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[PMID]:29260226
[Au] Autor:Saccone G; Maruotti GM; Giudicepietro A; Martinelli P; Italian Preterm Birth Prevention (IPP) Working Group
[Ad] Endereço:Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.
[Ti] Título:Effect of Cervical Pessary on Spontaneous Preterm Birth in Women With Singleton Pregnancies and Short Cervical Length: A Randomized Clinical Trial.
[So] Source:JAMA;318(23):2317-2324, 2017 12 19.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Spontaneous preterm birth is a major cause of perinatal morbidity and mortality. It is unclear if a cervical pessary can reduce the risk of spontaneous preterm delivery. Objective: To test whether in asymptomatic women with singleton pregnancies and no prior spontaneous preterm birth but with short cervical length on transvaginal ultrasound, use of a cervical pessary would reduce the rate of spontaneous preterm birth at less than 34 weeks of gestation. Design, Setting, and Participants: Parallel-group, nonblinded, randomized clinical trial conducted from March 1, 2016, to May 25, 2017, at a single center in Italy. Asymptomatic women with singleton gestations, no previous spontaneous preterm births, and cervical lengths of 25 mm or less at 18 weeks 0 days to 23 weeks 6 days of gestation were eligible. Interventions: Patients were randomized 1:1 to receive either cervical pessary (n = 150) or no pessary (n = 150). The pessary was removed between 37 weeks 0 days and 37 weeks 6 days of gestation or earlier if clinically indicated. The control group received standard care. For cervical length of 20 mm or shorter, women in both groups were prescribed vaginal progesterone, 200 mg/d, until 36 weeks 6 days of gestation. No bed rest or activity restriction was recommended. Main Outcomes and Measures: The primary end point was spontaneous preterm birth at less than 34 weeks of gestation. Secondary outcomes were adverse events. Results: Among 300 women who were randomized (mean age, 29 [SD, 6.3] years; mean gestational age, 22 [SD, 1.3] weeks), 100% completed the trial. The primary end point occurred in 11 women (7.3%) in the pessary group and 23 women (15.3%) in the control group (between-group difference, -8.0% [95% CI, -15.7% to -0.4]; relative risk, 0.48 [95% CI, 0.24-0.95]). During follow-up, the pessary group had a higher rate of increased or new vaginal discharge (86.7% vs 46.0%; between-group difference, +40.7% [95% CI, +30.1%-+50.3%]; relative risk, 1.88 [95% CI, 1.57-2.27]). Conclusions and Relevance: Among women without prior spontaneous preterm birth who had asymptomatic singleton pregnancies and short transvaginal cervical length, use of a cervical pessary, compared with no pessary use, resulted in a lower rate of spontaneous preterm birth at less than 34 weeks of gestation. The results of this single-center, nonblinded study among selected pregnant women require confirmation in multicenter clinical trials. Trial Registration: clinicaltrials.gov Identifier: NCT02716909.
[Mh] Termos MeSH primário: Colo do Útero/anatomia & histologia
Pessários
Nascimento Prematuro/prevenção & controle
[Mh] Termos MeSH secundário: Administração Intravaginal
Adulto
Medida do Comprimento Cervical
Terapia Combinada
Feminino
Seres Humanos
Estimativa de Kaplan-Meier
Gravidez
Progesterona/uso terapêutico
Progestinas/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Progestins); 4G7DS2Q64Y (Progesterone)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171221
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.18956


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[PMID]:29190738
[Au] Autor:McGee D; Smith A; Poncil S; Patterson A; Bernstein AI; Racicot K
[Ad] Endereço:Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, United States of America.
[Ti] Título:Cervical HSV-2 infection causes cervical remodeling and increases risk for ascending infection and preterm birth.
[So] Source:PLoS One;12(11):e0188645, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Preterm birth (PTB), or birth before 37 weeks gestation, is the leading cause of neonatal mortality worldwide. Cervical viral infections have been established as risk factors for PTB in women, although the mechanism leading to increased risk is unknown. Using a mouse model of pregnancy, we determined that intra-vaginal HSV2 infection caused increased rates of preterm birth following an intra-vaginal bacterial infection. HSV2 infection resulted in histological changes in the cervix mimicking cervical ripening, including significant collagen remodeling and increased hyaluronic acid synthesis. Viral infection also caused aberrant expression of estrogen and progesterone receptor in the cervical epithelium. Further analysis using human ectocervical cells demonstrated a role for Src kinase in virus-mediated changes in estrogen receptor and hyaluronic acid expression. In conclusion, HSV2 affects proteins involved in tissue hormone responsiveness, causes significant changes reminiscent of premature cervical ripening, and increases risk of preterm birth. Studies such as this improve our chances of identifying clinical interventions in the future.
