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Factors Associated with Spontaneous Preterm Birth after Ultrasound-Indicated Cerclage.

ABSTRACT: Ultrasound-indicated cerclage (UIC) is recommended to prevent spontaneous preterm birth (sPTB) in women with a short cervix at mid-trimester and a history of PTB. We assessed the factors related to sPTB after UIC and determined the corresponding risks. This retrospective cohort study was conducted at a university hospital. UIC was performed between 15 and 26 weeks of gestation in women with a cervical length of <2.5 cm. Univariate and multivariate analyses were used to examine factors associated with sPTB after UIC. An earlier gestational age and shorter cervical length at UIC were associated with sPTB after UIC. While PTB history was not associated with an increased risk of sPTB, it did increase the risk of repeat cerclage after UIC. Higher levels of preoperative serum inflammatory markers and obesity significantly increased the risk of sPTB after UIC. These findings provide helpful guidance for patient counseling and management in predicting the delivery timing after UIC in women with a short cervix in the mid-trimester.

SUBMITTER: Lee KN

PROVIDER: S-EPMC10744759 | biostudies-literature | 2023 Dec

REPOSITORIES: biostudies-literature

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Factors Associated with Spontaneous Preterm Birth after Ultrasound-Indicated Cerclage.

Lee Kyong-No KN Yun Sangho S Park So-Yoon SY Kim Kyoungseon K Lee Keun-Young KY Lee Jae Jun JJ Son Ga-Hyun GH

Journal of personalized medicine 20231201 12

Ultrasound-indicated cerclage (UIC) is recommended to prevent spontaneous preterm birth (sPTB) in women with a short cervix at mid-trimester and a history of PTB. We assessed the factors related to sPTB after UIC and determined the corresponding risks. This retrospective cohort study was conducted at a university hospital. UIC was performed between 15 and 26 weeks of gestation in women with a cervical length of <2.5 cm. Univariate and multivariate analyses were used to examine factors associated ...[more]

PMID: 38138905

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Project description:BackgroundPreterm birth (PTB) is the leading cause of infant mortality. Risk for PTB is influenced by multiple biological pathways, many of which are poorly understood. Some PTBs result from medically indicated labor following complications from hypertension and/or diabetes, while many others are spontaneous with unknown causes. Previously, investigation of potential risk factors has been limited by a lack of data on maternal medical history and the difficulty of classifying PTBs as indicated or spontaneous. Here, we leverage electronic health record (EHR) data (patient health information including demographics, diagnoses, and medications) and a supplemental curated pregnancy database to overcome these limitations. Novel associations may provide new insight into the pathophysiology of PTB as well as help identify individuals who would be at risk of PTB.MethodsWe quantified associations between maternal diagnoses and preterm birth both with and without controlling for maternal age and socioeconomic factors within a University of California, San Francisco (UCSF), EHR cohort with 10,643 births (nterm = 9692, nspontaneous_preterm = 449, nindicated_preterm = 418) and maternal pre-conception diagnoses derived from International Classification of Diseases (ICD) 9 and 10 codes.ResultsThirty diagnoses significantly and robustly (False Discovery Rate (FDR) < 0.05) associated with indicated PTBs compared to term. We discovered known (hypertension, diabetes, and chronic kidney disease) and less established (blood, cardiac, gynecological, and liver diagnoses) associations. Essential hypertension had the most significant association with indicated PTB (adjusted pBH = 4 × 10-20, adjusted OR = 6 (95% CI 4-8)), and the odds ratios for the significant diagnoses ranged from 2 to 23. The results for indicated PTB largely recapitulated the diagnosis associations with all PTBs. However, no diagnosis significantly associated with spontaneous PTB.ConclusionsOur study underscores the limitations of approaches that combine indicated and spontaneous births. When combined, significant associations were almost entirely driven by indicated PTBs, although the spontaneous and indicated groups were of a similar size. Investigating the spontaneous population has the potential to reveal new pathways and understanding of the heterogeneity of PTB.

