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Della Corte L, Lavitola G, Bifulco G. How endocervicoscopy can impact obstetric outcomes in women undergoing LEEP for CIN2 + : a retrospective cohort analysis. Arch Gynecol Obstet 2023; 308:507-513. [PMID: 37264271 DOI: 10.1007/s00404-023-07087-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/19/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE To assess the impact of preoperative endocervicoscopy on obstetric outcomes and complications in women undergoing LEEP for CIN2 + . METHODS This was a retrospective cohort study carried out between October 2012 and April 2018. All women had undergone cervical length measurement at T0 (before LEEP), T1 (6 months after LEEP), and T2 (at 20 weeks of pregnancy) through transvaginal ultrasound examination after LEEP for CIN2 + . A total of 528 patients fulfilled our inclusion criteria and contributed to the final analysis: 288 had undergone endocervicoscopy before the excisional procedure (Group A), while the remaining 240 (Group B) did not. RESULTS Patients who did not undergo endocervicoscopy showed a greater amount of tissue excised at LEEP compared to those of Group A (6.7% vs 31.9% in Group A and B, p < 0.01, respectively). A statistically relevant difference was detected in the lesion margins involvement: negative in 93.8% in Group A compared to 65.6% in Group B. The cervicometry before the treatment resulted in similar between the two groups, while a statistically significant difference was noted after 6 months (37.5 ± 2.9 mm in Group A vs 35.1 ± 3.8 mm in Group B, p < 0.01) and at 20th week pregnancy (36.9 ± 5.3 mm in Group A vs 33.5 ± 5.6 mm in Group B, p < 0.01). The number of pregnancies after LEEP as well as the difference in the elapsed time (in months) did not result in a statistical significance between the two groups. The threatened preterm labor (TPL) and the threatened miscarriage showed a statistically significant difference in incidence between the two groups (4,2% and 4.2% in Group A vs 15.3% and 25% in Group B, p < 0.01, respectively). CONCLUSION Endocervicoscopy reduces the size of the LEEP sample and in particular its depth, saving healthy cervical tissue, and guarantees the total eradication of the lesion as the resection margins are negative in almost all cases, allowing for a reduction of the rate of TPL and threatened miscarriage in women with CIN2 + , especially with Type 2 or 3 cervical squamocolumnar junction (SCJ).
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Affiliation(s)
- Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131, Naples, Italy.
| | - Giada Lavitola
- Department of Public Health, University of Naples Federico II, 80131, Naples, Italy
| | - Giuseppe Bifulco
- Department of Public Health, University of Naples Federico II, 80131, Naples, Italy
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Wang XJ, Li XT, Chen N, Huang L, Huang SX, Chen TT, Liu GH, Hu RF. Mental health, sleep quality, and hormonal circadian rhythms in pregnant women with threatened preterm labor: a prospective observational study. BMC Pregnancy Childbirth 2023; 23:501. [PMID: 37420176 DOI: 10.1186/s12884-023-05801-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 06/20/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Threatened preterm labor (TPL) is an important obstetrical challenge. Pregnant women with TPL may develop psychological and physical problems such as mental health disorders, sleep disturbance, and hormonal circadian rhythm disruption. This study aimed to investigate the current state of mental health, sleep quality, and circadian rhythms of cortisol and melatonin secretion in pregnant women with TPL and normal pregnant women (NPW). METHODS A prospective observational clinical study was conducted at a maternal and child health hospital in Fuzhou, China, between June and July 2022. A total of 50 women between 32 and 36 weeks of gestation (TPL group, n = 20; NPW group, n = 30) were recruited. Data on anxiety symptom (Zung's Self-rating Anxiety Scale, SAS), depression symptom (Edinburgh Postnatal Depression Scale, EPDS), subjective sleep quality (Pittsburgh Sleep Quality Index, PSQI) and objective sleep outcomes (measured by actigraphy) of the pregnant women were collected at the time of enrolment. Salivary samples were collected once every 6 h (i.e., at 06:00, 12:00, 18:00, and 00:00) during 2 consecutive days to measure the circadian rhythm of hormone (cortisol and melatonin). RESULTS There were no differences found in the total scores of SAS, EPDS scores, subjective sleep quality between the TPL and NPW groups (P > 0.05). In contrast, significant differences were found in sleep efficiency, total sleep time, wake time after sleep onset, and average awakening time between the groups (P < 0.05). The circadian rhythm of melatonin secretion was disrupted in the TPL group (P = 0.350); however, it was maintained in the NPW group (P = 0.044). The circadian rhythm of cortisol secretion was disrupted in both groups (P > 0.05). CONCLUSIONS In the third trimester of pregnancy, women with TPL suffer from poorer sleep quality and disruption of circadian rhythm of melatonin secretion compared with NPW. Nevertheless, there were no differences found in mental health (i.e., anxiety and depression) and circadian rhythm of cortisol secretion. Large-scale studies should be conducted to evaluate these changes in women with TPL. TRIAL REGISTRATION The study was registered from Chinese Clinical Trial Registry (Number: ChiCTR2200060674) on 07/06/2022.