[Mh] Termos MeSH primário: Medida do Comprimento Cervical
Herpes Genital/patologia
Herpesvirus Humano 2/patogenicidade
Nascimento Prematuro
[Mh] Termos MeSH secundário: Animais
Infecções por Escherichia coli/complicações
Infecções por Escherichia coli/fisiopatologia
Feminino
Herpes Genital/complicações
Herpes Genital/fisiopatologia
Seres Humanos
Camundongos
Camundongos Endogâmicos C57BL
Modelos Animais
Gravidez
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180217
[Lr] Data última revisão:
180217
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0188645


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[PMID]:28726322
[Au] Autor:Odibo AO
[Ad] Endereço:Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
[Ti] Título:Screening and prevention of preterm birth: what is a clinician to do?
[So] Source:Acta Obstet Gynecol Scand;96(8):905-906, 2017 08.
[Is] ISSN:1600-0412
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Medida do Comprimento Cervical
Nascimento Prematuro/prevenção & controle
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Gravidez
[Pt] Tipo de publicação:JOURNAL ARTICLE; COMMENT
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170814
[Lr] Data última revisão:
170814
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170721
[St] Status:MEDLINE
[do] DOI:10.1111/aogs.13142


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[PMID]:28639273
[Au] Autor:Wang S; Feng L
[Ad] Endereço:Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
[Ti] Título:A single-center retrospective study of pregnancy outcomes after emergency cerclage for cervical insufficiency.
[So] Source:Int J Gynaecol Obstet;139(1):9-13, 2017 Oct.
[Is] ISSN:1879-3479
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To compare maternal and perinatal outcomes after emergency cerclage with those after elective cerclage. METHODS: In a retrospective review, data were assessed from women with a viable singleton pregnancy who underwent elective or emergency cerclage for cervical insufficiency at the Tongji Hospital, Wuhan, China, between January 2010 and July 2015. Subgroup analyses based on cervical length (CL; ≤15, 15-25, and 25-30 mm) were also conducted among women undergoing emergency cerclage. RESULTS: In total, 68 women underwent elective cerclage and 53 underwent emergency cerclage. The suture-to-delivery interval was significantly longer in the elective group (19.17 ± 5.86 weeks) than in the emergency group (11.29 ± 7.27 weeks; P<0.001). There was no difference between the elective and emergency groups in mean pregnancy length at delivery, frequency of Apgar score below 7 at 5 minutes (live births only), or birth weight (live births only). An inverse trend in the degree of CL shortening with pregnancy outcomes was observed; women with a CL of 25-30 mm had the best outcomes. CONCLUSION: Pregnancy outcomes were similar after emergency and elective cerclage. There was an inverse trend in the degree of CL shortening with pregnancy outcomes in the emergency cerclage group, with better outcomes observed for women with longer CL.
[Mh] Termos MeSH primário: Incompetência do Colo do Útero/epidemiologia
[Mh] Termos MeSH secundário: Adulto
Cerclagem Cervical
Medida do Comprimento Cervical
China/epidemiologia
Procedimentos Cirúrgicos Eletivos
Serviços Médicos de Emergência
Feminino
Seres Humanos
Gravidez
Resultado da Gravidez
Estudos Retrospectivos
Fatores de Tempo
Incompetência do Colo do Útero/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171006
[Lr] Data última revisão:
171006
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170623
[St] Status:MEDLINE
[do] DOI:10.1002/ijgo.12244


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[PMID]:28486361
[Au] Autor:Sahasrabudhe N; Igel C; Echevarria GC; Dar P; Wolfe D; Bernstein PS; Angert R; Dayal A; Gallagher P; Rosner M
[Ad] Endereço:Departments of Obstetrics & Gynecology and Women's Health and Pediatrics, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, and the Departments of Anesthesiology, Perioperative Care and Pain Medicine and Obstetrics and Gynecology, New York University School of Medicine, New York, New York.
[Ti] Título:Universal Cervical Length Screening and Antenatal Corticosteroid Timing.
