > or = 3 cm and iatrogenic delivery for fetal or maternal indication when not in active labor. The clinical management was determined by the attending obstetrician. The primary outcome of the study was delivery within 7 days of presentation. RESULTS: Delivery within 7 days of presentation occurred in 58/101 (57%) pregnancies. Logistic regression analysis demonstrated that significant independent contribution in the prediction of delivery within 7 days was provided by cervical length (odds ratio (OR) = 0.91, 95% CI 0.86-0.96, P = 0.001), gestation at presentation (OR = 1.35, 95% CI 1.14-1.59, P = 0.001) and presence of contractions at presentation (OR = 3.07, 95% CI 1.05-8.92, P = 0.039) with no significant independent contribution from ethnic origin, maternal age, body mass index, parity, previous history of preterm delivery, cigarette smoking, vaginal bleeding or the administration of tocolytics, antibiotics or steroids. CONCLUSION: In women with preterm prelabor amniorrhexis prediction of delivery within 7 days is provided by cervical length, gestation and presence of contractions at presentation.     

宫颈长度联合胎儿纤维连接蛋白检测对预测早产的临床价值

目的探讨超声宫颈长度(CL)检测联合宫颈分泌物胎儿纤维连接蛋白(fFN)检测在早产预测中的临床价值。方法对2011年1月至2013年1月期间收治的120例先兆早产孕妇分别进行超声CL检测和宫颈分泌物fFN检测,比较两种方式分别单独检测和联合检测预测早产敏感度、特异度、阳性预测值、阴性预测值。结果本组120例孕妇中,78例(65.0%)CL30 mm,其中59例(75.6%)发生早产;42例CL≥30 mm,其中13例(30.9%)发生早产。CL30 mm孕妇早产发生率高于CL≥30 mm孕妇(χ2=20.893,P=0.000)。120例早产孕妇CL值为明显低于足月产孕妇(t=5.752,P=0.000)。120例孕妇中fFN(+)89例(74.2%),其中65例(78.0%)发生早产;fFN(-)31例,其中7例(22.6%)发生早产,fFN(+)孕妇早产发生率高于fFN(-)孕妇(χ2=22.329,P=0.000)。所有孕妇中,CL30 mm且fFN(+)共57例,均发生早产。CL、fFN联合检测与二者分别单独检测敏感度差异无统计学意义(与fFN检测比较χ2=3.434,P=0.064),但CL、fFN联合检测特异度和阳性预测值均为100%,分别高于CL检测的60.4%和fFN检测的78.0%(χ2=23.688、18.395,P=0.000、0.000)。结论超声CL测量联合宫颈分泌物fFN检测可提高早产预测的准确率,有利于改善先兆早产孕妇妊娠结局。     

Change in cervical length in cases resulting in threatened preterm labor

Purpose  

To determine the predisposing changes in cervical length (CL) and the critical range of CL in which significant uterine contractions emerge resulting in threatened preterm labor (TPL).     

Targeted therapy for threatened preterm labor based on sonographic measurement of the cervical length: a randomized controlled trial.

OBJECTIVE: False positive diagnosis of preterm labor is common. As a consequence, medications including corticosteroids to promote fetal lung maturity and tocolysis are prescribed unnecessarily. We tested the hypothesis that management of threatened preterm labor based on measurement of cervical length by ultrasonography can reduce the number of women who receive inappropriate treatment. METHODS: Forty-one women with threatened preterm labor for whom a clinical decision was made to prescribe antenatal corticosteroids and tocolysis were randomized to have their cervical length measured by transvaginal ultrasound (n=21) or to receive therapy as planned (n=20). Fourteen women in the ultrasound group had a cervix longer than 15 mm and the therapy was withheld, while the other seven with a short cervix were managed in the same way as the control group. RESULTS: Three women (14%) in the ultrasound group were treated inappropriately with antenatal corticosteroids because they remained undelivered for more than a week. This compared favorably with the control group where 18 out of 20 (90%) received corticosteroids unnecessarily (relative risk (RR) 0.16; 95% confidence interval (CI), 0.05-0.39). Tocolysis was given to only seven women (33.3%) in the ultrasound group compared with 20 (100%) in the control group (RR 0.3; 95% CI, 0.15-0.54). There were no babies in either group who were born prematurely without being given a full course of antenatal corticosteroid therapy. CONCLUSION: Women with threatened preterm labor and cervical length more than 15 mm should not receive tocolysis. The issue of the safety of withholding corticosteroid therapy in this clinical scenario warrants further study.     