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Affiliation(s)
- Xiao-Juan Wang
- School of Nursing, Fujian Medical University, 1 Xue Yuan Road, University Town, Fujian, Fuzhou, China
| | - Xiao-Ting Li
- School of Nursing, Fujian Medical University, 1 Xue Yuan Road, University Town, Fujian, Fuzhou, China
| | - Na Chen
- School of Nursing, Fujian Medical University, 1 Xue Yuan Road, University Town, Fujian, Fuzhou, China
| | - Long Huang
- School of Nursing, Fujian Medical University, 1 Xue Yuan Road, University Town, Fujian, Fuzhou, China
| | - Shui-Xiu Huang
- School of Nursing, Fujian Medical University, 1 Xue Yuan Road, University Town, Fujian, Fuzhou, China
| | - Ting-Ting Chen
- School of Nursing, Fujian Medical University, 1 Xue Yuan Road, University Town, Fujian, Fuzhou, China
| | - Gui-Hua Liu
- School of Nursing, Fujian Medical University, 1 Xue Yuan Road, University Town, Fujian, Fuzhou, China.
| | - Rong-Fang Hu
- School of Nursing, Fujian Medical University, 1 Xue Yuan Road, University Town, Fujian, Fuzhou, China.
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Melchor Corcóstegui I, Unibaso Rodríguez E, Ruiz Blanco N, Nikolova T, Nikolova N, Burgos San Cristóbal J, Melchor Marcos JC. Is mid-trimester cervical length screening effective for reduction of threatened preterm labor? Taiwan J Obstet Gynecol 2023; 62:412-416. [PMID: 37188445 DOI: 10.1016/j.tjog.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE To assess the incidence of threatened preterm labor and preterm labor admissions and treatment of women with singleton gestations and no prior preterm birth before and after implementation of the universal mid-trimester transvaginal ultrasound cervical length screening. MATERIALS AND METHODS A retrospective cohort study included of singleton gestations without a history of preterm birth presenting with threatened preterm labor between 24 0/7 and 36 6/7 gestational week in two study periods: before and after the implementation of the universal cervical length screening. Women with cervical length <25 mm were considered being at high risk for preterm birth and were prescribed a treatment with vaginal progesterone daily. The primary outcome was the incidence of threatened preterm labor. Secondary outcomes were the incidence of preterm labor. RESULTS We have found a significant increase in the incidence of threatened preterm labor from 6.42% (410/6378) in 2011 to 11.61% (483/4158) in 2018 (p < 0.0001). Gestational age at triage consult was lower in than in 2011, although the rate of admission for threatened preterm labor was similar in both periods. There was a significant decrease in the incidence of preterm delivery <37 weeks from 25.60% in 2011 to 15.94% in 2018 (p < 0.0004). Although there was a reduction in preterm delivery ≤34 weeks, this reduction was not significant. CONCLUSION The universal mid-trimester cervical length screening in asymptomatic women is not associated with a reduction in the frequency of threatened preterm labor or the admission rate for preterm labor, but reduces the rate of preterm births.
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Affiliation(s)
- Iñigo Melchor Corcóstegui
- Department of Obstetrics and Gynecology, BioCruces Health Research Institute, Cruces University Hospital (UPV/EHU), Vizcaya, Spain
| | - Estíbaliz Unibaso Rodríguez
- Department of Obstetrics and Gynecology, BioCruces Health Research Institute, Cruces University Hospital (UPV/EHU), Vizcaya, Spain
| | - Nagore Ruiz Blanco
- Department of Obstetrics and Gynecology, BioCruces Health Research Institute, Cruces University Hospital (UPV/EHU), Vizcaya, Spain
| | - Tanja Nikolova
- Department of Obstetrics and Gynecology, Klinikum Mittelbaden Baden-Baden, Academic Teaching Hospital of Heidelberg University, Germany
| | - Natasha Nikolova
- Center of Perinatal and Reproductive Medicine, Medical School, University of Perugia, Italy
| | - Jorge Burgos San Cristóbal
- Department of Obstetrics and Gynecology, BioCruces Health Research Institute, Cruces University Hospital (UPV/EHU), Vizcaya, Spain
| | - Juan Carlos Melchor Marcos
- Department of Obstetrics and Gynecology, BioCruces Health Research Institute, Cruces University Hospital (UPV/EHU), Vizcaya, Spain.
