Targeted therapy for threatened preterm labor based on sonographic measurement of the cervical length: a randomized controlled trial

Alfirević, Z̄arko; Allen-Coward, H.; Molina, Francisca S.; Padilla, María del Carmen; Nicolaides, Kypros H.

doi:10.1002/uog.3908

Cited by 64 publications

(49 citation statements)

References 9 publications

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“…In a recent study from 2005, Tsoi et al [5] found that only 0.7% of the women with a CL of 15 mm or more delivered within 7 days, and this result has been supported by a randomized study including 41 women [10] .…”

Section: Introductionmentioning

confidence: 61%

“…In comparison to previous studies [5,10,[14][15][16] , our study was performed in a clinical setting and not in a selected study population. This may provide a better knowledge of the usefulness of CL measurement in clinical practice when several obstetricians perform the examinations.…”

Section: Discussionmentioning

confidence: 99%

“…In 2007, Alfirevic et al [10] performed a randomized study to investigate if a CL cutoff value of 15 mm was clinically useful in determining treatment for women presenting with threatened preterm labor. They found that none of 14 women with a CL 6 15 mm who were not treated with tocolytics delivered within 7 days.…”

Section: Discussionmentioning

confidence: 99%

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Can a 15-mm Cervical Length Cutoff Discriminate between Low and High Risk of Preterm Delivery in Women with Threatened Preterm Labor?

Wulff

Ekelund²,

Hedegaard³

et al. 2010

Fetal Diagn Ther

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Objectives: To investigate if a cervical length (CL) cutoff of 15 mm is relevant to use in women with threatened preterm labor. Methods: From 2006 to 2009, 146 women with singleton pregnancies were admitted with threatened preterm labor between 23 and 33+6 weeks of gestation at Copenhagen University Hospital. Transvaginal sonographic measurement of CL was carried out on admission. Outcome measures were spontaneous delivery within 48 h, within 7 days and delivery before 34 weeks according to a CL cutoff of 15 mm. Results: CL was <15 mm in 36 women (24.7%) and ≧15 mm in 110 women (75.3%). Spontaneous delivery occurred within 48 h or 7 days of presentation and before 34 weeks in 25, 38.9 and 50.0% of women with CL <15 mm and 3.6, 9.1 and 11.8% of women with CL ≧15 mm, respectively. The 15-mm CL cutoff had a sensitivity, false positive rate and negative predictive value for delivery within 48 h of 69.0, 20.3 and 96.4%, and within 7 days of 58.3, 18.1 and 90.9%. Women with CL <15 mm had odds of delivery within 7 days of 6.4 (95% CI 2.5–16.2). Conclusion: Although a 15-mm CL defines a group of women at high risk of spontaneous preterm delivery, 10 out of 110 women (9.1%) with a CL ≧15 mm deliver within 7 days.

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Section: Introductionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

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Can a 15-mm Cervical Length Cutoff Discriminate between Low and High Risk of Preterm Delivery in Women with Threatened Preterm Labor?

Wulff

Ekelund²,

Hedegaard³

et al. 2010

Fetal Diagn Ther

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“…Диагностика преждевременных родов при мно-гоплодии связана с определенными трудностями, так как нередко отсутствует специфическая сим-птоматика. Диагноз начала преждевременных родов может быть уточнен с помощью трансва-гинального УЗИ с измерением длины шейки мат-ки или определения фибронектина плода в шееч-но-влагалищном секрете [22,31,32,33].…”

Section: преждевременные родыunclassified

Management of Pregnancy and Delivery in Multiple Pregnancy

et al. 2016

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“…As many as 28% of pregnant patients presenting with signs and symptoms of PTL are admitted to the hospital [2], but only as few as 5% of these women will deliver within 7 days [3] [4]. Therefore, approximately 85% of patients admitted to the hospital for impending PTL do not deliver within the next 7 days [5]. This statistic highlights the urgent need for more accurate ways to identify those women with a true risk of impending spontaneous preterm birth (PTB), defined as birth prior to the completion of the 37th week of gestation, to avoid unnecessary administration of potentially harmful therapeutics.…”

Section: Introductionmentioning

confidence: 99%

Comparison of PAMG-1 and phIGFBP-1 Tests for the Prediction of Preterm Delivery in Patients with Preterm Labor

Hadzi-Lega¹,

Maier²,

Helmer³

et al. 2017

OJOG

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Objective: To compare PAMG-1 and phIGFBP-1 tests in predicting impending spontaneous preterm delivery within 7 days upon presentation in pregnant women with symptoms of preterm labor. Study Design: From September 2014 to April 2015 women with singleton gestation, symptoms of preterm labor, GA 22 -35, participated in this prospective cohort study upon admission. Recruited patients had intact membranes and a minimal cervical dilatation of ≤3 cm. Vaginal swabs for phIGFBP-1 and PAMG-1 were taken in addition to routine treatment. Biochemical test results were blinded and had no effect on management of patients. Results: A total of 96 patients were screened for inclusion into the trial; 57 met the inclusion criteria for final analysis. The PAMG-1 test was positive in 5.7% of patients, while phIGFBP-1 test was positive in 29.8% of patients. The prediction of spontaneous preterm delivery within 7 days of admission in patients with a cervical length < 25 mm (30%), the PAMG-1 test and phIGFBP-1 test showed a SN of 100% and 100%; SP of 83.3% and 50.0%, (p ≤ 0.05); PPV of 71.4% and 45.5%; and NPV of 100% and 100%. 89.5% of women who received corticosteroids and 84.2% of women who received tocolysis did not go into preterm labor within one week. Conclusion: Our study supports the high negative predictability of biochemical tests to rule out spontaneous preterm labor in patients with a short cervix. However, our study strongly suggests that the PAMG-1 test is more accurate for predicting imminent spontaneous preterm delivery as compared to phIGFBP-1. These findings can significantly reduce economic burden caused by unnecessary admission and treatment of patients suspected of preterm labor. Such a reduction in the use of corticosteroids and tocolytics would lead to a reduction in the short and long term health effects associated with the use of

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Targeted therapy for threatened preterm labor based on sonographic measurement of the cervical length: a randomized controlled trial

Abstract: Objective (RR 0.3; 95% CI,

Cited by 64 publications

References 9 publications

Can a 15-mm Cervical Length Cutoff Discriminate between Low and High Risk of Preterm Delivery in Women with Threatened Preterm Labor?

Can a 15-mm Cervical Length Cutoff Discriminate between Low and High Risk of Preterm Delivery in Women with Threatened Preterm Labor?

Management of Pregnancy and Delivery in Multiple Pregnancy

Comparison of PAMG-1 and phIGFBP-1 Tests for the Prediction of Preterm Delivery in Patients with Preterm Labor

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