[So] Source:Obstet Gynecol;129(6):1104-1108, 2017 Jun.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To evaluate the relationship between universal transvaginal screening for short cervical length in the second trimester and the timing of antenatal corticosteroids. METHODS: We performed a retrospective cohort study of patients with nonanomalous singleton gestations and spontaneous preterm birth between 24 and 34 weeks of gestation after the initiation of a universal transvaginal cervical length screening program between October 2012 and August 2015. Our primary outcome was antenatal corticosteroid administration to a delivery interval of fewer than 7 days. Secondary outcomes were delivery 24 hours to 7 days after the initial steroid injection, steroid administration to delivery interval, neonatal survival, neonatal intensive care unit length of stay, and respiratory distress syndrome. Multivariable logistic regression was used to estimate the association between antenatal corticosteroid timing and the diagnosis of a short cervix adjusted for potential confounders. RESULTS: Among 266 eligible patients, 69 with a short cervical length and 197 without a short cervical length were identified. There were no statistically significant differences in baseline characteristics between the groups. During the study period, 64 of 69 (92.8%) of patients with a short cervix and 176 of 197 (89.3%) without a short cervix received at least one steroid injection before delivery (P=.411). Steroids were given within 7 days of delivery in 33 of 69 (47.8) patients with a short cervix compared with 126 of 197 (64%) patients in the no short cervix group (P=.015; adjusted odds ratio 0.51, 95% confidence interval 0.29-0.9). Median interval between steroid administration and delivery was 8 days in patients diagnosed with a short cervix compared with 3 days for those without a short cervical length (P<.001). CONCLUSION: Patients identified as having a short cervical length by universal transvaginal ultrasound screening were at greater risk of delivering more than 7 days after the initiation of corticosteroids for fetal lung maturation compared with women without a short cervical length.
[Mh] Termos MeSH primário: Corticosteroides/administração & dosagem
Medida do Comprimento Cervical
Colo do Útero/diagnóstico por imagem
Nascimento Prematuro/diagnóstico por imagem
[Mh] Termos MeSH secundário: Adulto
Estudos de Coortes
Parto Obstétrico
Feminino
Maturidade dos Órgãos Fetais
Seres Humanos
Avaliação de Processos e Resultados (Cuidados de Saúde)
Gravidez
Resultado da Gravidez
Segundo Trimestre da Gravidez
Nascimento Prematuro/prevenção & controle
Estudos Retrospectivos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Adrenal Cortex Hormones)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170714
[Lr] Data última revisão:
170714
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170510
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002029


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[PMID]:28397052
[Au] Autor:Wang S; Wang Y; Feng L
[Ad] Endereço:Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
[Ti] Título:Pregnancy outcomes following transvaginal cerclage for cervical insufficiency: Results from a single-center retrospective study.
[So] Source:J Huazhong Univ Sci Technolog Med Sci;37(2):237-242, 2017 Apr.
[Is] ISSN:1672-0733
[Cp] País de publicação:China
[La] Idioma:eng
[Ab] Resumo:To study maternal and perinatal outcomes after cervical cerclage in both singleton and twin pregnancies, we retrospectively reviewed women undergoing cervical cerclage for cervical insufficiency at Tongji Hospital, Wuhan, China from January 1, 2010 to July 31, 2015 to evaluate primary and secondary outcomes for subgroups with cervical length (CL) ≤15, >15 to <25, and ≥25 mm. Of 166 patients who underwent cervical cerclage, after exclusion of patients with missed abortion and continuing pregnancy, 141 patients (121 singleton and 20 twin pregnancies) were included in the analysis. Mean gestational age at birth was 34.22 and 28.27 weeks for singleton and twin pregnancies, respectively. There were 17 (14.05%) and 13 (33.33%) neonatal deaths in singleton and twin pregnancies, respectively. Mean age (31.60±4.62 vs. 31.22±4.63 years, P=0.39) and gestational weeks at cerclage (18.50±4.62 vs. 19.31±4.99, P=0.47) were similar for both groups. Mean gestational weeks at delivery (34.22±5.77 vs. 28.27±6.17, P<0.001) and the suture to delivery interval (15.72±7.15 vs. 8.96±6.70, P<0.001) were significantly longer in the singleton group. These variables indicate a linear negative correlation with the degree of CL shortening, with better outcomes in patients with CL ≥25 mm who underwent cerclage, both in singleton and twin pregnancies. No difference in mode of delivery existed between the singleton group and twin group. Our results indicate a high risk of preterm delivery in both groups, especially in the twin group. Patients with a history of preterm labor and CL >25 mm in the current pregnancy, possibly in a twin pregnancy, could benefit from elective cervical cerclage; however, cervical cerclage was inadvisable for twin pregnancies with a CL >15 and <25 mm. Our data emphasize the importance of re-evaluating the efficacy of cervical cerclage for twin pregnancies in well-designed clinical trials.