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Campos-Berga L, Moreno-Giménez A, Sahuquillo-Leal R, Hervás D, Diago V, Navalón P, Vento M, García-Blanco A. Emotional regulation and psychomotor development after threatening preterm labor: a prospective study. Eur Child Adolesc Psychiatry 2022; 31:473-81. [PMID: 33585967 DOI: 10.1007/s00787-021-01733-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 01/28/2021] [Indexed: 01/09/2023]
Abstract
A threatened preterm labor (TPL) represents an adverse prenatal event that may affect fetal neurodevelopment, even in absence of prematurity. Indeed, late-preterm infants, without neurological complications, also exhibit neurodevelopment impairment with psychomotor delay as well as emotional regulation disturbances, considered early manifestations of neuropsychiatric disorders. The aim of this study is to examine the impact of TPL on infant's psychomotor development and temperament. This prospective cohort study recruited mothers who suffered from a TPL and a control group of mothers without TPL and full-term gestation (n = 61). TPL infants were classified into three groups depending on delivery time: Full-Term (n = 37), Late-Preterm (n = 66), and Very-Preterm (n = 38). Neurodevelopmental assessment was performed at 6 months using the Ages & Stages Questionnaires for psychomotor development and the Infant Behaviour Questionnaire-Revised for temperament. After controlling for potential cofounders (multiple pregnancy and in vitro fertilization), Full-Term TPL infants, relative to the control group, exhibited development delay in Communication (p = 0.044) and Personal-social domains (p = 0.005) as well as temperament disturbances with higher Negative Affect (p = 0.013), lower Positive Affect (p = 0.010), and worse Emotional Regulation (p < 0.001) compared to Control. No differences were found between Full-Term and Late-Preterm TPL infants. TPL may represent a risk factor for neurodevelopmental disturbances in the offspring, affecting both psychomotor and emotional infant competences, even when infants were born at term.
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Lavie A, Czuzoj-Shulman N, Spence AR, Barrett J, Abenhaim HA. Hospital antenatal admissions for threatened preterm labor: how long should we be "observing"? Arch Gynecol Obstet 2021; 305:31-37. [PMID: 34328542 DOI: 10.1007/s00404-021-06106-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/22/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE We sought to describe temporal trends in hospital admissions for threatened preterm labor (TPTL) and to examine hospital admission duration among women delivered or discharged undelivered. METHODS We carried out a cohort study on all TPTL admissions among pregnancies with a live singleton fetus and intact membranes between 1999 and 2015 using the United States' Healthcare Cost and Utilization Project-Nationwide Inpatient Sample. ICD-9 codes were used to identify women with TPTL. Duration of antenatal admission length of stay was calculated in days following admission to hospital until delivery ("Delivery Admission") or undelivered discharge ("Observation Admission"). Analyses included evaluating trends of birth admissions over total admissions, identifying predictors of delivery using logistic regression, and measuring risk for delivery with increasing duration of antepartum hospitalization. RESULTS Of 15,335,288 pregnancy admissions, 1,089,987 admissions were for TPTL, with 61.8% being 'Delivery Admissions". During the 16-year study period, overall rates of TPTL admissions declined with a rising proportion of admissions being "Delivery Admissions". "Delivery Admissions" were more common among patients who were older, non-Caucasian, obese, or who had placental abruption. "Observation Admissions" were more common among admissions for antepartum hemorrhage or antepartum spotting. Among all "Delivery Admissions" for TPTL, 89% had delivered within 2 days, 7% delivered within 3-6 days, and 5% delivered beyond 6 days. CONCLUSION Overall admissions for TPTL declined over the study period with increasing proportions being "Delivery Admissions". Protocols taking into consideration declining risk of preterm birth among patients undelivered after 2 days may be helpful in reducing unnecessary prolonged observation admissions.
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Affiliation(s)
- Anat Lavie
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Canada
| | - Nicholas Czuzoj-Shulman
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Pav H, Room 325, 5790 Cote-Des-Neiges Road, Montreal, QC, H3S 1Y9, Canada
| | - Andrea R Spence
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Pav H, Room 325, 5790 Cote-Des-Neiges Road, Montreal, QC, H3S 1Y9, Canada
| | - Jon Barrett
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Haim Arie Abenhaim
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Canada. .,Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Pav H, Room 325, 5790 Cote-Des-Neiges Road, Montreal, QC, H3S 1Y9, Canada.
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Saito-Abe M, Yamamoto-Hanada K, Pak K, Sato M, Irahara M, Mezawa H, Sasaki H, Nishizato M, Ishitsuka K, Konishi M, Yang L, Ohya Y, Suzuki K. Association of Maternal History of Allergic Features with Preterm Pregnancy Outcomes in the Japan Environment and Children's Study. Int Arch Allergy Immunol 2021; 182:650-662. [PMID: 33601376 DOI: 10.1159/000513749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/14/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Previous studies have reported that maternal asthma increases the risk of preterm birth. We hypothesized that inflammatory reactions caused by allergic diseases might affect the uterine environment and, subsequently, perinatal outcomes. The objective of this study was to examine the associations between allergic features among mothers and preterm pregnancy outcomes in a nationwide birth cohort. METHODS We analyzed data from pregnant women obtained from the Japanese Environment and Children's Study (JECS), a nationwide general birth cohort study. We used binomial and multinomial logistic regression models to examine the associations between maternal allergic features and preterm birth, threatened preterm labor (TPL), and preterm premature rupture of the membrane (PPROM). RESULTS A total of 97,683 pregnant women were included. Prevalence of preterm birth, TPL, and PPROM was 4.7, 19.6, and 1.2%, respectively. Maternal history of allergic diseases (asthma, allergic rhinitis, allergic conjunctivitis, food allergy, drug allergy, and contact dermatitis) increased the risk of TPL(adjusted odds ratio [aOR] = 1.11 [95% CI: 1.06-1.17], aOR = 1.12 [1.08-1.16], aOR = 1.10 [1.04-1.16], aOR = 1.17 [1.09-1.26], aOR = 1.35 [1.23-1.48], and aOR = 1.34 [1.20-1.49], respectively). Although some maternal allergic features showed a negative association with preterm birth, the variables affecting preterm birth differed according to the gestational age of the fetus (22-33 weeks vs. 34-36 weeks). There were no significant associations between maternal allergic features and PPROM. CONCLUSION Maternal allergic disease, except atopic dermatitis, may increase the risk of TPL. Comorbidity of maternal allergic disorders and perinatal adverse outcomes require further investigation.
