Cervical length screening for prevention of preterm birth in singleton pregnancy with threatened preterm labor: systematic review and meta‐analysis of randomized controlled trials using individual patient‐level data

Berghella, Vincenzo; Palacio, Montse; Ness, Amen; Alfirević, Z̄arko; Nicolaides, Kypros H.; Saccone, Gabriele

doi:10.1002/uog.17388

Cited by 121 publications

(93 citation statements)

References 17 publications

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“…36–39 A 2016 systematic review and meta-analysis of RCTs using individual patient-level data concluded that knowledge of CL in women with symptoms of acute PTL was associated with a significant reduction in PTB o 37 weeks gestation (RR 0.64, 95% CI: 0.44–0.94). 40 However, the other outcomes, which included PTB o36, o34, o32, o30, and o28 weeks gestation, time from randomization to delivery, time from evaluation to discharge, and other neonatal outcomes were not statistically different between those who had knowledge of CL and those who did not. Thus, the clinical impact of CL measurement in this population remains unclear.…”

Section: Introductionmentioning

confidence: 84%

Predicting preterm birth: Cervical length and fetal fibronectin

Son

Miller

2017

Seminars in Perinatology

123

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Spontaneous preterm birth remains the leading cause of neonatal morbidity and mortality worldwide, and accounts for a significant global health burden. Several obstetric strategies to screen for spontaneous preterm delivery, such as cervical length and fetal fibronectin measurement, have emerged. However, the effectiveness of these strategies relies on their ability to accurately predict those pregnancies at increased risk for spontaneous preterm birth (SPTB). Transvaginal cervical shortening is predictive of preterm birth and when coupled with appropriate preterm birth prevention strategies, has been associated with reductions in SPTB in asymptomatic women with a singleton gestation. The use of qualitative fetal fibronectin may be useful in conjunction with cervical length assessment in women with acute preterm labor symptoms, but data supporting its clinical utility remain limited. As both cervical length and qualitative fetal fibronectin have limited capacity to predict preterm birth, further studies are needed to investigate other potential screening modalities.

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Section: Introductionmentioning

confidence: 84%

Predicting preterm birth: Cervical length and fetal fibronectin

Son

Miller

2017

Seminars in Perinatology

123

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“…Nevertheless, the present analysis has some limitations. First, there were no data on cervical length, a maternal condition that is highly associated with the occurrence of sPTB . Second, it was an observational study with retrospective data collection after delivery for variables related to pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Cluster analysis identifying clinical phenotypes of preterm birth and related maternal and neonatal outcomes from the Brazilian Multicentre Study on Preterm Birth

Souza

Cecatti

Passini

et al. 2019

Intl J Gynecology & Obste

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Objective To explore a conceptual framework of clinical conditions associated with preterm birth (PTB) by cluster analysis, assessing determinants for different PTB subtypes and related maternal and neonatal outcomes. Methods Secondary analysis of the Brazilian Multicentre Study on Preterm Birth of 33 740 births in 20 maternity hospitals between April 2011 and July 2012. In accordance with a prototype concept based on maternal, fetal, and placental conditions, an adapted k‐means model and fuzzy algorithm were used to identify clusters using predefined conditions. The mains outcomes were phenotype clusters and maternal and neonatal outcomes. Results Among 4150 PTBs, three clusters of PTB phenotypes were identified: women who had PTB without any predefined conditions; women with mixed conditions; and women who had pre‐eclampsia, eclampsia, HELLP syndrome and fetal growth restriction. The prevalence of different preterm subtypes differed significantly in the three clusters, varying from 80.95% of provider‐initiated PTBs in cluster 3–6.62% in cluster 1 (P<0.001). Although some maternal characteristics differed among the clusters, maternal and neonatal outcomes did not. Conclusions The analysis identified three clusters with distinct phenotypes. Women from the different clusters had different subtypes of PTB and maternal and pregnancy characteristics.

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“…Screening for sPTB in IVF/ICSI pregnancies is advisable in order to apply preventive strategies [41][42][43][44][45] . Transvaginal cervical length measurement has been used successfully in symptomatic or asymptomatic women to predict sPTB [45][46][47] . It is unlikely that transvaginal cervical length would perform differently in IVF/ICSI pregnancies as compared with spontaneously conceived ones.…”

Section: Implications For Clinical Practice and Future Researchmentioning

confidence: 99%