Correlation of Qualitative Alpha1-microglobulin, Values of Interleukin 6, Cervicometry and Cervical Infection in Pregnant Women with Symptoms of Preterm Birth

Background

One of the problems in modern obstetrics is how to identify and select pregnant women who are most likely to give premature birth. In the last ten years, due to false-positive test results, i.e., tests with low positive predictive values, there is an increase in unnecessary hospitalization days as well as unnecessary therapy. The probability of preterm birth is 25% in a population of pregnant women with symptoms of preterm birth.

Objective

The aim was to analyze diagnostic accuracy of tests for the purpose of predicting premature births in< 37th and <34th week of pregnancy.Incidence of preterm births in < 37th week of pregnancy was 28%, while the incidence of preterm births up until 34th week of pregnancy, was < 8%.

Methods

We included two groups of pregnant women in a prospective study; one group with the symptoms of threatening preterm birth between 22nd and 37th week of pregnancyand the other one of the same gestation period with no symptoms.

Results

Each pregnant woman underwent test for placental alphamicroglobulin-1, cervical length screening, cervical sampling for microbiological analysis, blood sampling for IL6 and CRP analysis. There were 16% of preterm births, up until 7 days from hospitalization, and they were all PAMG-1 positive; There is 75% of preterm births if PAMG-1 is positive with cervical length under 25mm. Combining tests, we reached the best predictive accuracy with positive PAMG-1 test, cervical length under 15mm along with the increase of CRP values above 15.96%.

Conclusion

Total number of hospitalization days was 29% with preterm births up to 71% with full term births regardless the symptomatology, which justifies further studies towards releasing the pressure from the health care system and from doctors as well in the process of reaching a decision on treatment of pregnant women with the signs of preterm birth.

Clinical and ultrasonographic parameters in assessment of labor induction success in nulliparous women

Purpose: Evaluation of simplified Bishop score and ultrasound cervicometry in the assessment of labor induction success in nulliparous women.Methods: Prospective cohort study included 146 nulliparous women with singleton pregnancy and indications for labor induction. Prior to labor induction, cervicometry and Bishop score were determined. Upon delivery, patients were classified as those delivered vaginally and by cesarean section (CS) after unsuccessful labor induction.Results: Bishop score >5 was found in 47.95% of vaginally delivered women and 12.33% of patients delivered by CS (p < .01). Cervicometry had appropriate findings in 34.2% of vaginally delivered women and 75.3% of those delivered by CS (p < .01). Bishop score (>5 versus ≤5) had lower sensitivity (52.05%) and specificity (12.33%) than cervicometry (good versus unfavorable findings) (sensitivity 65.75%, specificity 75.34%) for prediction of labor induction success. If Bishop score was ≤5, cervicometry had 50.0% sensitivity and 78.13% specificity, while if Bishop score was >5, 82.86% sensitivity and 55.56% specificity. Obtained model for predicting labor induction outcome in nulliparous women based on their clinical and ultrasonographical characteristics identified the Bishop score as the most important predictor.Conclusions: Study confirmed the usefulness of simplified Bishop score and ultrasound cervicometry in the assessment of labor induction success in nulliparous women.

Cervical cerclage - history and contemporary use

OBJECTIVE

Contemporary role of cerclage as a preterm birth treatment.

DESIGN

Review article.

SETTING

Department of Obstetrics and Gynecology of the First Faculty of Medicine and General Teaching Hospital in Prague.

METHODS

Research of existing literature, predominantly foreign journal articles, but also Czech literature and personal experience with the method.

RESULTS

Cerclage is one of the well-known surgical procedures carried out during pregnancy. Its aim is to provide a mechanical support to the cervical canal and to keep the cervix closed. The cervical mucous plug serves as a mechanical barrier between the vagina and the uterine cavity, but it also contains many immune components which protect the fetal compartment from ascendent infections. Application of a cervical stitch can help to retain the mucous plug and thus increases the immunity of the cervical canal. Results of 15 randomised studies (Cochraine Database of Systematic R) suggest that in women with increased risk of preterm birth, cerclage decreases the occurrence of preterm birth relative to the expectant management.

CONCLUSIONS

Despite the decreasing numbers of cerclage surgeries, it is still a useful method of preterm birth prevention for a specific group of women. More recently, a progesterone treatment has gained popularity. Its application, however, must begin before the 16th week of pregnancy.

Cervical length measured by transvaginal ultrasonography and cervicovaginal infection as predictor of preterm birth risk

Introduction:

The study shows possibilities of transvaginal sonographic measurement of the cervix in prediction of premature birth risk.

Goals:

The aim of the study was to follow up the cervical length in the pregnant from 16^th to 37^th week, as well as to do a microbiological analysis of the vaginal and cervical flora and to identify relation between the cervical shortening and microbiological flora as well as with a premature birth.

Material and methods:

The investigation was conducted as a prospective study on two groups of female patients in Clinical Centre of Banja Luka. In the high risk group we had 8% of patients with cervical length bellow than 15mm, 30% of patients with cervical length from 15 to 25m and 62% of patients with cervical length bigger than 25mm. In the low risk group we had no patients with cervical length bellow 15mm, 95% of patients had cervical length bigger than 25mm and 5% of patients had cervical length from 15 do 25mm.

Results:

The regression coefficient of the cervical length in the high risk group was 0.44mm, while in the low risk group it was 0.26mm. In the high risk group 67.56% patients had a positive cervical smear finding, while in the low risk group it was 4%. A high premature birth (defined as birth before 36.6 weeks) incidence of 50% was presented in patients with cervical length bellow 15mm. In the group of patients with cervical length up to 25mm the premature risk incidence was 10.52±0.05. In the high risk group of patients with a positive cervical smear finding, regarding the cervical length the percentage was as follows; in the subgroup of 15mm length 88,89±11,87, in subgroup from 15 to 25mm was 62,07±11,43 and in the subgroup bigger than 25mm, 60.06±8.05.

Conclusion:

By the analysis of the first and second goal of our study we can conclude that ultrasound assessment of cervical length is simple and feasible in the 16^th week of pregnancy in both groups, with high and low risk. The length of the cervix in this period is shorter in the high risk group compared with the low-risk group. This difference was not statistically significant, however, it clearly demonstrated connection between shorten length of the cervix with the preterm birth. A regression analysis shows that the shortening of the cervix length is more frequent in high risk group which is to be expected, bearing in mind that in this group, the risk of preterm delivery was significantly higher.