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Affiliation(s)
- Mayko Saito-Abe
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan, .,Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Nagakute, Japan,
| | - Kiwako Yamamoto-Hanada
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Kyongsun Pak
- Division of Biostatistics, Department of Data Management, Center for Clinical Research, National Center for Child Health and Development, Tokyo, Japan
| | - Miori Sato
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan.,Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Makoto Irahara
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Hidetoshi Mezawa
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Hatoko Sasaki
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Minaho Nishizato
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Kazue Ishitsuka
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Mizuho Konishi
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Limin Yang
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Yukihiro Ohya
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Kohta Suzuki
- Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
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Ye C, Katagiri S, Miyasaka N, Kobayashi H, Khemwong T, Nagasawa T, Izumi Y. The periodontopathic bacteria in placenta, saliva and subgingival plaque of threatened preterm labor and preterm low birth weight cases: a longitudinal study in Japanese pregnant women. Clin Oral Investig 2020; 24:4261-4270. [PMID: 32333174 DOI: 10.1007/s00784-020-03287-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/14/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study determined the quantity of periodontopathic bacteria in saliva, subgingival plaque, and placenta on the threatened preterm labor (TPL) and preterm low birth weight (PLBW) subjects in order to identify specific periodontal pathogens with high association to adverse pregnancy outcomes. METHODS We used real-time PCR with TaqMan probe and ELISA to detect the amount of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Fusobacterium nucleatum, and Prevotella intermedia in subgingival plaque, saliva, and placenta tissue, in addition to serum IgG titers against these bacteria in 28 patients with TPL and 36 healthy pregnant women. RESULTS Thirteen of 64 births delivered PLBW infants. All 6 periodontopathic bacteria were detected in the placenta samples. The amount of F. nucleatum and detection frequency of T. denticola in placental samples was significantly higher in the TPL group than in the healthy group. Meanwhile, the age, anti-P. gingival IgG in serum, amount of P. gingivalis and T. forsythia in plaque samples, detection frequency of P. intermedia in saliva, and percentage of pocket probing depth ≥ 5 mm were higher in TPL-PLBW births than those in TPL-Healthy delivery (HD) group and/or in H-HD group. Ordinal logistic regression analysis revealed that the presence of F. nucleatum in placental tissues was significantly associated with TPL, while the maternal age was significantly associated with PLBW in TPL. CONCLUSION Our findings suggested all 6 bacteria may access the placenta. The increased presence of F. nucleatum in placenta might be related to TPL, while advanced maternal age might be associated with PLBW in TPL. CLINICAL RELEVANCE Periodontal therapy should be applied to reduce the deep periodontal pocket sites and the colonization of periodontal pathogens in high-risk population.
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Affiliation(s)
- Changchang Ye
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Periodontology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Sayaka Katagiri
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Naoyuki Miyasaka
- Department of Pediatrics, Perinatal and Maternal Medicine, Tokyo Medical and Dental University Medical Hospital, Tokyo, Japan
| | - Hiroaki Kobayashi
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan.
