Prognosis in cervical insufficiency at less than 32 weeks of gestation

Mitani, Minoru; Matsuda, Yoshihisa; Ono, Érika; Akizawa, Yoshika; Ohta, Hiroaki

doi:10.1016/j.ejogrb.2005.06.011

Cited by 7 publications

(6 citation statements)

References 17 publications

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“…This result suggests that the neonatal outcomes were not associated with cervical incompetence but rather preterm birth itself was the major risk factor for postnatal adverse outcomes. Our results disagree with the findings of Mitani et al [14] that cervical incompetence was a significant factor related to the occurrence of neonatal death and abnormal cerebral ultrasound scans. Their study was preformed among 17 different neonatal centers, and there could have been differences in the treatment modalities among the institutions.…”

Section: Discussioncontrasting

confidence: 57%

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Effects of Maternal Cervical Incompetence on Morbidity and Mortality of Very Low Birthweight Neonates

Sung

Lee²,

Ju³

2010

Neonatology

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Background: Cervical incompetence is a well-recognized cause of preterm birth, but little is known about its relationship with neonatal morbidity and mortality. Objectives: We examined the hypothesis that maternal cervical incompetence may be associated with postnatal morbidities in preterm neonates. Methods: A retrospective cohort analysis was conducted for all the preterm neonates who were admitted to our institution with a birthweight of less than 1,500 g. They were divided into two groups: one with cervical incompetence and the other without it. The outcomes of postnatal morbidity, defined as respiratory distress syndrome (RDS), patent ductus arteriosus (PDA), bronchopulmonary dysplasia (BPD), white matter disease (WMD), retinopathy of prematurity (ROP), early sepsis, and mortality were compared. Results: Two hundred and four neonates were eligible for this study: 80 of them were with cervical incompetence and 124 were without it. Gestational age and birthweight were earlier and lower in the cervical incompetence group (27.3 ± 2.0 vs. 29.5 ± 2.7 weeks, p < 0.000; 1,043.1 ± 247.0 vs. 1,142.2 ± 253.4 g, p = 0.006). There were no differences in the incidence of RDS (p = 0.067), PDA (p = 0.095), WMD (p = 0.601), and mortality (p = 0.403). BPD (p = 0.027), ROP (p = 0.026) and early sepsis (p = 0.002) were significantly different. However, when the incidences were stratified by gestational age [<28 weeks vs. 28–29 (+6) weeks vs. ≧30 weeks], the results were similar in both groups including BPD, ROP, and early sepsis. Conclusion: We found that cervical incompetence does not negatively affect the postnatal adverse outcomes and mortality after stratified analysis by gestational age.

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Section: Discussioncontrasting

confidence: 57%

“…However, there are only a few reports that have shown a relationship between maternal cervical incompetence and postnatal outcomes of preterm neonates of very low birthweight (VLBW; birthweight ! 1,500 g) [12][13][14] .…”

Section: Introductionmentioning

confidence: 99%

Effects of Maternal Cervical Incompetence on Morbidity and Mortality of Very Low Birthweight Neonates

Sung

Lee²,

Ju³

2010

Neonatology

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“…cervical hypoplasia [51][52][53][54], exposure to diethylstilbestrol (DES) in utero [55][56][57][58][59][60][61], etc. ), genetic syndromes (such as Ehlers-Danlos syndrome) [62], subclinical intra-amniotic infection [63][64][65] or intra-amniotic inflammation [66,67], or the elusive condition referred to as cervical insufficiency [68][69][70]. A decrease in progesterone action has been implicated in untimely cervical ripening [71][72][73][74][75][76][77][78], as this hormone plays a key role in maintaining the cervix as long and closed during pregnancy [77][78][79][80][81][82][83][84][85][86][87][88].…”

Section: Introductionmentioning

confidence: 99%

Sterile intra-amniotic inflammation in asymptomatic patients with a sonographic short cervix: prevalence and clinical significance

Romero

Miranda

Chaiworapongsa

et al. 2014

The Journal of Maternal-Fetal & Neonatal Medicine

160

122

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Objective To determine the frequency and clinical significance of sterile- and microbial-associated intra-amniotic inflammation in asymptomatic patients with a sonographic short cervix. Methods Amniotic fluid (AF) samples obtained by transabdominal amniocentesis from 231 asymptomatic women with a sonographic short cervix [cervical length (CL) ≤25 mm] were analyzed using cultivation techniques (for aerobic and anaerobic as well as genital mycoplasmas) and broad-range polymerase chain reaction (PCR) coupled with electrospray ionization mass spectrometry (PCR/ESI-MS). The frequency and magnitude of intra-amniotic inflammation [defined as an AF interleukin (IL)-6 concentration ≥2.6 ng/mL], acute histologic placental inflammation, spontaneous preterm delivery, and the amniocentesis-to-delivery interval were examined according to the results of AF cultures, PCR/ESI-MS and AF IL-6 concentrations. Results Ten percent (24/231) of patients with a sonographic short cervix had sterile intra-amniotic inflammation (an elevated AF IL-6 concentration without evidence of microorganisms using cultivation and molecular methods). Sterile intra-amniotic inflammation was significantly more frequent than microbial-associated intra-amniotic inflammation [10.4% (24/231) vs. 2.2% (5/231); p<0.001]. Patients with sterile intra-amniotic inflammation had a significantly higher rate of spontaneous preterm delivery <34 weeks of gestation [70.8% (17/24) vs. 31.6% (55/174); p<0.001] and a significantly shorter amniocentesis-to-delivery interval than patients without intra-amniotic inflammation [median 35, (IQR: 10 – 70) vs. median 71, (IQR: 47 – 98) days, (p<0.0001)]. Conclusion Sterile intra-amniotic inflammation is more common than microbial-associated intra-amniotic inflammation in asymptomatic women with a sonographic short cervix, and is associated with increased risk of spontaneous preterm delivery (<34 weeks). Further investigation is required to determine the causes of sterile intra-amniotic inflammation and the mechanisms whereby this condition is associated with a short cervix and spontaneous preterm delivery.

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“…Preterm labor (PTL) was defined as the demonstrated progressive dilation of the cervix with uterine contractions before 36 weeks of gestation [17]. Premature rupture of membranes (PROM) was defined as the leakage of watery discharge [18].…”

Section: Definitionsmentioning

confidence: 99%

“…Daily non-stress testing was performed, and a biophysical profile was obtained when needed. Ritodrine hydrochloride was administered when signs of PTL appeared [17]. Magnesium sulfate administration was initiated in preeclampsia cases for hypertension (blood pressure 140/90 mmHg or greater) plus overt proteinuria or both [14,19].…”

Section: Definitionsmentioning

confidence: 99%