Cervical length in the early second trimester for detection of triplet pregnancies at risk for preterm birth.

OBJECTIVE: Preterm triplet delivery is common and has a tremendous impact on neonatal mortality and morbidity. We aimed at assessing early second-trimester cervical length as a means of detecting triplet pregnancies at risk for preterm birth. METHODS: Cervical length was measured in triplet pregnancies during weeks 14 to 20. Cervical length of less than 25 mm was used as a cutoff to divide individuals into 2 groups. Perinatal outcome parameters were compared between the 2 groups and included gestational age at delivery, birth weights, and neonatal intensive care unit admission rates. Sensitivity, specificity, and positive and negative predictive values were calculated for cervical length as a screening method for preterm birth. RESULTS: We evaluated 36 triplets during weeks 14 to 20. Cervical length of less than 25 mm was measured in 14 (group I), 12 of which were delivered before 32 weeks (mean +/- SD, 28.4 +/- 3.1 weeks). Four of 22 women with cervical length of greater than 25 mm (group II) had delivery before 32 weeks (mean, 30.1 +/- 1.8 weeks). The mean gestational age at delivery for all parturients from group II was 33.1 +/- 2.1 weeks (P < .05). Group I neonates had lower birth weights (972 versus 1889 g; P < .001) and higher rates of low 5-minute Apgar scores and neonatal intensive care unit admissions compared with group II neonates. The sensitivity of a shorter cervix as a predictor of preterm labor was 75%, with specificity of 90%, a positive predictive value of 83%, and a negative predictive value of 81%. CONCLUSIONS: Cervical length of less than 25 mm at 14 to 20 weeks' gestation is associated with preterm delivery and adverse perinatal outcome in triplet pregnancies.     

Cervical length screening for predicting preterm birth: A comparative review of guidelines

A cervical length (CL) assessment may predict preterm birth (PTB). This study aimed to analyze and compare the recommendations of guidelines on the role of CL in the prediction of PTB. There is no consensus regarding universal screening of asymptomatic women without a history of prior spontaneous PTB (sPTB), using CL. On the other hand, CL assessment is recommended in cases with a history of sPTB due to the high recurrence rate. Finally, there is discrepancy regarding CL assessment in asymptomatic women with multiple pregnancy. Although far from perfect, CL measurement remains the best available method to predict PTB.     

Transvaginal sonographic cervical length changes during normal pregnancy.

OBJECTIVE: To examine the relationship between cervical length and gestational age in normal pregnancy in nulliparous versus parous women. METHODS: We studied a cross-sectional sample of 321 pregnant women, including 185 nulliparous and 136 multiparous women. The inclusion criteria were sonographic confirmation of gestational age within the 12th week, the absence of any risk factors for preterm birth, and uncomplicated pregnancy with expected delivery during the 38th to 42nd weeks. Cervical length was measured in a straight line if the cervix did not show any curvature; in the presence of cervical curvature, the measurement was broken down into 2 or more segments. RESULTS: There was a relationship between gestational age and cervical length, which could be described with a linear function (R = 0.92; R2 = 0.85; P < .001). Moreover, there was no statistically significant difference between multiparous and nulliparous women. CONCLUSIONS: Our study shows that cervical length is comparable in nulliparous and multiparous women throughout pregnancy. In both groups, it actually shows a progressive, linear reduction between the 10th and 40th weeks. Reference ranges constructed for the whole gestational period might be more useful than a single cut-off value for more efficient prevention and management of preterm birth.     

58例多胎妊娠孕妇减胎术后妊娠结局分析及护理*

目的: 分析多胎妊娠减胎术后的妊娠结局并总结护理的要点。方法: 回顾性分析2016年1月至2018年12月行减胎术的58例多胎妊娠孕妇临床资料,术前对其进行心理护理、术后进行饮食及活动指导,分析减胎术后的妊娠结局。结果: 所有多胎妊娠均减至单胎或双胎,孕早期减胎与孕中期减胎比较,在术后2周内流产率、活产胎儿分娩孕周方面差异无统计学意义（P>0.05）,孕中期减胎较孕早期减胎新生儿出生体质量更重,差异有统计学意义（P<0.05）;心内注射氯化钾（KCl）减胎和射频消融（RFA）减胎两种手术方法比较,在术后2周内流产率、分娩孕周、围生儿存活率方面差异无统计学意义（P>0.05）。结论: 减胎术可在孕早中期进行,KCl减胎及RAF减胎均可改善多胎妊娠的妊娠结局。术前心理护理及术后饮食、活动指导,对妊娠结局有益。     

Cervical length for prediction of preterm birth in women with multiple prior induced abortions.

OBJECTIVE: To determine whether transvaginal sonographic cervical length predicts preterm birth in women with multiple prior induced abortions. METHODS: This was a retrospective cohort study using the Thomas Jefferson University Prematurity Database. Patients with a singleton pregnancy and a history of more than one induced abortion were identified. Exclusion criteria were cerclage and indicated preterm birth. Subjects were followed with transvaginal ultrasound measurement of the cervix between 14 and 24 weeks' gestation and grouped into those with and those without a short cervix; a cervical length of < 25 mm was considered short. The primary outcome was spontaneous preterm birth at < 35 weeks. RESULTS: Fifteen of the 65 (23%) women with more than one induced abortion included in the study had a short cervix. The demographics and risk factors were similar between those with and those without a short cervix. The overall incidence of preterm birth was 21.5% (14/65); in women with a short cervix the incidence was 47% (7/15) and in women without a short cervix it was 14% (7/50). The sensitivity, specificity and positive and negative predictive values of a short cervix in the prediction of preterm birth were 50%, 84%, 47% and 86%, respectively. The relative risk of a short cervix for spontaneous preterm birth was 3.3 (95% CI, 1.4-7.4). CONCLUSION: A cervical length of < 25 mm on transvaginal ultrasound is predictive of preterm birth in women with more than one prior induced abortion. Women with multiple prior induced abortions and a short cervix have a 3.3-fold greater chance of spontaneous preterm birth compared with those with a cervical length of > or = 25mm.     