| | - Thatawee Khemwong
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Toshiyuki Nagasawa
- Division of Periodontology and Endodontology, Department of Oral Rehabilitation, School of Dentistry, Health Sciences University of Hokkaido, Sapporo, Japan
| | - Yuichi Izumi
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
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Desplanches T, Lejeune C, Cottenet J, Sagot P, Quantin C. Cost-effectiveness of diagnostic tests for threatened preterm labor in singleton pregnancy in France. Cost Eff Resour Alloc 2018; 16:21. [PMID: 29983643 PMCID: PMC6003030 DOI: 10.1186/s12962-018-0106-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 06/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies have showed that the early diagnosis of threatened preterm labor decreases neonatal morbidity and mortality, avoids maternal morbidity induced by antepartum bed rest and unnecessary treatment, and reduces costs. Although there are many diagnostic tests, none is clearly recommended by international guidelines. The aim of our study was to compare seven diagnostic methods in terms of effectiveness and cost using a decision analysis model in singleton pregnancy presenting threatened preterm labor, between 24 and 34 weeks of gestation. METHODS Seven diagnostic strategies based on individual or combined use of the following tests: cervical length, cervical fibronectin test, cervical interleukin test and protein in maternal serum, were compared using a decision analysis model. Effectiveness was expressed in terms of serious adverse neonatal events avoided (neonatal morbidity and mortality) at the hospital discharge. The economic analysis was performed from the health care system perspective. Deterministic and probabilistic analyses were performed to test the robustness of the model. RESULTS At 24-34 weeks of gestation, the association of cervical length and qualitative fibronectin was the most efficient strategy dominating all alternatives, reducing the perinatal death or severe neonatal morbidity rate up to 15% and the costs up to 31% according to the gestational age. This result was confirmed by the deterministic sensitivity analyses. The probabilistic analysis showed that the association of cervical length and qualitative fibronectin dominated cervical length < 15 mm in more than 90% of the simulations. The comparison with the other tests revealed more uncertainty. CONCLUSIONS A test using cervical length and qualitative fetal fibronectin appears to be the best diagnostic strategy. Decisions regarding its generalization and funding in France in this population of women should take into account the high, lifetime costs induced by prematurity.
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Affiliation(s)
- Thomas Desplanches
- Service de Gynécologie-Obstétrique, Médecine Fœtale et Stérilité Conjugale, CHU de Dijon, 21000 Dijon, France
| | - Catherine Lejeune
- EPICAD LNC-UMR1231, Burgundy & Franche Comte University, Dijon, France
- Clinical Epidemiology Unit, Inserm, CIC 1432, Dijon, France
- Clinical Epidemiology Unit, Clinical Investigation Center, Dijon University Hospital, Dijon, France
| | - Jonathan Cottenet
- Clinical Epidemiology Unit, Inserm, CIC 1432, Dijon, France
- Clinical Epidemiology Unit, Clinical Investigation Center, Dijon University Hospital, Dijon, France
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France
- Bourgogne Franche-Comté University, Dijon, France
| | - Paul Sagot
- Service de Gynécologie-Obstétrique, Médecine Fœtale et Stérilité Conjugale, CHU de Dijon, 21000 Dijon, France
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Catherine Quantin
- Clinical Epidemiology Unit, Inserm, CIC 1432, Dijon, France
- Clinical Epidemiology Unit, Clinical Investigation Center, Dijon University Hospital, Dijon, France
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France
- Bourgogne Franche-Comté University, Dijon, France
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
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Coloma M, Kang F, Vallejo-Torres L, Díaz P, Méndez Y, Álvarez de la Rosa M. Economic consequences of over-diagnosis of threatened preterm labor. Int J Gynaecol Obstet 2018; 141:200-205. [PMID: 29369336 DOI: 10.1002/ijgo.12450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/31/2017] [Accepted: 01/23/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate whether adherence to a cervical length-based protocol can reduce both unnecessary admissions and the socioeconomic costs associated with inappropriately admitted patients. METHODS The present retrospective observational study included women admitted for threatened preterm labor (TPL) at 24-34 weeks of pregnancy to a tertiary hospital in the Canary Islands, 2009-2014. Data were reviewed from all patients admitted for TPL. Those with a long cervix (>25 mm) were classified as "inappropriate admissions", and both the economic burden based on diagnosis-related group (DRG) and the social costs associated with sick leave for these women were calculated. RESULTS During the 6-year study period, 430 women were admitted for TPL. The rate of inappropriate hospital admissions was 45% in the first year, but was reduced to 23% in the final year (P<0.001); the premature delivery rates in these years did not differ (P=0.224). The mean DRG-based cost of the admission per patient with a long cervix was EU euros €2099. The total annual costs from inappropriate admission (both social security sick leave costs and hospital costs) were estimated to be up to €571 047.37 during the 6-year study period, and reduced from €60 420.76 in 2009 to €29 998.04 in 2014. CONCLUSION Reductions in inappropriate admissions from applying cervical length-based management protocol could reduce healthcare costs without increasing the incidence of premature delivery.
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Affiliation(s)
- Marta Coloma
- Servicio de Ginecología y Obstetricia, Complejo Hospitalario Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Fatima Kang
- Servicio de Ginecología y Obstetricia, Complejo Hospitalario Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Laura Vallejo-Torres
- Servicio de Evaluación del Servicio Canario de la Salud, Fundación Canaria de Investigación Sanitaria, Tenerife, Spain
| | | | - Yurena Méndez
- Servicio de Ginecología y Obstetricia, Complejo Hospitalario Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Margarita Álvarez de la Rosa
- Servicio de Ginecología y Obstetricia, Complejo Hospitalario Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
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10
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Haghighi L, Rashidi M, Najmi Z, Homam H, Hashemi N, Mobasseri A, Moradi Y. Comparison of intramuscular progesterone with oral nifedipine for treating threatened preterm labor: A randomized controlled trial. Med J Islam Repub Iran 2017; 31:56. [PMID: 29445685 DOI: 10.14196/mjiri.31.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Indexed: 01/18/2023] Open
Abstract
Background: Threatened preterm labor (TPL) is the leading cause of hospitalization during pregnancy. Tocolytic agents are the
primary therapeutic options for TPL. The aim of this study is to compare intramuscular progesterone with oral nifedipine as a tocolytic
agent.
