Significance of highly phosphorylated insulin-like growth factor binding protein-1 and cervical length for prediction of preterm delivery in twin pregnancies

BACKGROUND A twin pregnancy can carry greater risks than singleton pregnancies.About 60 in 100 twin pregnancies result in spontaneous birth before 37 wk,which is associated with several complications in the premature babies.Clinical detection of biomarkers may help to predict the possibility of premature birth so that corresponding interventions can be given to the pregnant women in a timely manner,in order to reduce the risk of preterm birth and improve the outcomes of the newborn infants.AIM To explore the clinical value of transvaginal ultrasound measurement of cervical length combined with insulin-like growth factor binding protein-1(IGFBP-1)hyperphosphorylation in cervical secretions as predictors of preterm delivery in twin pregnancies.METHODS A total of 254 pregnant women with twin pregnancies,who were admitted to Hainan General Hospital and underwent maternity examination,were selected as the study subjects from January 2015 to December 2018.All participants received transvaginal ultrasound measurement of cervical length and phosphorylated IGFBP-1(phIGFBP-1)test between 24 and 34 wk gestation.The pregnancy outcomes were analyzed.RESULTS Of the women with a positive phIGFBP-1 test result,preterm birth rate was higher in those with a cervical length≤25 mm than those with a cervical length>25 mm(all P<0.05).Similarly,in women with a negative phIGFBP-1 test result,preterm birth rate was higher in those with a cervical length≤25 mm than those with a cervical length>25 mm(all P<0.05).The sensitivity,specificity,and positive and negative predictive values of the phIGFBP-1 test combined with the cervical length test were 95.71%,91.21%,95.12%and 92.22%,respectively,for the prediction of preterm birth.CONCLUSION Cervical length combined with phIGFBP-1 tests is of value for the prediction of outcomes of preterm delivery in twin pregnancies.

An implementation study of barriers to universal cervical length screening for preterm birth prevention at tertiary hospitals in Thailand:Healthcare managers’perspectives

Objective:To identify healthcare managers’perspectives on the barriers to implementing cervical length screening to prevent preterm births.Methods:In PhaseⅠ,10 healthcare managers were interviewed.PhaseⅡcomprised questionnaire development and data validation.In PhaseⅢ,the questionnaire was administered to 40 participants,and responses were analyzed.Results:Their average related work experience was(21.0±7.2)years;39(97.5%)respondents also had healthcare management responsibilities at their respective hospitals.Most hospitals were reported to have enough obstetricians(31 cases,77.5%)and to be able to accurately perform cervical length measurements(22 cases,55.0%).However,no funding was allocated to universal cervical length screening(39 cases,97.5%).Most respondents believed that implementing universal screening,as per Ministry of Public Health policies,would prevent preterm births(28 cases,70.0%).Moreover,they suggested that hospital fees for cervical length measurements should be waived(34 cases,85.0%).Three main perceived barriers to universal screening at tertiary hospitals were identified.They were heavy obstetrician workloads(20 cases,50.0%);inadequate numbers of medical personnel(24 cases,60.0%);not believing that the screening test could prevent preterm birth(8 cases,20%)and lack of free drug support for preterm birth prevention in high-risk cases(29 cases,72.5%).Conclusions:The main obstacles to universal cervical length screening are heavy staff workloads and inadequate government funding for ultrasound scanning and hormone therapy.The healthcare managers do not believe that the universal cervical length screening can help to reduce preterm birth.

Correlation between Endocervical Length in the First Trimester and Spontaneous Preterm Delivery