[Mh] Termos MeSH primário: Cerclagem Cervical/mortalidade
Resultado da Gravidez/epidemiologia
Gravidez de Gêmeos/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Medida do Comprimento Cervical
Feminino
Idade Gestacional
Seres Humanos
Gravidez
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:171104
[Lr] Data última revisão:
171104
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170412
[St] Status:MEDLINE
[do] DOI:10.1007/s11596-017-1721-0


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[PMID]:28358839
[Au] Autor:Lee SM; Park KH; Jung EY; Jang JA; Yoo HN
[Ad] Endereço:Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
[Ti] Título:Frequency and clinical significance of short cervix in patients with preterm premature rupture of membranes.
[So] Source:PLoS One;12(3):e0174657, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Cervical length measurement has been uggested as a useful tool for predicting intra-amniotic infection/inflammation in preterm labor, but little information is available in the setting of preterm premature rupture of membranes (pPROM). We aimed to determine whether a short cervical length is independently associated with an increased risk of intra-amniotic infection or inflammation and impending preterm delivery in women with pPROM. METHODS: This was a retrospective cohort study involving 171 consecutive singleton pregnant women with pPROM (21+0-33+6 weeks' gestation), who underwent amniocentesis. Amniotic fluid (AF) was cultured, and assayed for interleukin (IL)-6 and IL-8. Cervical length was measured at the time of amniocentesis by transvaginal ultrasonography with an aseptic technique. Short cervical length was defined as a cervical length of ≤15 mm. Intra-amniotic infection was defined as a positive AF culture for microorganisms and intra-amniotic inflammation was defined as elevated AF concentrations of IL-6 or IL-8 (IL-6 ≥1.5 ng/mL and/or IL-8 ≥1.3 ng/mL). RESULTS: Fifty (29.2%) women had a sonographic cervical length of ≤15mm. On univariate analysis, short cervical length was associated with an increased risk for intra-amniotic infection and/or inflammation; no other parameters studied showed a significant association. Multivariable analyses indicated that short cervical length was significantly associated with a higher risk of impending preterm delivery (within 2 days of measurement, within 7 days of measurement, and before 34 weeks), and remained significant after adjustment for potential confounders. CONCLUSION: In women with pPROM, short cervical length is associated with an increased risk for intra-amniotic infection/inflammation and associated with impending preterm delivery, independent of the presence of intra-amniotic infection/inflammation.
[Mh] Termos MeSH primário: Líquido Amniótico/microbiologia
Colo do Útero/fisiopatologia
Ruptura Prematura de Membranas Fetais/fisiopatologia
Inflamação/fisiopatologia
Complicações Infecciosas na Gravidez/fisiopatologia
[Mh] Termos MeSH secundário: Adulto
Amniocentese
Líquido Amniótico/metabolismo
Medida do Comprimento Cervical
Colo do Útero/anatomia & histologia
Colo do Útero/microbiologia
Feminino
Ruptura Prematura de Membranas Fetais/microbiologia
Seres Humanos
Inflamação/microbiologia
Interleucina-6/metabolismo
Interleucina-8/metabolismo
Trabalho de Parto Prematuro
Gravidez
Complicações Infecciosas na Gravidez/microbiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Interleukin-6); 0 (Interleukin-8)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170822
[Lr] Data última revisão:
170822
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170331
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0174657


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[PMID]:28295170
[Au] Autor:Pedretti MK; Kazemier BM; Dickinson JE; Mol BW
[Ad] Endereço:School of Women's and Infants' Health, The University of Western Australia, Perth, Western Australia, Australia.
[Ti] Título:Implementing universal cervical length screening in asymptomatic women with singleton pregnancies: challenges and opportunities.
[So] Source:Aust N Z J Obstet Gynaecol;57(2):221-227, 2017 Apr.