Methods: This randomized controlled trial was carried out in a teaching hospital (Shahid Akbarabadi) in Tehran, Iran, from December
2011 to November 2012. Three hundred and fifteen singleton pregnant women aged >18 yrs at 26-34 weeks’ gestation with the diagnosis
of threatened preterm labor (TPL) were randomly received either intramuscular progesterone or oral nifedipine for tocolysis. Maternal
and neonatal outcomes were then compared between the two interventions. P value less than 0.05 was considered statistically significant.
IRCT registration number of this study is IRCT201112198469N1
Results: The success rate of progesterone and nifedipine in treating TPL were 83% and 82.7%, respectively. There was no significant
difference between the two interventions with regard to gestational age at delivery, type of delivery, the time interval until the delivery,
birth weight, NICU admission rate and hospital stays. Progesterone administration was associated with lower duration of NICU stay as
compared with nifedipine (0.33±0.77 days vs.1.5±3.2 days, p<0.05). None of the two drugs caused any major side effects.
Conclusion: Single dose intramuscular progesterone is as effective as oral nifedipine in treating TPL. It also significantly reduces the
NICU stay.
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García-Blanco A, Diago V, Serrano De La Cruz V, Hervás D, Cháfer-Pericás C, Vento M. Can stress biomarkers predict preterm birth in women with threatened preterm labor? Psychoneuroendocrinology 2017; 83:19-24. [PMID: 28558282 DOI: 10.1016/j.psyneuen.2017.05.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/22/2017] [Accepted: 05/22/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Preterm birth is a major paediatric challenge difficult to prevent and with major adverse outcomes. Prenatal stress plays an important role on preterm birth; however, there are few stress-related models to predict preterm birth in women with Threatened Preterm Labor (TPL). OBJECTIVE The aim of this work is to study the influence of stress biomarkers on time until birth in TPL women. METHODS Eligible participants were pregnant women between 24 and 31 gestational weeks admitted to the hospital with TPL diagnosis (n=166). Stress-related biomarkers (α-amylase and cortisol) were determined in saliva samples after TPL diagnosis. Participants were followed-up until labor. A parametric survival model was constructed based on α-amylase, cortisol), TPL gestational week, age, parity, and multiple pregnancy. The model was adjusted using a logistic distribution and it was implemented as a nomogram to predict the labor probability at 7- and 14-day term. RESULTS The time until labor was associated with cortisol (p=0.001), gestational week at TPL diagnosis (p=0.004), and age (p=0.02). Importantly, high cortisol levels at TPL diagnosis were predictive of latency to labor. Validation of the model yielded an optimum corrected AUC value of 0.63. CONCLUSIONS High cortisol levels at TPL diagnosis may have an important role in the preterm birth prediction. Our statistical model implemented as a nomogram provided accurate predictions of individual prognosis of pregnant women.
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Affiliation(s)
- Ana García-Blanco
- Neonatal Research Unit, Health Research Institute La Fe, Valencia, Spain; University of Valencia, Valencia, Spain.
| | - Vicente Diago
- Division of Obstetrics and Gynecology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - David Hervás
- Biostatistics Unit, Health Research Institute La Fe, Valencia, Spain
| | | | - Máximo Vento
- Neonatal Research Unit, Health Research Institute La Fe, Valencia, Spain
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12
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Noguchi T, Sado T, Naruse K, Kobayashi H. Vaginal fluid pH and buffer capacity for predicting false preterm labor in Japanese women. Int J Gynaecol Obstet 2016; 134:69-74. [PMID: 27039048 DOI: 10.1016/j.ijgo.2015.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/16/2015] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the relationship between preterm labor and delivery, and the pH and buffer capacity of vaginal secretions. METHODS Between January 1, 2009 and March 31, 2012, two cohorts of patients at 22-36weeks of pregnancy were enrolled in a prospective cohort study at Nara Medical University Hospital, Japan. Patients experiencing preterm contractions and a control group of patients experiencing normal pregnancies were included. The pH and buffer capacity of vaginal secretions were measured and compared. RESULTS Of the 237 patients enrolled, 48 (20.3%) were experiencing symptoms of preterm labor and 189 (79.7%) were included in the control group. The pH was higher (P<0.001) and the buffer capacity was lower (P=0.0135) in the vaginal secretions of the patients experiencing preterm contractions compared with the control group. There was no difference in the pH and buffer capacity of the vaginal secretions of symptomatic patients who would experience preterm delivery and those who would not. Receiver operating characteristic curve analyses demonstrated that vaginal-secretion pH and buffer capacity could differentiate between patients experiencing preterm contractions and those not, but could not differentiate between patients who would experience preterm delivery and those who would not. CONCLUSION Vaginal-secretion pH and buffer capacity could be useful in diagnosing preterm labor; further studies are needed to determine potential practical diagnostic criteria.