多胎妊娠减胎术后妊娠结局的护理干预影响评价

目的观察多胎妊娠减胎术后护理干预对妊娠结局的影响。方法选取2010年1—12月行常规护理的多胎妊娠减胎术孕妇50例和2011年1月—2012年6月行优质护理的多胎妊娠减胎术孕妇50例,对比2组产妇的妊娠结局。结果 2组产妇减灭胚胎数无统计学差异,但在术后感染率、术后流产率、新生儿出生率及畸形率等方面差异具有统计学意义(P<0.05)。结论对多胎妊娠减胎术产妇施以优质护理干预,可以较好地改善妊娠结局。     

"I couldn't think that far": infertile women's decision making about multifetal reduction

In this phenomenological study women's experiences regarding their decisions to undergo or forgo multifetal reduction of their higher-order multiple pregnancies were explored. Seven women who had conceived higher-order multiple pregnancies as the result of in vitro fertilization were interviewed. Four participants accepted reduction, whereas three participants declined. Three themes were discerned: (a) the presence of infertility as a barrier to contemplating hyperfertility; (b) multiple-birth pregnancy as yet another form of loss for infertile women; and (c) the lasting effects of having made the decision.     

The microbiological effects of endovaginal sonographic assessment of cervical length.

OBJECTIVE: To determine whether performance of endovaginal sonography for the measurement of cervical length results in a statistically significant change in endocervical culture results. METHODS: Women attending a routine prenatal clinic were offered enrollment in the study. Exclusion criteria included the presence of a cervical cerclage, vaginal examination or coitus within the preceding 24 hours, antibiotic therapy within the preceding 7 days, or the presence of ruptured membranes. A sterile speculum examination and collection of cervical cultures were performed before (initial) and immediately after (final) endovaginal sonographic measurement of cervical length. Quantitative cultures were completed and evaluated for differences in growth by a standardized 4-quadrant technique. RESULTS: A total of 25 women enrolled and completed the study protocol. Quantitative assessment of colony growth showed that the mean growth in the initial samples +/- SD was 3.48+/-1.74, with 1+ indicating growth in 1 quadrant; 2+, growth in the first and second quadrants; 3+, growth in the first, second, and third quadrants; and 4+, growth in all quadrants. The mean growth cultured in the final sample was 3.79+/-2.26 (P = .364; 95% confidence interval of the difference, -1.00 to +381). CONCLUSIONS: The results of this study do not show a statistically significant inoculation effect associated with performance of endovaginal sonography for the measurement of cervical length.     

Fetal gender and sonographic assessment of crown-rump length: implications for multifetal pregnancy reduction.

OBJECTIVES: Fetal size is a common criterion for the selection of an individual fetus to be reduced during multifetal pregnancy reduction. We investigated whether a difference in crown-rump length (CRL) exists between male and female fetuses at 9-13 weeks' gestation. METHODS: A total of 883 singleton pregnancies was evaluated at the time of chorionic villus sampling. The mean gestational age at the time of intervention was 10.9 weeks. Pregnancies were dated by certain last menstrual period (LMP). Pregnancies with uncertain dating by LMP or with a sonographic difference of gestational age > 1 week compared with LMP were excluded, as were all cases with chromosomal abnormalities. CRL differences between male and female fetuses were compared using Student's t-test. RESULTS: A total of 417 female and 466 male fetuses fulfilled our study criteria. Their gestational ages ranged between 9.3 and 13.9 weeks. We found no significant difference in size between the male and female fetuses. CONCLUSION: Using the CRL to guide multifetal pregnancy reduction should not result in a clinically significant selection of either gender.     

超声引导下孕中期选择性多胎妊娠减胎术23例分析

目的 探讨超声引导下孕中期选择性多胎妊娠减胎术的临床应用价值。方法 超声引导下对23例孕中期多胎妊娠进行选择性减胎术，其中多胎妊娠中异常胎儿减胎7例，要求减少胎儿数目16例。结果 对23例孕妇施行减胎术共26例次，一次减胎成功率96．2％（25／26），再次减胎矫正后成功率100％。共手术减灭胎儿25个（2例四胎妊娠同时减去2个胎儿）。23例全部分娩。其中〉36周分娩者12例，32-36周7例，28-32周2例，〈28周2例（流产）。在23例分娩的孕妇中20例获存活健康新生儿32名，妊娠成功率86．96％。结论 超声引导下孕中期选择性多胎妊娠减胎术是一种方法简单、定位准确、安全可靠、有效的微创操作技术，为多胎妊娠的管理提供了一个新的方法。     

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。     

妊娠中期宫颈弹性参数联合宫颈长度对自发性早产的预测价值

目的:评估妊娠中期宫颈软硬度特点,探讨宫颈弹性参数联合宫颈长度(CL)对自发性早产(sPTB)的预测价值。方法:回顾性分析2018年1月至2019年12月在成都市妇女儿童中心医院进行产前超声检查的147例足月产孕妇(足月产组)和24例sPTB孕妇(sPTB组)的临床资料。妊娠16～28周时采用经阴道超声E-Cervix...