[Is] ISSN:1479-828X
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:Cervical length (CL) screening has been successfully utilised to identify asymptomatic women, with a singleton pregnancy, at risk of preterm birth (PTB), thereby providing an opportunity to offer interventions that may reduce that risk. Cervical length screening with ultrasound is most effectively performed with a transvaginal approach. Universal cervical length screening, encompassing all singleton pregnancies rather than restricting screening to those considered at increased risk of PTB, is currently not widely used, despite a growing body of evidence in support of its utility for PTB prevention. There are a number of barriers that may prevent or restrict the implementation of a universal CL screening program. These include cost, availability of vaginal progesterone and other treatment options, reluctance of women to undergo transvaginal ultrasound and the perceptions and beliefs of medical practitioners. Given that mid-pregnancy CL measurement is a recognised predictor of spontaneous PTB, that most cases of PTB occur with no prior maternal history and that there are interventions available that may reduce the risk of PTB, we believe there is a clear role for routine CL screening to be adopted as a component of the fetal morphology ultrasound examination. As a strategy to reduce PTB rates, discussion and counselling about PTB prevention and CL screening should be adopted as a core element of prenatal care.
[Mh] Termos MeSH primário: Medida do Comprimento Cervical
Colo do Útero/diagnóstico por imagem
Programas de Rastreamento
Nascimento Prematuro/prevenção & controle
[Mh] Termos MeSH secundário: Doenças Assintomáticas
Atitude do Pessoal de Saúde
Aconselhamento Diretivo
Feminino
Acesso aos Serviços de Saúde
Seres Humanos
Programas de Rastreamento/economia
Aceitação pelo Paciente de Cuidados de Saúde
Gravidez
Cuidado Pré-Natal
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171025
[Lr] Data última revisão:
171025
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170316
[St] Status:MEDLINE
[do] DOI:10.1111/ajo.12586


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[PMID]:28291893
[Au] Autor:Esplin MS; Elovitz MA; Iams JD; Parker CB; Wapner RJ; Grobman WA; Simhan HN; Wing DA; Haas DM; Silver RM; Hoffman MK; Peaceman AM; Caritis SN; Parry S; Wadhwa P; Foroud T; Mercer BM; Hunter SM; Saade GR; Reddy UM; nuMoM2b Network
[Ad] Endereço:Intermountain Healthcare, Salt Lake City, Utah2University of Utah Health Sciences Center, Salt Lake City.
[Ti] Título:Predictive Accuracy of Serial Transvaginal Cervical Lengths and Quantitative Vaginal Fetal Fibronectin Levels for Spontaneous Preterm Birth Among Nulliparous Women.
[So] Source:JAMA;317(10):1047-1056, 2017 03 14.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Spontaneous preterm birth is a leading cause of infant mortality. Prediction, largely based on prior pregnancy outcomes, is not possible in women pregnant for the first time. Objective: To assess the accuracy of universal screening to predict spontaneous preterm birth in nulliparous women using serial measurements of vaginal fetal fibronectin levels and cervical length. Design, Settings, and Participants: A prospective observational cohort study of nulliparous women with singleton pregnancies, from 8 clinical sites across the United States between October 2010 and May 2014. Women and clinicians were blinded to results unless cervical shortening less than 15 mm was identified. Exposures: Transvaginal cervical length and quantitative vaginal fetal fibronectin levels were reviewed at 2 study visits 4 or more weeks apart. Main Outcomes and Measures: Spontaneous preterm birth at less than 37 weeks was the primary outcome. Cervical length and quantitative fetal fibronectin were considered independently and together at each visit. Measurement distributions were compared for spontaneous preterm birth vs all other births. Spontaneous preterm birth before 32 weeks was a secondary outcome. Results: The study included 9410 women (median age, 27.0 [interquartile range, 9.0] years; 60.7% non-Hispanic white, 13.8% non-Hispanic black, 16.5% Hispanic, 4.0% Asian, and 5.1% other), of whom 474 (5.0%) had spontaneous preterm births, 335 (3.6%) had medically indicated preterm births, and 8601 (91.4%) had term births. Among women with spontaneous preterm birth, cervical length of 25 mm or less occurred in 35 of 439 (8.0%) at 16 to 22 weeks' gestation and in 94 of 403 (23.3%) at 22 to 30 weeks' gestation. Fetal fibronectin levels of 50 ng/mL or greater at 16 to 22 weeks identified 30 of 410 women (7.3%) with spontaneous preterm birth and 31 of 384 (8.1%) at 22 to 30 weeks. The area under the receiver operating characteristic curve for screening between 22 and 30 weeks for fetal fibronectin level alone was 0.59 (95% CI, 0.56-0.62), for transvaginal cervical length alone was 0.67 (95% CI, 0.64-0.70), and for the combination as continuous variables was 0.67 (95% CI, 0.64-0.70). Conclusions and Relevance: Among nulliparous women with singleton pregnancies, quantitative vaginal fetal fibronectin and serial transvaginal ultrasound cervical length had low predictive accuracy for spontaneous preterm birth. These findings do not support routine use of these tests in such women.
