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Cervical length (CL) measured by transvaginal ultrasound is an effective screening test for the prevention of preterm birth (PTB). The criteria for an effective screening test are all met by CL. It studies an important condition (PTB); it is safe and acceptable by >99% of women; it recognises an early asymptomatic phase that precedes PTB by many weeks; it has a well-described technique, is reproducible, is predictive of PTB in all populations studies so far; and, perhaps most importantly, it has been shown that 'early' treatment is effective in prevention. These two interventions, effective only in specific populations, are ultrasound-indicated cerclage and vaginal progesterone.  相似文献   

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Objective: The objective of this study is to estimate the risk of preterm birth in patients with an ultrasound or physical exam indicated cervical cerclage based on the results of fetal fibronectin (fFN) and cervical length (CL) screening.

Methods: Retrospective cohort of patients with a singleton pregnancy and an ultrasound or physical exam indicated Shirodkar cerclage placed by one maternal–fetal medicine practice from November 2005 to January 2015. Patients routinely underwent serial CL and fFN testing from 22 to 32 weeks. Based on ROC curve analysis, a short CL was defined as?≤15?mm. All fFN and CL results included are from after the cerclage placement.

Results: One hundred and four patients were included. Seventy eight (75%) patients had an ultrasound-indicated cerclage and 26 (25%) patients had a physical exam-indicated cerclage. A positive fFN was associate with preterm birth?<32 weeks (15.6% versus 4.2%, p?=?0.043), <35 weeks (37.5% versus 11.1%, p?=?0.002), <37 weeks (65.6% versus 20.8%, p?<?0.001), and earlier gestational ages at delivery (35.2?±?3.9 versus 37.4?±?2.9, p?=?0.001). A short CL was also associated with preterm birth?<35 weeks (50.0% versus 11.9%, p?<?0.01), preterm birth?<37 weeks (55.0% versus 29.8%, p?=?0.033), and earlier gestational ages at delivery (34.8?±?4.1 versus 37.2?±?3.0, p?=?0.004). The risk of preterm birth?<32, <35, and?<37 weeks increased significantly with the number of abnormal markers.

Conclusion: In patients with an ultrasound or physical exam indicated cerclage, a positive fFN and a short CL are both associated with preterm birth. The risk of preterm birth increases with the number of abnormal biomarkers.  相似文献   

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Objective: To estimate the association between a positive fetal fibronectin (fFN) and spontaneous preterm birth (SPTB) in twin pregnancies with a shortened cervical length (CL).

Study design: Retrospective cohort study of asymptomatic twin pregnancies managed by a single MFM practice from 2005 to 2016. We included all women with a shortened CL ≤25?mm at 22–28 weeks, and compared outcomes between women with a positive and negative fFN result.

Results: One hundred fifty-five patients were included, 129 (83.2%) of whom had a negative fFN and 26 (16.8%) of whom had a positive fFN. Baseline characteristics were similar between groups, except for the CL at the time of diagnosis of short cervix (15?mm in the positive fFN group versus 20?mm in the negative fFN group, p?=?.002). The risk of SPTB <32 weeks was significantly higher in the positive fFN group (46.2 versus 12.6%, aOR 3.54, 95% CI 1.26, 9.92) and the mean gestational age at delivery was significantly earlier (31.1 versus 35.2 weeks, p?Conclusions: In asymptomatic women with twin pregnancies and a shortened CL, a positive fFN is significantly associated with SPTB and can modify the risk substantially. If performing a screening CL assessment in a twin pregnancy, fFN testing should be done concurrently.  相似文献   

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Objective: To evaluate the efficacy of salivary progesterone, cervical length measurement in predicting preterm birth (PTB).

Methods: Prospective observational study included 240 pregnant women with gestational age (GA) 26–34 weeks classified into two equal groups; group one are high risk for PTB (those with symptoms of uterine contractions or history of one or more spontaneous preterm delivery or second trimester abortion) and group 2 are controls.

Results: There was a highly significant difference between the two study groups regarding GA at delivery (31.3?±?3.75 in high risk versus 38.5?±?1.3 in control), cervical length measured by transvaginal ultrasound (24.7?±?8.6 in high risk versus 40.1?±?4.67 in control) and salivary progesterone level (728.9?±?222.3 in high risk versus 1099.9?±?189.4 in control; p?p value 0.035) but not in low risk group (p value 0.492). CL measurement showed a sensitivity of 71.5% with 100% specificity, 100% PPV, 69.97% NPV and accuracy of 83%, while salivary progesterone showed a sensitivity of 84% with 90% specificity, 89.8% PPV, 85.9% NPV and accuracy of 92.2%.

Conclusion: The measurement of both salivary progesterone and cervical length are good predictors for development of PTB.  相似文献   

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Objectives: To evaluate differences in risk factors and delivery outcomes among women with spontaneous preterm birth (sPTB) with short (≤25?mm) versus normal (>25?mm) cervical length (CL).

Methods: Secondary analysis of a prospective cohort study of singleton gestations between 18 0/7 and 23 6/7 weeks, without prior sPTB, undergoing universal transvaginal CL screening between 1 January 2012 and 31 December 2013. Only women with sPTB (<37 0/7 weeks) were included. Demographic characteristics, risk factors for sPTB, delivery outcomes and presentation of PTB were collected. The primary outcome was mean number of risk factors.

Results: The cohort included 2071 women, of which 145 (7%) had PTB and 84 (4%) had sPTB. Sixty-nine (82%) women with sPTB had a CL >25?mm and 15 (18%) had a CL≤25?mm. Women with a short CL did not differ from women with normal CL with respect to demographic variables or mean number of risk factors (4.20?±?2.11 versus 3.52?±?1.97, p?=?0.23), but they did deliver at a significantly earlier gestational age (25.0?±?1.1 versus 34.6?±?3.1 weeks, p?<?0.01). The distribution of the presentation of sPTB was different in women with a short versus normal CL (p?<?0.01).

Conclusions: Among women with sPTB, women with a short CL had similar number of risk factors, but were more likely to deliver at a significantly earlier gestational age. A short CL identifies women at risk for very early sPTB.  相似文献   

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