Clinical significance of early (< 20 weeks) vs. late (20-24 weeks) detection of sonographic short cervix in asymptomatic women in the mid-trimester.
Edi Vaisbuch,Edi Vaisbuch,Roberto Romero,Roberto Romero,Offer Erez,Offer Erez,Juan Pedro Kusanovic,Juan Pedro Kusanovic,Shali Mazaki-Tovi,Shali Mazaki-Tovi,Francesca Gotsch,Vivian Romero,Clara Ward,Tinnakorn Chaiworapongsa,Tinnakorn Chaiworapongsa,Pooja Mittal,Pooja Mittal,Yoram Sorokin,Sonia S. Hassan,Sonia S. Hassan +19 more
TLDR
The aim of this study was to determine whether the risk of early spontaneous preterm delivery in asymptomatic women with a sonographic cervical length of ≤ 15 mm in the mid‐trimester changes as a function of gestational age at diagnosis.Abstract:
Objective—The aim of this study was to determine whether the risk of early spontaneous preterm delivery (sPTD) in asymptomatic women with a sonographic cervical length ≤15 mm in the mid-trimester changes as a function of gestational age at diagnos Methods—This cohort study included 109 asymptomatic patients with a sonographic sonographic cervical length ≤15 mm diagnosed at 14–24 weeks of gestation. Women with a multifetal gestation, cerclage, and those with a cervical dilatation >2 cm were excluded. The study population was stratified by gestational age at diagnosis (<20 weeks vs. 20–24 weeks) and by cervical length (≤10 mm vs. 11–15 mm). The primary outcome variables were PTD <28 and <32 weeks’ gestation and the diagnosis-to-delivery interval. Results—1) The median gestational age at diagnosis of a short cervix before 20 weeks and at 20–24 weeks was 18.9 and 22.7 weeks, respectively; 2) women diagnosed before 20 weeks had a higher rate of sPTD at <28 weeks (76.9% vs. 30.9%; p<0.001) and at <32 weeks (80.8% vs. 48.1%; p=0.004), and a shorter median diagnosis-to-delivery interval (21 vs. 61.5 days, p=0.003) than those diagnosed at 20–24 weeks; 3) The rate of amniotic fluid “sludge” was higher among patients diagnosed at <20 weeks of gestation than those diagnosed between 20 and 24 weeks (92.3% vs. 48.2%;p<0.001). Conclusions—Asymptomatic women with a sonographic cervical length ≤15 mm diagnosed before 20 weeks have a dramatic and significantly higher risk of early preterm delivery than women diagnosed at 20–24 weeks. These findings can be helpful to physicians in counseling these patients, and may suggest different mechanisms of disease leading to a sonographic short cervix before or after 20 weeks of gestation.read more
Citations
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Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized, double-blind, placebo-controlled trial
Sonia S. Hassan,Sonia S. Hassan,Roberto Romero,Roberto Romero,Roberto Romero,D. Vidyadhari,S. Fusey,Jason K. Baxter,Meena Khandelwal,J. Vijayaraghavan,Y. Trivedi,Priya Soma-Pillay,P. Sambarey,Ashlesha K. Dayal,V. Potapov,John M. O'Brien,John M. O'Brien,V. Astakhov,O. Yuzko,W. Kinzler,B. Dattel,H. Sehdev,L. Mazheika,D. Manchulenko,M. T. Gervasi,Lisa M. Sullivan,Agustin Conde-Agudelo,James A. Phillips,George W. Creasy +28 more
TL;DR: The efficacy and safety of using micronized vaginal progesterone gel to reduce the risk of preterm birth and associated neonatal complications in women with a sonographic short cervix is determined.
Journal ArticleDOI
Vaginal progesterone in women with an asymptomatic sonographic short cervix in the midtrimester decreases preterm delivery and neonatal morbidity: a systematic review and metaanalysis of individual patient data
Roberto Romero,Kypros H. Nicolaides,Agustin Conde-Agudelo,Ann Tabor,Ann Tabor,John M. O'Brien,Elcin Cetingoz,Eduardo Ribeiro da Fonseca,George W. Creasy,Katharina Klein,Line Rode,Priya Soma-Pillay,Shalini Fusey,Cetin Cam,Zarko Alfirevic,Sonia S. Hassan,Sonia S. Hassan +16 more
TL;DR: Vaginal progesterone administration to asymptomatic women with a sonographic short cervix in the midtrimester reduces the risk of preterm birth and neonatal morbidity and mortality.
