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Wharton LK, Anumba DOC. Techniques for detecting cervical remodeling as a predictor for spontaneous preterm birth: current evidence and future research avenues in patients with multiple pregnancies. J Matern Fetal Neonatal Med 2023; 36:2262081. [PMID: 37778754 DOI: 10.1080/14767058.2023.2262081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 09/18/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Spontaneous preterm birth occurs more frequently in multiple pregnancies. This syndrome has multiple triggers that result in a unified downstream pathway of cervical remodeling, uterine activity, and progressive cervical dilatation. Whilst the triggers for labor in multiple pregnancy may be different from singletons, the downstream changes will be the same. Identifying patients at risk of preterm birth is a priority as interventions to delay delivery and optimize the fetus can be initiated. Methods for screening for risk of preterm birth which focus on the detection of cervical remodeling may therefore have potential in this population. METHODS This review explores the evidence for the predictive utility for preterm birth of several published techniques that assess the physical, biomechanical, and optical properties of the cervix, with a focus on those which have been studied in multiple pregnancies and highlighting targets for future research in this population. RESULTS Fifteen techniques are discussed which assess the physical, biomechanical, and optical properties of the cervix in pregnancy. Of these, only three techniques that evaluated the predictive accuracy of a technique in patients with multiple pregnancies were identified: uterocervical angle, cervical consistency index, and cervical elastography. Of these, measurement of the uterocervical angle has the strongest evidence. Several techniques have shown predictive potential in singleton pregnancies, but have not yet been studied in multiple pregnancies, which would be a logical expansion of research. CONCLUSION Research on techniques with predictive utility for PTB in patients with multiple pregnancies is limited but should be a research priority. Overall, the theory supports the investigation of cervical remodeling as a predictor of PTB, and there are numerous techniques in development that may have potential in this field.
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Affiliation(s)
- L K Wharton
- Academic Unit of Reproductive and Developmental Medicine, Faculty of Medicine Dentistry and Health, The University of Sheffield, Sheffield, UK
| | - D O C Anumba
- Academic Unit of Reproductive and Developmental Medicine, Faculty of Medicine Dentistry and Health, The University of Sheffield, Sheffield, UK
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Martínez-Varea A, Satorres E, Florez S, Domenech J, Desco-Blay J, Monfort-Pitarch S, Hueso M, Perales-Marín A, Diago-Almela V. Comparison of Maternal-Fetal Outcomes among Unvaccinated and Vaccinated Pregnant Women with COVID-19. J Pers Med 2022; 12:jpm12122008. [PMID: 36556229 PMCID: PMC9787626 DOI: 10.3390/jpm12122008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/22/2022] [Accepted: 12/02/2022] [Indexed: 12/07/2022] Open
Abstract
Background: This study sought to elucidate whether COVID-19 vaccination, during gestation or before conception, entails a decreased incidence of severe COVID-19 disease during pregnancy. Methods: This retrospective cohort study included all pregnant women that were followed up at a tertiary University Hospital with SARS-CoV-2 infection diagnosed between 1 March 2020 and 30 July 2022. The primary outcome of the study was to compare maternal and perinatal outcomes in unvaccinated and vaccinated pregnant patients with SARS-CoV-2 infection. Results: A total of 487 pregnant women with SARS-CoV-2 infection were included. SARS-CoV-2 infection during the third trimester of pregnancy was associated with an 89% lower probability of positive cord-blood SARS-CoV-2 IgG antibodies (OR 0.112; 95% CI 0.039-0.316), compared with infection during the first or the second trimester. Vaccinated pregnant women (201 (41.27%)) with COVID-19 had an 80% lower risk for developing pneumonia and requiring hospital admission due to COVID-19 than unvaccinated patients (aOR 0.209; 95% CI 0.044-0.985). Noticeably, pregnant patients with SARS-CoV-2 infection with at least two doses of the COVID-19 vaccine did not develop severe COVID-19. Conclusion: Vaccinated women with SARS-CoV-2 infection during pregnancy are associated with decreased hospital admission due to COVID-19 as well as reduced progression to severe COVID-19.
