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.

Papillary Muscle Relocation in Secondary Mitral Regurgitation: Midterm Outcomes

Background: Mitral valve repair in secondary mitral regurgitation is still uncertain as the chance of recurrence is approximately 30 percent after solely undersized annuloplasty. Some procedures adding to the subvalvular level are proposed to alleviate the recurrent rate. This study was to evaluate the clinical and echocardiographic outcomes of papillary muscle relocation plus undersized ring in secondary mitral regurgitation (2nd MR). Methods: Medical records of moderate to severe 2nd MR with tethering depth of more than 1 cm patients who underwent papillary muscle relocation plus undersized ring from 2014 to 2020 were reviewed. Clinical and echocardiographic parameters before and after operation were analyzed. Results: Thirty-two patients were included during the 6-year period. There was no perioperative mortality. Two patients died at one year from ischemic stroke and car accidents with overall 5-year survival of 93.7%. All patients were in NYHA class I and II with MR grading as trivial or mild at a median follow-up of 33 months. Postoperative mean tenting depth, area and posterior leaflet angle decreased remarkably from 1.18 cm, 2.61 cm2 and 46.5 degree to 0.65 cm, 1.22 cm2 and 28.6 degree, respectively (p 0.001, 0.02, and 0.01). Moreover, left ventricular function and remodeling were also notably improved (EF;38.2% vs 49.1%: p = 0.018, LVEDD;62.8 vs 54.6 mm: p = 0.005, LVESD;50.2 vs 42.4 mm: p = 0.01). Conclusions: Papillary muscle relocation combined with undersized annuloplasty improved mid-term clinical outcomes. Apart from reduction of recurrent MR rate, restoration of mitral configuration and reverse LV remodeling could be the effect of adding subvalvular correction in this pathology.