Introduction: Prematurity is a public health problem in Brazil, with 12% of deliveries occurring before 37 weeks of gestation. The measurement of the cervix in the second trimester is already established as a method of screening for prematurity and some studies point out advantages to start this screening in the first trimester. Objective: To define the correlation between the length of the endocervix by transvaginal ultrasound in the first trimester (11 to 14 weeks) with spontaneous early deliveries. Method: A prospective and observational study realized in a suplementar and private ultrasound clinic and hospital of Porto Alegre, Brazil between 2019-2020. Ultrasound screening of cervix was performed in singleton pregnancies in first and second trimester of pregnancy and correlated with age of delivery. Results: 142 pregnant women were studied, 80% were in the first pregnancy. The average age was 33.8 years. The rate of prematurity was 18% before 37 weeks and 4% before 34 weeks. The average of cervix measured in the first and second trimesters in deliveries before 34 weeks was 32.7 mm and 29.3 mm, respectively. In term deliveries the median cervical length was 38.8 mm and 37.8 mm, respectively. When analyzing the measurements of the cervix in the second trimester, the cervix was smaller (p = 0.008) among deliveries below 34 weeks (29 mm) than deliveries after 37 weeks. No statistically related differences were found between preterm birth and first trimester cervix measurements. Conclusions: In this study, we did not observe a statistically significant relationship between first trimester cervix measurement and prematurity. More studies are needed to evaluate this finding. However, the measurement of the cervix in the second trimester is different from that found in the literature. This suggests a possible new cut-off point that increases the sensitivity of transvaginal ultrasound as a method of preventing prematurity.

Cervical Length at 28-32 Weeks of Gestation Predicts Preterm Birth

Objective:To evaluate the ability of cervical length(CL)at 28-32 weeks of gestation to predict spontaneous preterm delivery and preterm premature rupture of membranes(PPROM).Methods:It was a retrospective cohort study that vaginal ultrasonography at approximately 28-32 weeks of gestation was performed in 14,953 women between 17-49 years old with singleton pregnancies who delivered after 28 weeks of gestation at the Peking University First Hospital from June 2008 to December 2012.The pregnancy outcomes were followed and the relationship between the CL and preterm delivery or PPROM was assessed.The relative risk was calculated to assess group differences in the likelihood of an event occurring.Results:The overall prevalence of preterm delivery was 5.7%(858/14,953);the incidence for therapeutic preterm delivery was 2.1%(318/14,953),for spontaneous preterm delivery was 0.9%(133/14,953),and for PPROM was 2.7%(407/14,953).Excluding the 318 women who had therapeutic preterm delivery,the relative risk of preterm delivery for women with a CL between 25 mm and<30 mm,between 15 mm and<25 mm,and<15 mm was 3.7,9.3,and 30.2,respectively.The sensitivity,specificity,and positive and negative predictive values of CL<25 mm at 28-32 weeks of gestation as the cut-off value for predicting preterm delivery were 19.8%,97.5%,23.4%,and 96.9%,respectively.For preterm delivery before 35 weeks of gestation,the sensitivity,specificity,and positive and negative predictive values of a CL<25 mm at 28-32 weeks of gestation as the cut-off value were 30.0%,97.2%,11.8%,and 99.1%,respectively.In addition,women with PPROM(n=407)had significantly shorter CL(31.9±7.4)mm at 28-32 weeks of gestation compared that of women without PPROM(34.0±8.3)mm.The incidence of PPROM in women with a CL£25 mm at 28-32 weeks of gestation(19.4%,79/407)was significantly lower than that for women with a CL>25 mm(80.6%,328/407,P<0.05).Conclusion:CL at 28-32 weeks of gestation can predict spontaneous preterm delivery,and is valuable for predicting PPROM.

Prevention and not merely prediction of preterm labor and delivery

Different methods have been proposed to screen for preterm labor and delivery; most of these aim to pre-dict the risk that preterm delivery is going to take place. However, interesting though this knowledge might be, knowing the future is of no use when no changes can be made. Recent publications have suggested new and exciting modalities to actually diminish the frequency of preterm birth in patients selected by transvaginal cervical length measurement; these modalities include vaginal progesterone and vaginal pessaries. Although promising, many questions remain to be answered; not least about the long term outcome for both neonates and mothers, but also on the eventual introduction of such strategies to the general obstetric population. One of the main problems that urgently needs clarifcation is how we are going to offer this best of medicine to those needing it most： deprived and socially isolated women who have the highest risk for preterm laborand delivery, probably not due to any congenital cervi-cal problems, but to a combination of environmental, microbiological and social factors, including transgen-erational poverty and deprivation.

