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Vincenzo Berghella - One of the best experts on this subject based on the ideXlab platform.

  • Gestational age at Cervical Length Measurement and incidence of preterm birth.
    Obstetrics and gynecology, 2020
    Co-Authors: Vincenzo Berghella, Amanda Roman, Constantine Daskalakis, Amen Ness, Jason K Baxter
    Abstract:

    To estimate the risk of spontaneous preterm birth based on transvaginal ultrasound Cervical Length and gestational age at which Cervical Length was measured. Women at high risk for spontaneous preterm birth and with transvaginal ultrasound Cervical Length Measurements between weeks 12 and 32 were identified at one institution between July 1995 and June 2005. Inclusion criteria for women at high risk for spontaneous preterm birth were prior spontaneous preterm birth at 14 to 35 weeks, cone biopsy, müllerian anomaly, or two or more dilation and evacuations. Women with multiple gestations, cerclage, indicated preterm birth, or fetal anomalies were excluded. Logistic regression was used to estimate the spontaneous preterm birth risk before 35, 32, and 28 weeks. Seven hundred five women received 2,601 transvaginal ultrasound Measurements for Cervical Length. The incidences of spontaneous preterm birth before 35, 32, and 28 weeks were 17.7, 10.6, and 6.7%, respectively. The risk of spontaneous preterm birth before 35 weeks decreased by approximately 6% for each additional millimeter of Cervical Length (odds ratio 0.94, 95% confidence interval, 0.92-0.95, P=.001) and by approximately 5% for each additional week of pregnancy at which the Cervical Length was measured (odds ratio 0.95, 95% confidence interval 0.92-0.98, P=.004). Similar results were obtained for spontaneous preterm birth before 32 and 28 weeks. Gestational age at which transvaginal ultrasound Cervical Length is measured significantly affects the calculation of risk of spontaneous preterm birth. The spontaneous preterm birth risk increases as the Length of the cervix declines and as the gestational age decreases. These spontaneous preterm birth risks are important for counseling and management for women with various degrees of short Cervical Length at different gestational ages. II.

  • using Cervical Length Measurement for lower spontaneous preterm birth rates among women with threatened preterm labor
    Obstetrics & Gynecology, 2018
    Co-Authors: Giuseppe Chiossi, George R Saade, Baha M Sibai, Vincenzo Berghella
    Abstract:

    Spontaneous preterm birth is a leading cause of perinatal morbidity and mortality; however, accurate identification of women who will deliver prematurely after the onset of uterine contractions is still challenging, because less than 10% actually give birth within 7 days of presentation. Risk strati

  • gestational age at Cervical Length Measurement and incidence of preterm birth
    Obstetrics & Gynecology, 2007
    Co-Authors: Vincenzo Berghella, Amanda Roman, Constantine Daskalakis, Amen Ness, Jason K Baxter
    Abstract:

    OBJECTIVE:To estimate the risk of spontaneous preterm birth based on transvaginal ultrasound Cervical Length and gestational age at which Cervical Length was measured.METHODS:Women at high risk for spontaneous preterm birth and with transvaginal ultrasound Cervical Length Measurements between weeks

F Goffinet - One of the best experts on this subject based on the ideXlab platform.

  • selective use of sonographic Cervical Length Measurement for predicting imminent preterm delivery in women with preterm labor and intact membranes
    Ultrasound in Obstetrics & Gynecology, 2008
    Co-Authors: Thomas Schmitz, Gilles Kayem, F Maillard, M T Lebret, D Cabrol, F Goffinet
    Abstract:

    Objectives To determine, in a population of women with preterm labor and intact membranes, whether ultrasound Cervical Length Measurement performed only in patients selected according to the Bishop score predicts imminent preterm delivery better than does systematic Cervical Length Measurement in the entire population. Methods The Bishop score and sonographic Cervical Length were recorded prospectively in women with preterm labor between 24 and 34 completed weeks' gestation. Outcome measures were preterm delivery within 48 h and within 7 days. Predictive values were calculated for each marker separately and then in combination. Results Of the study population of 395 women, 17 (4.3%) and 32 (8.1%) delivered within 48 h and within 7 days, respectively, following inclusion. For delivery within 7 days, areas under the Bishop score (0.848) and sonographic Cervical Length (0.813) receiver–operating characteristics curves did not differ significantly. For the selective use of sonographic Cervical Length Measurement in patients selected according to the Bishop score, the test was considered positive if the Bishop score was ≥ 8, or 4–7 with Cervical Length ≤ 30 mm. This test was as sensitive (94%) but more specific (60% vs. 42%, P < 0.001) for predicting preterm birth within 7 days than was sonographic Cervical Length with a 30-mm cut-off value in the entire population. Results were similar for delivery within 48 h. Conclusion For predicting imminent preterm delivery in women with preterm labor, measuring sonographic Cervical Length only in patients with a Bishop score between 4 and 7, compared with a strategy of systematic Measurement in the entire population, reduces by 30% the number of false positives and might thus decrease unnecessary therapeutic intervention. Copyright © 2008 ISUOG. Published by John Wiley & Sons, Ltd.

  • selective use of fetal fibronectin detection after Cervical Length Measurement to predict spontaneous preterm delivery in women with preterm labor
    American Journal of Obstetrics and Gynecology, 2006
    Co-Authors: Thomas Schmitz, Gilles Kayem, F Maillard, D Cabrol, Sandrine Bessardbacquaert, Y Fulla, F Goffinet
    Abstract:

    Objective The purpose of this study was to determine whether selective use of fetal fibronectin detection after ultrasound Measurement of Cervical Length predicts preterm delivery in symptomatic patients better than either indicator alone. Study design This prospective blinded study performed both tests on 359 women hospitalized for preterm labor between 18 and 34 completed weeks' gestation. The primary outcome was preterm delivery before 35 weeks'gestation. Results Among the 359 women included, 48 (13.4%) delivered before 35 weeks' gestation. The sensitivity, specificity, and positive and negative predictive values of Cervical Length ≤25 mm were 75%, 63%, 24%, and 94%, respectively, and of fetal fibronectin ≥50 ng/mL, 63%, 81%, 33%, and 93%. Fetal fibronectin detection was significantly ( P Conclusion Selective use of fetal fibronectin detection after Cervical Length Measurement is more specific than Cervical Length and as effective as fetal fibronectin assays in the entire population of women in preterm labor for predicting preterm birth.

G H A Visser - One of the best experts on this subject based on the ideXlab platform.

  • transperineal versus transvaginal sonographic Cervical Length Measurement in second and third trimester pregnancies
    Ultrasound in Obstetrics & Gynecology, 2008
    Co-Authors: M Meijerhoogeveen, P Stoutenbeek, G H A Visser
    Abstract:

    Objective To investigate the reliability of, and patient satisfaction with, transperineal Cervical Length Measurement during the third trimester of pregnancy and to compare these with Measurement during the mid-trimester, using transvaginal sonographic imaging of the cervix as a reference. Methods Women attending an outpatient clinic for Cervical Length Measurement before 29 weeks or after 35 weeks of gestation were examined by transvaginal and transperineal ultrasound and the results compared. Preference for either method was indicated by both sonographers and patients. Results Seventy-one patients participated in the study, 23 in the second and 48 in the third trimester of pregnancy. There was failure to obtain a clear image on transperineal ultrasound in 30% of mid-trimester pregnancies, and in 19% of third-trimester cases. Elevation of the patient's hips improved the image in five out of 10 women in whom the scan was repeated following a postural change. Transvaginal Cervical Length Measurements could be obtained in all cases. There was a strong correlation between transvaginal and transperineal measured Cervical Length (Pearson's correlation coefficient = 0.85). Sonographers preferred transvaginal images of the cervix irrespective of whether they were obtained in the second or third trimester. Transperineal ultrasound was judged as not or mildly painful by most women, but transvaginal ultrasound was preferred. Conclusions Transvaginal ultrasound is the least painful, most feasible, and probably most accurate method with which to measure Cervical Length in the third trimester of pregnancy. Transperineal ultrasound is a feasible alternative, although its application in clinical practice is restricted by the need for an experienced sonographer. Copyright © 2008 ISUOG. Published by John Wiley & Sons, Ltd.