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Affiliation(s)
- Alicia Martínez-Varea
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain
- Correspondence:
| | - Elena Satorres
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain
| | - Sandra Florez
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain
| | - Josep Domenech
- Department of Economics and Social Sciences, Universitat Politècnica de València, Camí de Vera s/n, 46022 Valencia, Spain
| | - Julia Desco-Blay
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain
| | - Sagrario Monfort-Pitarch
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain
| | - María Hueso
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain
| | - Alfredo Perales-Marín
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain
| | - Vicente Diago-Almela
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain
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Prediction of Preterm Birth with Serial Measurements of Ultrasound Markers. CURRENT HEALTH SCIENCES JOURNAL 2022; 48:162-168. [PMID: 36320871 PMCID: PMC9590368 DOI: 10.12865/chsj.48.02.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/14/2022] [Indexed: 11/17/2022]
Abstract
To compare the ability of cervical length (CL), anterior cervical angle (ACA), and cervical consistency index (CCI) to predict premature birth. METHODS This prospective study involved 85 pregnant women who gave birth prematurely and a control group of 31 pregnant women who gave birth at term. The study was performed in the Obstetrics and Gynecology Clinic of the Municipal Clinical Hospital Filanthropia Craiova between January 1, 2019, and January 1, 2022. Cases were examined using transvaginal ultrasonography (TVU) in the second and third trimesters of pregnancy, and cervical length (CL), Anterior Cervical Angle (ACA), and Cervical Consistency Index (CCI) were measured. RESULTS The mean value from the three measurements at all three parameters was statistically significant with preterm birth (p<0.05). Cervical length <25mm, was highly significant in the prediction of preterm labor with a sensitivity of 99%, specificity of 61%, positive predictive value (PPV) of 78%, negative predictive value (NPV) of 97 %, and a positive likelihood ratio (LR+) of 2.54 and negative likelihood ratio (LR-) of 0.02. CCI also remains, despite low specificity and PPV values, a potential predictive parameter in the prediction of preterm birth, with a sensitivity of 73%, NPV of 92% and a LR+of 1.32 and LR- of 0.6 also correlated with CL, CCI being more difficult to interpret as an independent predictive parameter. CONCLUSIONS CL remains the standard parameter for predicting the preterm birth, but in combination with other parameters, the prediction rate can increase significantly.
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Normative Values of Mid Trimester Cervical Consistency Index in Women Delivering at Term. JOURNAL OF FETAL MEDICINE 2021. [DOI: 10.1007/s40556-021-00294-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Preterm births affect around 15 million children a year worldwide. Current medical efforts focus on mitigating the effects of prematurity, not on preventing it. Diagnostic methods are based on parent traits and transvaginal ultrasound, during which the length of the cervix is examined. Approximately 30% of preterm births are not correctly predicted due to the complexity of this process and its subjective assessment. Based on recent research, there is hope that machine learning can be a helpful tool to support the diagnosis of preterm births. The objective of this study is to present various machine learning algorithms applied to preterm birth prediction. The wide spectrum of analysed data sets is the advantage of this survey. They range from electrohysterogram signals through electronic health records to transvaginal ultrasounds. Reviews of works on preterm birth already exist; however, this is the first review that includes works that are based on a transvaginal ultrasound examination. In this work, we present a critical appraisal of popular methods that have employed machine learning methods for preterm birth prediction. Moreover, we summarise the most common challenges incurred and discuss their possible application in the future.
