Sonographic cervical length, vaginal bleeding, and the risk of preterm birth

Ramaeker, Devon M.; Simhan, Hyagriv N.

doi:10.1016/j.ajog.2011.10.879

Cited by 22 publications

(12 citation statements)

References 5 publications

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“…Prior research has identified decidual hemorrhage, which broadly defined includes both subchorionic hemorrhage and placental abruption as independent risk factors for both SPTB and PPROM. 10–12 We also noted a trend towards a greater proportion of non-responders having a history of a placental abruption in a prior pregnancy, but this did not reach statistical significance. These findings together, however, may suggest that women with SPTB and vaginal bleeding or a component of decidual hemorrhage may be less likely to benefit from 17OHP-C compared to women with other SPTB phenotypes.…”

Section: Commentmentioning

confidence: 77%

Predictors of response to 17-alpha hydroxyprogesterone caproate for prevention of recurrent spontaneous preterm birth

Manuck

Esplin

Biggio

et al. 2016

American Journal of Obstetrics and Gynecology

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Background Prematurity is the leading cause of neonatal morbidity and mortality amongst non-anomalous neonates in the United States. Intramuscular 17-alpha hydroxyprogesterone caproate (17OHP-C) injections reduce the risk of recurrent prematurity by approximately one third. Unfortunately, prophylactic 17OHP-C is not always effective, and one-third of high-risk women will have a recurrent PTB despite 17OHP-C therapy. The reasons for this variability in response are unknown. Previous investigators have examined the influence of a variety of factors on 17OHP-C response, but have analyzed data used a fixed outcome of ‘term’ delivery to define progesterone response. Objective We hypothesized that the demographics, history, and pregnancy course among women who deliver at a similar gestational age with 17-alpha hydroxyprogesterone caproate (17OHP-C) for recurrent spontaneous preterm birth (SPTB) prevention differs when compared to those women who deliver later with 17OHP-C, and that these associations could be refined by using a contemporary definition of 17OHP-C ‘responder.’ Study Design This was a planned secondary analysis of a prospective, multi-center, longitudinal study of women with ≥ 1 prior documented singleton SPTB <37 weeks gestation. Data were collected at 3 pre-specified gestational age epochs during pregnancy. All women included in this analysis received 17OHP-C during the studied pregnancy. We classified women as a 17OHP-C responder or non-responder by calculating the difference in delivery gestational age between the 17OHP-C treated pregnancy and her earliest SPTB. Responders were defined as those with pregnancy extending ≥3 weeks later with 17OHP-C compared to the delivery gestational age of their earliest prior SPTB. Data were analyzed using chi-square, t-test, and logistic regression. Results 155 women met inclusion criteria. The 118 responders delivered later on average (37.7 weeks) than the 37 non-responders (33.5 weeks), p<0.001. Among responders, 32% (38/118) had a recurrent SPTB. Demographics (age, race/ethnicity, education, and parity) were similar between groups. In the regression model, the gestational age of the prior SPTB (OR 0.68, 95% CI 0.56–0.82, p<0.001), vaginal bleeding/abruption in the current pregnancy (OR 0.24, 95% CI 0.06–0.88, p=0.031), and first-degree family history of SPTB (OR 0.37, 95% CI 0.15–0.88, p=0.024) were associated with response to 17OHP-C. Because women with a penultimate preterm pregnancy were more likely to be 17OHP-C non-responders, we performed an additional limited analysis examining only the 130 women whose penultimate pregnancy was preterm. In regression models, the results were similar to those in the main cohort. Conclusions Several historical and current pregnancy characteristics define women at risk for recurrent PTB at a similar gestational age despite 17OHP-C therapy. These data should be prospectively studied in larger cohorts and combined with genetic and environmental data to identify women most likely to benefit from this intervention.

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Section: Commentmentioning

confidence: 77%

Predictors of response to 17-alpha hydroxyprogesterone caproate for prevention of recurrent spontaneous preterm birth

Manuck

Esplin

Biggio

et al. 2016

American Journal of Obstetrics and Gynecology

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“…In women with threatened labor, the only independent predictors of delivery before 35 weeks are CL (OR: 0.84; 95% CI: 0.81-0.87) and vaginal bleeding (OR: 5.64; 95% CI: 2.20-14.42) [60].…”

Section: Reviewmentioning

confidence: 99%

Cervical length for the prediction and prevention of preterm birth

Di¹,

Berghella

2013

Expert Review of Obstetrics & Gynecology

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“…Devon Rameker et al, evaluated contribution of vaginal bleeding and cervical length to risk of preterm labour and found after accounting for cervical length and interaction, the adjusted odds ratio for vaginal bleeding and preterm birth was 4.8. 7,8 In present study, 20% of women had (n-26) threatened miscarriage along with other risk factor such as periodontal disease and urinary tract infection, 50% of these women had cervical length less than 25mm, out of which 86% had preterm birth.…”

Section: Discussionmentioning

confidence: 49%

Transvaginal ultrasonographic assessment of cervical length in prediction of preterm labour in high risk asymptomatic women

Pushparaj¹,

Nagaraj²

2018

Int J Reprod Contracept Obstet Gynecol

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Background: Preterm birth is an important cause of perinatal morbidity and mortality and has long term health implications. Aim of this study was to predict preterm labour by Transvaginal ultrasonographic cervical length measurement in high risk asymptomatic women which may help in decision making in managing these women.Methods: This study was conducted in Department of Obstetrics and Gynecology, Mahathma Gandhi Memorial Government Hospital, Trichy from August 2016 to September 2017 in 130 antenatal women with high risk factors such as prior spontaneous preterm birth, miscarriage. Transvaginal cervical length was measured and Gestational age at which delivery occurred was correlated and results were analyzed.Results: In present study, sensitivity of transvaginal cervical length measurement (cut off cervical length <25 mm) was 70.9% and specificity was 63% in prediction of preterm labour in high risk asymptomatic women. Positive and negative predictive value of cervical length in predicting preterm labour were 63.7 %and 70% respectively.Conclusions: Transvaginal cervical length measurement can be combined with anomaly scan in high risk women to predict preterm labor and is objective, reproducible and cost effective.

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Sonographic cervical length, vaginal bleeding, and the risk of preterm birth

Cited by 22 publications

References 5 publications

Predictors of response to 17-alpha hydroxyprogesterone caproate for prevention of recurrent spontaneous preterm birth

Predictors of response to 17-alpha hydroxyprogesterone caproate for prevention of recurrent spontaneous preterm birth

Cervical length for the prediction and prevention of preterm birth

Transvaginal ultrasonographic assessment of cervical length in prediction of preterm labour in high risk asymptomatic women

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