Accuracy of Transvaginal Ultrasound in Prediction of Latency Period in Women with Preterm Premature Rupture of Membranes

Background: Preterm prelabor rupture of membranes (PPROM) is a major cause of Pretem Birth (PTB), Pretem Birth (PTB) is the most significant cause of perinatal morbidity and mortality worldwide. Cervical length (CL), posterior uterocervical angle (PUCA) and anterior uterocervical angle (AUCA) have been postulated in several studies to have an important role in prediction of PTB. Up to our knowledge, this is the first study that combines the three cervical parameters in prediction of latency period in women with PPROM. Aim of the Work: To assess the accuracy of cervical length, posterior uterocervical angle and anterior uterocervical angle in prediction of latency period in women with Preterm prelabor rupture of membranes. Subjects and Methods: A Prospective cohort study on 205 women with PPROM was held at Ain Shams University Maternity Hospital, a transvaginal ultrasound was performed to measure cervical length, posterior uterocervical angle, anterior uterocervical angle. Results: A total of 205 pregnant women with PPROM were included in this study, the latency grade was within 2 days in 57 (27.8%) of cases while was after 2 days in 148 (72.2%) of cases. As regards cervical length cut-off value 25.0 mm, sensitivity was 78.9%, specificity was 65.5%, posterior uterocervical angle cut-off value 108.0°, sensitivity was 93.0%, specificity was 60.1%, and anterior uterocervical angle cut-off value 106.0°, sensitivity was 93.0%, specificity was 71.6%. Conclusion: The combination of cervical length (CL), posterior uterocervical angle (PUCA) and anterior uterocervical angle (AUCA) measurements greatly predicts the latency period in women with PPROM, and Anterior uterocervical angle (AUCA) ≥ 106.0° had the highest diagnostic value in predicting latency period within two days.

Transvaginal Sonographic Assessment of the Cervix for Prediction of Successful Induction of Labor in Nulliparous Women

Background: Induction of labor is commonly performed in obstetric practice. Many methods have been suggested as good predictors of the outcome of labor induction, yet none of them is satisfactory enough. Our study aims to assess cervical length and uterocervical angle measured by transvaginal ultrasound as predictors of successful induction of labor. Methods: Prospective cohort study conducted in Ain Shams University Maternity hospital over 150 nulliparous women undergoing induction of labor, in the period between May 2018 and August 2019. Transvaginal sonographic measurement of cervical length and uterocervical angle was done before induction of labor by prostaglandins. The patients were followed up till delivery and the outcome was recorded. Results: The best cut-off value of cervical length for prediction of success of labor induction was 32.3 mm with 60% sensitivity and 56% specificity and the best cut-off value of uterocervical angle was 110.2 degrees with 87% sensitivity and 93% specificity. The cervical length showed a significant negative correlation while the uterocervical angle showed a significant positive correlation with the success of labor induction. Conclusion: Cervical length and uterocervical angle are good predictors of successful labor induction.

Cervical Assessment by Transvaginal Ultrasound for Predicting Preterm Birth in Asymptomatic Women

Preterm birth(PTB)is defined as delivery before completing 37 weeks of gestation.It is the main cause of neonatal morbidity and mortality in the most countries.The inherent cervical length and strength are two main features of the cervix that determine whether or not a pregnant woman is at risk for PTB.Routine transvaginal cervical length screening was recommended for women with singleton pregnancy and history of prior spontaneous PTB,while the issue of universal cervical length screening and the screening in multiple gestations remain an object of debate.Strain sonoelastography and shear-wave sonoelastography have been used to evaluate the cervical stiffness in pregnant women,but the predictive value for PTB still requires further investigations.In this review,we will discuss the measurement methods of cervical length and cervical stiffness,and compare the value of cervical assessment by transvaginal ultrasound for predicting PTB in asymptomatic women.

Risk Assessment and Prevention of Spontaneous Preterm Birth

Preterm parturition is the consequence of pathological signals that activate the common pathway of parturition and considered as a syndrome.Many risk factors for spontaneous preterm birth(sPTB)have been identified.Two significant risk factors for sPTB are history of prior sPTB and short cervical length at midtrimester.17 hydroxyprogesterone caproate,vaginal progesterone,cerclage,and pessary have all been studied for prevention of sPTB.Difference in patient populations likely contributes to the conflicting study results.Further studies are needed to establish strategies in prevention of sPTB in singleton as well as multiple pregnancies.