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Affiliation(s)
- Taketoshi Noguchi
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan
| | - Toshiyuki Sado
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan
| | - Katsuhiko Naruse
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan
| | - Hiroshi Kobayashi
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan.
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13
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Hwang HS, Na SH, Hur SE, Lee SA, Lee KA, Cho GJ, Oh KY, Jin CH, Lee SM, Shin JE, Park KH, Lim JY, Choi SJ, Lee JH, Choi SK, Shim JY, Jo YS, Choi GY, Kim YH, Kil KC, Kim JW, Kwak DW, Kang YD, Kim YJ. Practice patterns in the management of threatened preterm labor in Korea: A multicenter retrospective study. Obstet Gynecol Sci 2015; 58:203-9. [PMID: 26023669 DOI: 10.5468/ogs.2015.58.3.203] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 04/07/2015] [Accepted: 04/08/2015] [Indexed: 11/17/2022] Open
Abstract
Objective This study aimed to examine clinical practice patterns in the management of pregnant women admitted with threatened preterm labor (TPL) in Korea. Methods Data from women admitted with a diagnosis of TPL were collected from 22 hospitals. TPL was defined as regular uterine contractions with or without other symptoms such as pelvic pressure, backache, increased vaginal discharge, menstrual-like cramps, bleeding/show and cervical changes. Data on general patient information, clinical characteristics at admission, use of tocolytics, antibiotics, and corticosteroids, and pregnancy outcomes were collected using an online data collections system. Results A total of 947 women with TPL were enrolled. First-line tocolysis was administered to 822 (86.8%) patients. As a first-line tocolysis, beta-agonists were used most frequently (510/822, 62.0%), followed by magnesium sulfate (183/822, 22.3%), calcium channel blockers (91/822, 11.1%), and atosiban (38/822, 4.6%). Of the 822 women with first-line tocolysis, second-line tocolysis were required in 364 (44.3%). Of 364 with second-line, 199 had third-line tocolysis (37.4%). Antibiotics were administered to 29.9% of patients (284/947) with single (215, 22.7%), dual (26, 2.7%), and triple combinations (43, 4.5%). Corticosteroids were administered to 420 (44.4%) patients. Betamethasone was administered to 298 patients (71.0%), and dexamethasone was administered to 122 patients (29.0%). Conclusion Practice patterns in the management of TPL in Korea were quite various. It is needed to develop standardized practice guidelines for TPL management.
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Lange TSD, Roos C, Bloemenkamp KWM, Bolte AC, Duvekot JJJ, Franssen MTM, Kok M, Oudijk MA, Porath MM, van der Post JAM, Mol BWJ. Impact of a randomized trial on maintenance tocolysis on length of hospital admission of women with threatened preterm labor in The Netherlands. Eur J Obstet Gynecol Reprod Biol 2015; 186:8-11. [PMID: 25596476 DOI: 10.1016/j.ejogrb.2014.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 11/25/2014] [Accepted: 12/05/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The APOSTEL-II trial was a multicenter randomized placebo-controlled trial, assessing the effectiveness of maintenance tocolysis with nifedipine. The trial showed maintenance tocolysis not to have an effect on perinatal outcome. Objective of the current study is to evaluate the effect of a negative trial on the length of hospital admission of women with threatened preterm labor. MATERIALS AND METHODS We evaluated length of hospital admission of all patients admitted with threatened preterm labor with a gestational age <32 weeks in 8 perinatal centers that participated in the APOSTEL-II trial. We studied only the first admission with threatened preterm labor, readmissions were excluded. We distinguished between the period before, the period during and the period after the trial. In a subgroup analysis, we differentiated for the group of women who delivered and for the group of women who did not deliver during the initial admission. RESULTS The mean length of hospital admission was 9.3 days before the start of the trial, 8.4 days during the recruitment period and 8.1 days after the trial was completed. The difference in mean length of hospital admission before and during the recruitment period was significantly different (p<001). COMMENTS The length of hospital admission of women with threatened preterm labor is found to be reduced during the recruitment period of the APOSTEL-II trial. This shows that the conduct of a randomized controlled trial itself has the potential to change daily practice.
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Affiliation(s)
- Thomas S de Lange
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
| | - Carolien Roos
- Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | - Kitty W M Bloemenkamp
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Antoinette C Bolte
- Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | - Johannes J J Duvekot
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Maureen T M Franssen
- Department of Obstetrics and Gynecology, University of Groningen, Academic Medical Center, Groningen, The Netherlands.
| | - Marjolein Kok
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
| | - Martijn A Oudijk
- Department of Obstetrics and Gynecology, University Medical Center, Utrecht, The Netherlands.
| | - Martina M Porath
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands.
| | - Joris A M van der Post
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
| | - Ben Willem J Mol
- School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide 5000, SA, Australia.