Prediction of preterm delivery in twin pregnancy: a prospective, observational study of cervical length and fetal fibronectin testing.

OBJECTIVE: To evaluate prospectively cervical length measurements and fetal fibronectin detection as predictors of spontaneous preterm delivery in an unselected population of twin pregnancies. METHODS: Transvaginal ultrasound assessments of cervical length were performed serially at 18, 24, 28 and 32 weeks' gestation. Receiver-operating characteristic curves were generated at each time point to determine the optimal cut-off for cervical length and rate of change in cervical length in the prediction of preterm delivery (< 35 weeks). A bedside assay for the detection of fetal fibronectin in the maternal vaginal secretions was performed prior to cervical length measurements from 24 weeks. Likelihood ratios (LRs) were used to assess the performance of each test. RESULTS: The spontaneous preterm delivery rate was 16.5% in 91 studied twin pregnancies. A cervical length /= 2.5 mm per week between 18 and 28 weeks' gestation also predicted preterm delivery (LR+ 10.8, sensitivity 16.7%). There was no relationship between the detection of fetal fibronectin and preterm delivery. CONCLUSIONS: This study confirms the value of transvaginal ultrasound assessment of cervical length as a predictor of preterm delivery in twin pregnancies. However, the poor sensitivity of this test makes it unsuitable as a single predictor of preterm delivery. Fetal fibronectin testing does not identify twin pregnancies destined to deliver prematurely.     

Impact of ultrasound cervical length assessment on duration of hospital stay in the clinical management of threatened preterm labor.

OBJECTIVE: To evaluate the impact of ultrasound cervical length measurement on duration of hospital stay in patients admitted for threatened preterm labor. STUDY DESIGN: This was a prospective, comparative study in 294 patients with threatened preterm labor in three hospitalization units (Units A, B and C). In the first phase of the study (observational), cervical length was measured by transvaginal ultrasound, but managing physicians were blinded to the results. In the second phase (interventional), physicians from Unit A remained blinded to cervical length information, but Units B and C incorporated these data into their clinical management protocols. Early discharge was contemplated if the cervix measured 25 mm or more on admission (Unit B) or no changes were observed over 48 h (Unit C). Duration of hospital stay and delivery rates within 7 days and before 37 weeks' gestation were recorded. RESULTS: Hospital stay was significantly reduced in Units B and C in the interventional phase, while no changes were observed in Unit A. Delivery rates within 7 days and before 37 weeks' gestation were similar in the three units during the two stages of the study. CONCLUSION: Routine use of ultrasound cervical length assessment in patients admitted with threatened preterm labor may reduce the duration of hospital stay without increasing the rate of preterm births. These data should be confirmed by means of an appropriately designed randomized clinical trial.     

经会阴超声测量宫颈长度对双胎先兆早产患者应用不同疗程阿托西班治疗的临床效果评估

目的:使用经会阴超声测量宫颈长度(CL)来评估不同疗程阿托西班治疗双胎妊娠先兆早产的疗效.方法:纳入2017年3月—2019年12月我院就诊的双胎妊娠妇女60例作为研究对象,随机数字表法将两组患者分为A组和B组,每组30例,均采用阿托西班治疗,A组予长疗程方案,B组使用短疗程方案.观察两组临床疗效、治疗前后CL、不良反...     