[Mh] Termos MeSH primário: Medida do Comprimento Cervical/métodos
Colo do Útero/anatomia & histologia
Fibronectinas/análise
Paridade
Nascimento Prematuro/diagnóstico
Vagina/química
[Mh] Termos MeSH secundário: Adolescente
Adulto
Área Sob a Curva
Biomarcadores/análise
Feminino
Feto
Idade Gestacional
Seres Humanos
Valor Preditivo dos Testes
Gravidez
Nascimento Prematuro/etnologia
Estudos Prospectivos
Curva ROC
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Nm] Nome de substância:
0 (Biomarkers); 0 (Fibronectins)
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170821
[Lr] Data última revisão:
170821
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170315
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.1373


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[PMID]:28178045
[Au] Autor:Boelig RC; Feltovich H; Spitz JL; Toland G; Berghella V; Iams JD
[Ad] Endereço:Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Sydney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; the Division of Maternal-Fetal Medicine, Obstetrics & Gynecology, Intermountain Healthcare, Utah Valley Hospital, Provo, Utah; the Perinatal Quality Foundation, Oklahoma City, Oklahoma; and the Ohio Perinatal Quality Collaborative, Columbus, Ohio.
[Ti] Título:Assessment of Transvaginal Ultrasound Cervical Length Image Quality.
[So] Source:Obstet Gynecol;129(3):536-541, 2017 Mar.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To use data from the Cervical Length Education and Review program to evaluate the quality of transvaginal cervical length ultrasonography by trained imagers (ie, ultrasonographers, radiologists, perinatologists). METHODS: This is a retrospective observational study of data from the Cervical Length Education and Review program. Candidates underwent an online lecture series, examination, and submitted a batch of images for review. For a candidate's batch of images to pass, all images must meet at least seven of the nine criteria assessed, the overall batch score needs to be 80% or greater, correct caliper placement must be met for all images, and the same criterion cannot be consistently missed. We also examined a subset of these criteria-appropriate image acquisitions, defined as an image that demonstrated both internal and external os and visualization of the entire endocervical canal. Primary outcome was the overall initial candidate pass rate; secondary outcomes included distribution of criteria missed in images and percentage of images that was inadequately acquired. RESULTS: Six hundred eighty-seven candidates submitted 3,748 images between June 10, 2012, and August 18, 2016. Eighty-five percent of candidates were ultrasonographers. Of the 687 initial batches submitted, 105 (15%) did not pass. Eight hundred thirty-seven images (22%) of all images failed at least one criterion; the most common image deficiencies were in "anterior width of cervix equals the posterior width" (33%), "failure to visualize" the internal or external os (29%), "cervix occupies 75% of image and bladder area visible" (33%), and incorrect caliper placement (24%). Two hundred fifty-six (7%) of all images failed to meet our criteria for adequate image acquisition. CONCLUSION: Fifteen percent of trained imagers failed to obtain appropriate cervical length imaging. This highlights the importance of a standardized cervical length training and certification program.
[Mh] Termos MeSH primário: Medida do Comprimento Cervical/normas
Colo do Útero/anatomia & histologia
Colo do Útero/diagnóstico por imagem
Endossonografia/normas
Pessoal de Saúde/normas
[Mh] Termos MeSH secundário: Medida do Comprimento Cervical/métodos
Competência Clínica
Feminino
Pessoal de Saúde/educação
Seres Humanos
Tamanho do Órgão
Gravidez
Estudos Retrospectivos
Vagina
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170616
[Lr] Data última revisão:
170616
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170209
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000001820



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