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Rosen H, Stratulat V, Aviram A, Melamed N, Barrett J, Glanc P. Mid-trimester cervical consistency index measurement and prediction of preterm birth before 34 and 37 weeks in twin pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:626-628. [PMID: 31762115 DOI: 10.1002/uog.21927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 11/12/2019] [Accepted: 11/15/2019] [Indexed: 06/10/2023]
Affiliation(s)
- H Rosen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - V Stratulat
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - A Aviram
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - N Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - J Barrett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - P Glanc
- Department of Radiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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van der Merwe J, Couck I, Russo F, Burgos-Artizzu XP, Deprest J, Palacio M, Lewi L. The Predictive Value of the Cervical Consistency Index to Predict Spontaneous Preterm Birth in Asymptomatic Twin Pregnancies at the Second-Trimester Ultrasound Scan: A Prospective Cohort Study. J Clin Med 2020; 9:jcm9061784. [PMID: 32521741 PMCID: PMC7356565 DOI: 10.3390/jcm9061784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/27/2020] [Accepted: 06/03/2020] [Indexed: 12/29/2022] Open
Abstract
Novel transvaginal ultrasound (TVU) markers have been proposed to improve spontaneous preterm birth (sPTB) prediction. Preliminary results of the cervical consistency index (CCI), uterocervical angle (UCA), and cervical texture (CTx) have been promising in singletons. However, in twin pregnancies, the results have been inconsistent. In this prospective cohort study of asymptomatic twin pregnancies assessed between 18+0–22+0 weeks, we evaluated TVU derived cervical length (CL), CCI, UCA, and the CTx to predict sPTB < 34+0 weeks. All iatrogenic PTB were excluded. In the final cohort of 63 pregnancies, the sPTB rate < 34+0 was 16.3%. The CCI, UCA, and CTx, including the CL was significantly different in the sPTB < 34+0 weeks group. The best area under the receiver operating characteristic curve (AUC) for sPTB < 34+0 weeks was achieved by the CCI 0.82 (95%CI, 0.72–0.93), followed by the UCA with AUC 0.72 (95%CI, 0.57–0.87). A logistic regression model incorporating parity, chorionicity, CCI, and UCA resulted in an AUC of 0.91 with a sensitivity of 55.3% and specificity of 88.1% for predicting sPTB < 34+0. The CCI performed better than other TVU markers to predict sPTB < 34+0 in twin gestations, and the best diagnostic accuracy was achieved by a combination of parity, chorionicity, CCI, and UCA.
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Affiliation(s)
- Johannes van der Merwe
- Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, 3000 Leuven, Belgium; (I.C.); (F.R.); (J.D.); (L.L.)
- Division Woman and Child, Department of Obstetrics and Gynaecology, University Hospitals Leuven, 3000 Leuven, Belgium
- Correspondence: ; Tel.: +32-016-341-732
| | - Isabel Couck
- Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, 3000 Leuven, Belgium; (I.C.); (F.R.); (J.D.); (L.L.)
- Division Woman and Child, Department of Obstetrics and Gynaecology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Francesca Russo
- Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, 3000 Leuven, Belgium; (I.C.); (F.R.); (J.D.); (L.L.)
- Division Woman and Child, Department of Obstetrics and Gynaecology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Xavier P. Burgos-Artizzu
- Fetal i + D Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine, Universitat de Barcelona, 08028 Barcelona, Spain; (X.P.B.-A.); (M.P.)
- Transmural Biotech S. L. Barcelona, 08028 Barcelona, Spain
| | - Jan Deprest
- Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, 3000 Leuven, Belgium; (I.C.); (F.R.); (J.D.); (L.L.)
- Division Woman and Child, Department of Obstetrics and Gynaecology, University Hospitals Leuven, 3000 Leuven, Belgium
- Institute for Women’s Health, UCL, London WC1E 6HU, UK
| | - Montse Palacio
- Fetal i + D Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine, Universitat de Barcelona, 08028 Barcelona, Spain; (X.P.B.-A.); (M.P.)
| | - Liesbeth Lewi
- Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, 3000 Leuven, Belgium; (I.C.); (F.R.); (J.D.); (L.L.)