超声检测宫颈长度预测早产的临床价值

目的探讨超声检测宫颈长度（cervicallength,CL）对先兆早产孕妇发生早产的预测价值。方法对2147例单胎先兆早产初产孕妇,分别经腹部、经阴道、经会阴超声检测CL,以CL〈2．6cm为宫颈缩短,追踪妊娠结局,比较三种方法对早产的预测价值。结果经腹部超声检测747例,CL〈2．6cm者早产率40．93％,CL≥2．6cm者早产率4．51％;经阴道超声检测689例,CL〈2．6cm者早产率69．85％,CL≥2．6cm者早产率1．45％;经会阴超声检测711例,CL〈2．6cm者早产率61．54％;CL≥2．6cm者早产率1．98％,三种检测方法检测的CL〈2．6cm组与CL≥2．6cm组的早产率差异均有统计学意义（P〈0．05）;经腹部、经阴道、经会阴超声测量预测早产的敏感性分别为78．57％、92．23％、89．72％,特异性分别为80．00％、93．00％、90．07％,阳性预测值分别为40．93％、69．85％、61．54％,阴性预测值分别为95．49％、98．55％、98．02％,经会阴、经阴道超声测量预测早产的敏感性、特异性、阳性预测值、阴性预测值均显著高于经腹部（P〈0．05）。结论超声检测CL对先兆早产孕妇发生早产有一定的预测意义。经会阴、经阴道超声预测早产的准确性优于经腹部超声。经会阴超声检测可以替代经阴道超声检测,从而提高患者治疗依从性。     

Preinduction sonographic measurement of cervical length in the prediction of successful induction of labor.

BACKGROUND: Induction of labor is carried out in approximately 20% of pregnancies. However, approximately 20% of women having induction of labor end up having a Cesarean delivery. The traditional method of predicting whether an induced labor will result in successful vaginal delivery is based on the preinduction "favorability" of the cervix as assessed by the Bishop score. However, this assessment is subjective and several studies have shown a poor predictive value for the outcome of induction. OBJECTIVES: To examine the relationship between preinduction sonographically measured cervical length and the Bishop score and to compare the two measurements in the prediction of successful vaginal delivery within 24 h of induction. METHODS: In this multicenter study, preinduction cervical assessment was undertaken in 240 women with singleton pregnancies at 37-42 weeks of gestation. The Bishop score was assessed by digital examination and the cervical length was measured by transvaginal sonography. RESULTS: Multiple regression analysis demonstrated that cervical length, Bishop score and parity provided independent contribution in the prediction of the likelihood of delivering vaginally within 24 h. Further examination of the different components of the Bishop score showed that only cervical length provided a significant contribution in the prediction of the likelihood of vaginal delivery within 24 h. In the receiver operating characteristic curves, the best cut-off point for the prediction of successful induction was 28 mm for cervical length and 3 for the Bishop score. However, cervical length appears to be a better predictor than the Bishop score, with a sensitivity of 0.87 and a specificity of 0.71 compared to 0.58 and 0.77, respectively. Similarly, the Kaplan-Meier survival curves indicate that better discriminatory results in the prediction of vaginal delivery within 24 h are achieved using cervical length rather than the Bishop score. CONCLUSION: Transvaginal sonographic measurement of cervical length provides a useful prediction of the likelihood of vaginal delivery within 24 h of induction.     

The role of ultrasound and fetal fibronectin in predicting the length of induced labor when the cervix is unfavorable.

OBJECTIVE: To compare cervical clinical data, ultrasound parameters and fetal fibronectin assessment in the prediction of the duration of induced labor when the cervix is unfavorable. METHODS: This was a prospective study of 90 pregnant women with a Bishop score /= 27 mm (P = 0.002 and P = 0.005). CONCLUSION: Cervical dilatation as assessed by digital examination is the best predictor of the duration of the latent phase and of that of the whole of labor. Ultrasound measurement of cervical length is not more accurate at predicting the duration of labor than are clinical data.     

全血细胞分析指标与先兆早产的相关性研究

目的探讨血红蛋白(HB)、血小板计数(PLT)、血小板分布宽度(PDW)、平均血小板体积(MPV)、血小板比容(PCT)水平在先兆早产孕妇临床中的价值和意义。方法选择184例先兆早产孕妇为先兆早产组,并收集同期进行产前检查的204例健康孕妇为对照组,检测HB、PLT、PDW、MPV、PCT等指标并分析评价。结果 (1)先兆早产组与对照组相比,MPV和HB降低,而PDW增高,差异有统计学意义(P0.01),先兆早产组与对照组的PLT、PCT差异无统计学意义(P0.05);(2)对先兆早产组的PDW作ROC曲线,发现其截点为16.45,曲线下面积为73.4%,对早产预测,敏感度为77.8%,特异度为44.4%。结论先兆早产孕妇中HB、MPV较健康孕妇降低,而PDW增高,当PDW大于16.45时,PDW对先兆流产有一定的诊断意义。