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Artunc Ulkumen B, Pala HG, Calik E, Oruc Koltan S. Platelet distribution width (PDW): A putative marker for threatened preterm labour. Pak J Med Sci 2014; 30:745-8. [PMID: 25097509 PMCID: PMC4121690 DOI: 10.12669/pjms.304.4991] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 04/03/2014] [Accepted: 04/09/2014] [Indexed: 02/05/2023] Open
Abstract
Objective: To determine the alterations of mean platelet volume (MPV), platelet distribution width (PDW), platelet level and hemoglobin level in pregnancies with threatened preterm labor (TPL). Methods: The retrospective analysis of 201 pregnant women with threatened preterm labour admitted to our clinic between 2009 and 2013 and 192 healthy pregnancies was conducted. The data regarding the maternal age, hemoglobin level, platelet count, mean platelet volume (MPV), platelet distribution width (PDW) was evaluated. Results: The mean MPV and hemoglobin levels were significantly lower in TPL group (p=0.001 and p=0.01, respectively). PDW levels were significantly higher in TPL group (p=0.05). (p=0.01). Regarding the platelet count, there was no statistically significant difference between the TPL and control groups. ROC curve analysis for PDW revealed an area under curve (AUC) 66.8%. By using a cut-off value 16.15 for PDW, sensitivity was 76.1% and specificity was 43.5% for TPL. Conclusion: MPV seems to be lower in threatened preterm deliveries, whereas PDW levels were increased suggesting the possible high grade inflammation and platelet activation in the pathology. Anemia occurs more frequently in threatened preterm delivery. Increased PDW levels especially > 16.15 may alert the obstetrician for the risk of the preterm delivery. However, further studies are needed to state the usefulness of the platelet indices in the diagnosis and clinical follow-up of preterm labor.
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Affiliation(s)
- Burcu Artunc Ulkumen
- Burcu Artunc Ulkumen, Obstetrics and Gynecology Department, Celal Bayar University, Hafsa Sultan Hospital, Uncubozkoy, Manisa-45210, Turkey
| | - Halil Gursoy Pala
- Halil Gursoy Pala, Obstetrics and Gynecology Department, Celal Bayar University, Hafsa Sultan Hospital, Uncubozkoy, Manisa-45210, Turkey
| | - Esat Calik
- Esat Calik, Obstetrics and Gynecology Department, Celal Bayar University, Hafsa Sultan Hospital, Uncubozkoy, Manisa-45210, Turkey
| | - Semra Oruc Koltan
- Semra Oruc Koltan, Obstetrics and Gynecology Department, Celal Bayar University, Hafsa Sultan Hospital, Uncubozkoy, Manisa-45210, Turkey
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16
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Yoshizato T, Tsujioka H, Horiuchi S, Shirota K, Obama H, Nojiri T, Yotsumoto F, Miyamato S. Change in cervical length in cases resulting in threatened preterm labor. J Med Ultrason (2001) 2010; 37:195-200. [PMID: 27278194 DOI: 10.1007/s10396-010-0279-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 06/07/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine the predisposing changes in cervical length (CL) and the critical range of CL in which significant uterine contractions emerge resulting in threatened preterm labor (TPL). METHODS Sixty-eight uncomplicated singleton pregnancies where the CL was <25 mm before 31 weeks were divided into cases with TPL (n = 23) or without (n = 45). CL and uterine contractions were monitored sequentially starting between 16 and 20 weeks. The gestational ages when a CL of <25 or <15 mm was first observed, the interval between these two measurements, and the CL value at TPL diagnosis were analyzed retrospectively. RESULTS (1) The gestational ages when a CL of <25 and <15 mm was first detected were lower in the TPL group (25 (median); 18-30 (range) and 28; 25-33 weeks, respectively) than in the non-TPL group (27; 20-30 and 33; 26-35 weeks; P = 0.030 and P < 0.001). (2) The interval between the two measurements was shorter in the TPL group (2.5; 0-15 weeks) than in the non-TPL group (5.5; 0-13 weeks, P = 0.034). (3) The CL value at TPL diagnosis was 13 mm (median), ranging from 7 to 18 mm. CONCLUSION Cases with early onset and subsequent rapid CL shortening before 31 weeks resulted in TPL when CL decreased below the range 7-18 mm.
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Affiliation(s)
- Toshiyuki Yoshizato
- Center for Maternal, Fetal and Neonatal Medicine, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan, Fukuoka, 814-0180, Japan.
| | - Hiroshi Tsujioka
- Department of Obstetrics and Gynecology, School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Shinji Horiuchi
- Department of Obstetrics and Gynecology, School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kyoko Shirota
- Department of Obstetrics and Gynecology, School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hirotsugu Obama
- Department of Obstetrics and Gynecology, School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takeshi Nojiri
- Department of Obstetrics and Gynecology, School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Fusanori Yotsumoto
- Department of Biochemistry School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Shingo Miyamato
- Department of Obstetrics and Gynecology, School of Medicine, Fukuoka University, Fukuoka, Japan
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