Journal ArticleDOI
Cervical cerclage for prevention of preterm delivery in women with a short cervix: A randomized, controlled trial
M S To,Zarko Alfirevic,Victoria Heath,S. Cicero,Ana Maria Cacho,Paula R Williamson,Kypros H. Nicolaides +6 more
TL;DR: In this trial, placing a cervical suture in women with a short cervix did not lower the risk of early preterm delivery in a substantial proportion of cases, but routinely measuring cervical length at 22 to 24 weeks gestation by transvaginal sonography does identify women who are at high risk of first-time delivery.
Journal ArticleDOI
Vaginal progesterone vs cervical cerclage for the prevention of preterm birth in women with a sonographic short cervix, previous preterm birth, and singleton gestation: a systematic review and indirect comparison metaanalysis
Agustin Conde-Agudelo,Roberto Romero,Kypros H. Nicolaides,Tinnakorn Chaiworapongsa,Tinnakorn Chaiworapongsa,John M. O'Brien,Elcin Cetingoz,Eduardo Ribeiro da Fonseca,George W. Creasy,Priya Soma-Pillay,Shalini Fusey,Cetin Cam,Zarko Alfirevic,Sonia S. Hassan,Sonia S. Hassan +14 more
TL;DR: Based on state-of-the-art methods for indirect comparisons, either vaginal progesterone or cerclage are equally efficacious in the prevention of preterm birth in women with a sonographic short cervix in the mid trimester, singleton gestation, and previous pre term birth.
Journal ArticleDOI
Midtrimester amniotic fluid concentrations of interleukin-6 and interferon-gamma-inducible protein-10: evidence for heterogeneity of intra-amniotic inflammation and associations with spontaneous early ( 32 weeks) preterm delivery.
Maria Teresa Gervasi,Roberto Romero,Gabriella Bracalente,Offer Erez,Zhong Dong,Sonia S. Hassan,Lami Yeo,Bo Hyun Yoon,Tinnakorn Chaiworapongsa +8 more
TL;DR: Although each type of inflammation is a risk factor for spontaneous preterm delivery, many patients had a term delivery without complication; and the amniotic fluid in the midtrimester did not contain microorganisms detectable with cultivation techniques.
References
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Journal ArticleDOI
The Length of the Cervix and the Risk of Spontaneous Premature Delivery
Jay D. Iams,Robert L. Goldenberg,Paul J. Meis,Brian M. Mercer,Atef H. Moawad,Anita Das,Elizabeth Thom,Donald McNellis,Rachel L. Copper,Francee Johnson,James M. Roberts +10 more
TL;DR: In this paper, a prospective multicenter study of pregnant women was conducted to measure the length of the cervix and documented the incidence of spontaneous preterm delivery before 35 weeks' gestation.
Journal ArticleDOI
Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis
Maria Kyrgiou,George Koliopoulos,Pierre Martin-Hirsch,Marc Arbyn,Walter Prendiville,Evangelos Paraskevaidis +5 more
TL;DR: All the excisional procedures to treat cervical intraepithelial neoplasia present similar pregnancy-related morbidity without apparent neonatal morbidity, andCaution in the treatment of young women with mild cervical abnormalities should be recommended.
Journal ArticleDOI
Progesterone and the risk of preterm birth among women with a short cervix.
TL;DR: In women with a short cervix, treatment with progesterone reduces the rate of spontaneous early preterm delivery and is associated with a nonsignificant reduction in neonatal morbidity.
Journal ArticleDOI
The role of inflammation and infection in preterm birth.
Roberto Romero,Jimmy Espinoza,Jimmy Espinoza,Luís F. Gonçalves,Luís F. Gonçalves,Juan Pedro Kusanovic,Lara A. Friel,Sonia S. Hassan,Sonia S. Hassan +8 more
TL;DR: The role of inflammation in preterm and term parturition is reviewed, which is the only pathological process for which both a firm causal link with preterm birth and a molecular pathophysiology defined are established.
Journal ArticleDOI
Microbial Prevalence, Diversity and Abundance in Amniotic Fluid During Preterm Labor: A Molecular and Culture-Based Investigation
Daniel B. DiGiulio,Daniel B. DiGiulio,Roberto Romero,Roberto Romero,Harold P. Amogan,Juan Pedro Kusanovic,Juan Pedro Kusanovic,Elisabeth M. Bik,Elisabeth M. Bik,Francesca Gotsch,Chong Jai Kim,Chong Jai Kim,Offer Erez,Offer Erez,Sam Edwin,David A. Relman,David A. Relman +16 more
TL;DR: The amniotic cavity of women in preterm labor harbors DNA from a greater diversity of microbes than previously suspected, including as-yet uncultivated, previously-uncharacterized taxa.
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