- Division Woman and Child, Department of Obstetrics and Gynaecology, University Hospitals Leuven, 3000 Leuven, Belgium
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Mendoza Cobaleda M, Ribera I, Maiz N, Goya M, Carreras E. Cervical modifications after pessary placement in singleton pregnancies with maternal short cervical length: 2D and 3D ultrasound evaluation. Acta Obstet Gynecol Scand 2019; 98:1442-1449. [PMID: 31102541 DOI: 10.1111/aogs.13647] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/19/2019] [Accepted: 05/10/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The use of a pessary proved to prevent preterm birth in asymptomatic women with mid-trimester short cervical length (CL); however, the precise mechanisms by which the pessary confers its benefit remain unclear. The aim of this study was to evaluate multiple cervical characteristics assessed by 2-dimensional and 3-dimensional ultrasound before and after placement of a cervical pessary to ascertain its mechanism of action. MATERIAL AND METHODS In this prospective cohort study, we assessed the cervical characteristics in singleton pregnancies with maternal short CL and compared them with matched reference women with normal CL. The variables evaluated were: CL, uterocervical angles, cervical consistency indices (cervical consistency index and CL consistency index), cervical volume and vascular indices. All variables were re-assessed immediately after pessary placement and 4-6 weeks later in all participants. Mann-Whitney U test was used to assess differences between groups and paired samples t test for comparisons in two different examinations in the same women. The aim of this study was to evaluate multiple cervical ultrasound variables before and after the placement of a cervical pessary and compare the evolution of these variables with a reference group with normal CL to better understand the device's mechanism of action. RESULTS Thirty-three women with short CL and 24 reference women with normal CL were enrolled. At the time of enrollment, gestational age and maternal baseline characteristics did not differ between groups. Immediately after pessary placement, CL increased, uterocervical angles were narrower and cervical consistency increased significantly. When the magnitude of change in cervical variables was compared over time between the reference group and the study group, median CL had increased in the study group (1.47 mm) but it had shortened in the reference group (-2.56 mm). These inverse trends were statistically significant (P = 0.006). CONCLUSIONS Cervical pessary reduces both uterocervical angles and corrects cervical angulation by pushing the cervix up toward the uterus. Maintaining the cervix aligned to the uterine axis leads to reduced cervical tissue stretch, so avoiding further cervical shortening. All these changes were present after pessary placement; however, the clinical implications of these findings remain unknown.
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Affiliation(s)
- Manel Mendoza Cobaleda
- Department of Obstetrics, Maternal Fetal Medicine Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Irene Ribera
- Department of Obstetrics, Maternal Fetal Medicine Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nerea Maiz
- Department of Obstetrics, Maternal Fetal Medicine Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Goya
- Department of Obstetrics, Maternal Fetal Medicine Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Carreras
- Department of Obstetrics, Maternal Fetal Medicine Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Abstract
Preterm birth, defined as birth occurring prior to 37 weeks gestation, is a serious obstetric problem accounting for 11% of pregnancies worldwide. It is associated with significant neonatal morbidity and mortality. Predictive tests for preterm birth are incredibly important, given the huge personal, economic, and health impacts of preterm birth. They can provide reassurance for women who are unlikely to deliver early, but they are also important for highlighting those women at higher risk of premature delivery so that we can offer prophylactic interventions and help guide antenatal management decisions. Unfortunately, there is unlikely to be a single test for predicting preterm birth, but a combination of tests is likely to improve clinical prediction. This review explores the clinical utility of the currently marketed predictive tests for preterm birth in both singleton and multiple pregnancies, as well as discussing novel predictive tests that may be useful in the future.
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Affiliation(s)
- Natalie Suff
- Department of Women's Health, King's College London, St Thomas' Hospital, London, UK.
| | - Lisa Story
- Department of Women's Health, King's College London, St Thomas' Hospital, London, UK; Centre for the Developing Brain, King's College London, St Thomas' Hospital, London, UK
| | - Andrew Shennan
- Department of Women's Health, King's College London, St Thomas' Hospital, London, UK
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Strain Cervical Elastography in Pregnancy: Feasibility Study and Its Usefulness in Prediction of Preterm Birth. JOURNAL OF FETAL MEDICINE 2018. [DOI: 10.1007/s40556-018-0178-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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