Project description:ObjectiveTo assess a continuum of cervical length (CL) cut-offs for the efficacy of ultrasound-indicated cerclage in women with previous spontaneous preterm birth (PTB).MethodsThis was a planned secondary analysis of a multicenter randomized clinical trial of ultrasound-indicated cerclage for the prevention of PTB in high-risk women. The efficacy of cerclage for preventing recurrent PTB < 35, < 32 and < 24 weeks' gestation was assessed using multivariable logistic regression analysis. Odds ratios (ORs) and CIs were estimated for a range of CL cut-offs using bootstrap regression. The 2.5(th) and 97.5(th) percentiles of bootstrapped ORs determined the CIs. Results were illustrated using smoothed curves superimposed on estimated ORs by CL cut-off.ResultsOf 301 women with a CL < 25 mm, 142 underwent ultrasound-indicated cerclage and 159 did not have cerclage placement. The few cases with CL < 10 mm limited the evaluation to CL cut-offs between < 10 mm and < 25 mm. For PTB < 35 weeks, ORs in women with a cerclage and CL < 25 mm were statistically significantly lower than in those without cerclage, and efficacy was maintained at smaller CL cut-offs. Results were similar for PTB < 32 weeks. For PTB < 24 weeks, results differed, with ORs increasing toward unity (no benefit), with wide CIs, for CL cut-offs between < 10 mm and < 15 mm, attributed to the small number of births < 24 weeks.ConclusionsThe efficacy of ultrasound-indicated cerclage in women with previous spontaneous PTB varies by action point CL cut-off and by PTB gestational age of interest. Cerclage significantly reduces the risk of PTB < 35 and < 32 weeks, at CL cut-offs between < 10 mm and < 25 mm, with the greatest reduction at shorter CL, affirming that women with prior spontaneous PTB and a short CL are appropriate candidates for ultrasound-indicated cerclage. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Project description:The effect of an exam-indicated cerclage (EIC) remains uncertain due to limited evidence from reviews covering pregnancies beyond this timeframe. With the 24-week mark serving as an international threshold for neonatal care initiation, the aim of this systematic review was to evaluate the available literature on the effectiveness of an EIC before 24 weeks of gestation. MEDLINE, EMBASE, Web of Science, CENTRAL, clinicaltrials.gov and WHO-ICTRP were searched for randomized controlled trials, cohort and case-control studies comparing EIC with expectant management in singleton pregnancies with cervical dilation ≤ 5 cm between 14 and 24 weeks of gestation to prevent preterm birth (PTB) < 37 weeks of gestation. Secondary outcomes included obstetrical and neonatal outcomes. Quality assessment was preformed using Newcastle-Ottawa Scale. Analyses were conducted using R(studio) version 3.6.1. and outcomes stated as odds ratios (OR) with 95 % confidence intervals (CI). Prospero: #CRD42019137400. The search yielded 787 potential studies. Four studies non-randomized (retrospective) could be included. Quality assessment showed overall good quality. The main weaknesses were retrospective designs, small sample sizes and the poor comparability of the intervention and control groups. The study population resulted in 215 women, among whom 163 (76 %) underwent cerclage placement and 52 (24 %) were expectantly managed. EIC compared with expectant management was associated with significant lower rates of PTB before 37 weeks (71.2 % vs 94.2 %; OR 0.11; 95 % CI 0.03-0.35), 34 weeks (49.1 % vs 86.5 %; OR 0.10; 95 % CI 0.03-0.31), 32 weeks (43.0 % vs 80.0 %; OR 0.13; 95 % CI 0.04-0.43), 28 weeks (43.0 % vs 75.0 %; OR 0.19; 95 % CI 0.07-0.51) and 24 weeks (23.3 % vs 50 %; OR 0.29; 95 % CI 0.13-0.65) of gestation, significant prolongation of the pregnancy (mean difference 39.14 days; 95 %CI 30.58-47.71; p-value <0.0001) and a greater gestational age at delivery (mean difference 4.91 weeks; 95 % CI 2.32-7.49; p-value 0.0002) compared to expectant management. The current literature suggests that EIC before 24 weeks of gestation is associated with improved pregnancy outcomes compared to expectant management. The results are limited by the lack of randomised trials and studied neonatal outcomes plus the potential for bias in the included studies.

Project description:ObjectiveTo estimate whether ultrasound measurement of the fetal adrenal gland remote from delivery in asymptomatic women can accurately predict spontaneous preterm birth.MethodsWe conducted a prospective multicenter observational nested cohort study of asymptomatic nulliparous women with a singleton pregnancy to study adverse pregnancy outcomes. Between 22 0/7 and 30 6/7 weeks of gestation, credentialed ultrasonographers measured the width (width), length (length), and, when able, depth (depth) of the "fetal zone" of the fetal adrenal gland as well as the width (Width), length (Length), and depth (Depth) of the total gland. We used the ratios of each measurement (width/Width, length/Length, and depth/Depth) to control for variation in adrenal size by gestational age. The accuracy of each ratio measurement in predicting spontaneous preterm birth at less than 37 0/7 weeks of gestation and spontaneous preterm birth at less than 34 0/7 weeks of gestation was assessed by receiver operating characteristic curves using area under the curve.ResultsPregnancy outcomes were available for 1,697 women with one or more fetal adrenal gland measurements. Spontaneous preterm birth at less than 37 0/7 weeks of gestation and spontaneous preterm birth at less than 34 0/7 weeks of gestation occurred in 82 (4.8%) and six women (0.4%), respectively. None of the fetal adrenal gland measurements distinguished spontaneous preterm birth from term birth. The areas under the curve (95% confidence intervals) for spontaneous preterm birth at less than 37 0/7 weeks of gestation were 0.51 (0.45-0.58), 0.50 (0.44-0.56), and 0.52 (0.41-0.63) for width/Width, length/Length, and depth/Depth ratios, respectively. The areas under the curve for spontaneous preterm birth at less than 34 0/7 weeks of gestation were 0.52 (0.25-0.79) and 0.55 (0.31-0.79) for width/Width and length/Length ratios, respectively. Additionally, none of the means of the gland measurements were statistically different between those delivering at term and spontaneous at preterm (P>.05).ConclusionFetal adrenal size, as measured by ultrasonography between 22 0/7 and 30 6/7 weeks of gestation, is not predictive of spontaneous preterm birth in asymptomatic nulliparous women.

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Factors Associated with Spontaneous Preterm Birth after Ultrasound-Indicated Cerclage.

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Factors Associated with Spontaneous Preterm Birth after Ultrasound-Indicated Cerclage.

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