  • Transperineal versus transvaginal sonographic Cervical Length Measurement in second‐ and third‐trimester pregnancies
    Ultrasound in Obstetrics & Gynecology, 2008
    Co-Authors: M. Meijer-hoogeveen, P Stoutenbeek, G H A Visser
    Abstract:

    Objective To investigate the reliability of, and patient satisfaction with, transperineal Cervical Length Measurement during the third trimester of pregnancy and to compare these with Measurement during the mid-trimester, using transvaginal sonographic imaging of the cervix as a reference. Methods Women attending an outpatient clinic for Cervical Length Measurement before 29 weeks or after 35 weeks of gestation were examined by transvaginal and transperineal ultrasound and the results compared. Preference for either method was indicated by both sonographers and patients. Results Seventy-one patients participated in the study, 23 in the second and 48 in the third trimester of pregnancy. There was failure to obtain a clear image on transperineal ultrasound in 30% of mid-trimester pregnancies, and in 19% of third-trimester cases. Elevation of the patient's hips improved the image in five out of 10 women in whom the scan was repeated following a postural change. Transvaginal Cervical Length Measurements could be obtained in all cases. There was a strong correlation between transvaginal and transperineal measured Cervical Length (Pearson's correlation coefficient = 0.85). Sonographers preferred transvaginal images of the cervix irrespective of whether they were obtained in the second or third trimester. Transperineal ultrasound was judged as not or mildly painful by most women, but transvaginal ultrasound was preferred. Conclusions Transvaginal ultrasound is the least painful, most feasible, and probably most accurate method with which to measure Cervical Length in the third trimester of pregnancy. Transperineal ultrasound is a feasible alternative, although its application in clinical practice is restricted by the need for an experienced sonographer. Copyright © 2008 ISUOG. Published by John Wiley & Sons, Ltd.

Brent C Opmeer - One of the best experts on this subject based on the ideXlab platform.

  • cost effectiveness analysis of Cervical Length Measurement and fibronectin testing in women with threatened preterm labor
    American Journal of Obstetrics and Gynecology, 2013
    Co-Authors: Gert Jan Van Baaren, William A Grobman, Patrick M M Bossuyt, Brent C Opmeer
    Abstract:

    Objective The objective of the study was to evaluate the cost-effectiveness of risk stratification with Cervical Length (CL) Measurement and/or fetal fibronectin (fFN) tests in women with threatened preterm labor between 24 and 34 weeks' gestation. Study Design We performed a model-based cost-effectiveness analysis to evaluate 7 test-treatment strategies in women with threatened preterm labor from a health care system perspective. Estimates on disease prevalence, costs, and test accuracy were based on medical literature. Results We found that additional fFN testing in the case of a CL between 10 and 30 mm is cost saving without compromising neonatal health outcomes, compared with a treat-all strategy or single CL testing. Implementing this strategy could lead to an annual cost saving between €2.8 million and €14.4 million in The Netherlands, a country with about 180,000 deliveries annually. Conclusion In women with threatened preterm labor between 24 and 34 weeks of gestation, the most cost-effective test strategy uses a combination of CL and fFN testing.

  • Cervical Length Measurement for the prediction of preterm birth in symptomatic women with a twin pregnancy a systematic review and meta analysis
    Obstetrics and Gynecology International, 2013
    Co-Authors: Sophie Liem, L Van De Mheen, Dick J Bekedam, M G Van Pampus, Brent C Opmeer
    Abstract:

    Objective. The aim of this study was to assess whether Cervical Length Measurement (CL) could predict preterm birth (PTB) in symptomatic women with a twin pregnancy. Methods. We searched MEDLINE and EMBASE to identify studies investigating the accuracy of CL Measurement in predicting PTB in symptomatic women with a twin pregnancy. We extracted data to construct two-by-two tables and used bivariate meta-analysis to generate point estimates of sensitivity and specificity. Results. Five studies () were included. Variation in definition of PTB and cut-off points for CL was strong. One study investigated delivery within seven days, demonstrating a sensitivity of 1.0 (95% CI: 0.83–1.0) and a specificity of 0.31 (95% CI 0.2–0.43) for a CL cutoff at 25 mm. Three studies reported on predicting PTB < 37 weeks at a CL cutoff of 30 mm, with sROC point estimates of 0.76 (95% CI: 0.66 to 0.84) and 0.37 (95% CI: 0.21 to 0.56) for sensitivity and specificity, respectively. For preterm birth <34 weeks, no pooled estimates could be estimated since only 2 studies with large heterogeneity were identified. Conclusions. There is limited evidence on the accuracy of Cervical Length Measurement testing the prediction of preterm birth in symptomatic women with a twin pregnancy, especially on the most important outcome, that is, delivery within 7 days.

  • Cervical Length Measurement for the prediction of preterm birth in symptomatic women with a twin pregnancy: a systematic review and meta-analysis
    Obstetrics and Gynecology International, 2013
    Co-Authors: Sophie Liem, L Van De Mheen, Dick J Bekedam, M G Van Pampus, Brent C Opmeer
    Abstract:

    Objective. The aim of this study was to assess whether Cervical Length Measurement (CL) could predict preterm birth (PTB) in symptomatic women with a twin pregnancy. Methods. We searched MEDLINE and EMBASE to identify studies investigating the accuracy of CL Measurement in predicting PTB in symptomatic women with a twin pregnancy. We extracted data to construct two-by-two tables and used bivariate meta-analysis to generate point estimates of sensitivity and specificity. Results. Five studies () were included. Variation in definition of PTB and cut-off points for CL was strong. One study investigated delivery within seven days, demonstrating a sensitivity of 1.0 (95% CI: 0.83–1.0) and a specificity of 0.31 (95% CI 0.2–0.43) for a CL cutoff at 25 mm. Three studies reported on predicting PTB < 37 weeks at a CL cutoff of 30 mm, with sROC point estimates of 0.76 (95% CI: 0.66 to 0.84) and 0.37 (95% CI: 0.21 to 0.56) for sensitivity and specificity, respectively. For preterm birth

  • Cervical Length Measurement for the prediction of preterm birth in multiple pregnancies a systematic review and bivariate meta analysis
    Obstetrical & Gynecological Survey, 2011
    Co-Authors: Maud A Hegeman, Brent C Opmeer, M Huis In A T Veld, Hein W Bruinse
    Abstract:

    Transvaginal sonography of the cervix can identify pregnancies at increased risk for preterm birth in both symptomatic and asymptomatic pregnant women. A previous randomized controlled trial has shown that vaginal progesterone is effective in preventing preterm birth in singleton women with asymptomatic Cervical shortening during the second trimester. Randomized trials in women with multiple pregnancies have failed to show a significant reduction in preterm birth after treatment with progesterone. Overdistention of the cervix in previous pregnancies may limit the predictive value of Cervical Length Measurement during the second trimester for preterm birth in multiple pregnancies. The aim of this meta-analysis was to review the predictive value of Cervical Length assessment for preterm birth in asymptomatic women with multiple pregnancies. The investigators conducted electronic searches of MEDLINE and Embase for published articles to 2009 as well as searches of reference lists of relevant articles not found with the electronic search. Two-by-two tables cross-classifying Cervical Length and gestational age were constructed from articles to score extracted descriptive data and study characteristics. The meta-analysis used a bivariate regression model analysis to construct summary receiver-operating characteristic (ROC) curves estimating sensitivity and specificity for changes in Cervical Length. A total of 21 studies involving 2757 women were identified Although there was a large variation in the gestational age, cutoff points of Cervical Length, and the exact definition of preterm birth, summary ROC curve estimates indicated that progressive shortening of Cervical Length was a good predictor of preterm birth before 34 weeks of gestation. ROC summary estimates showed sensitivity and specificity of 78% and 66%, respectively, at a Cervical Length of 35 mm, 41% and 87% at 30 mm, 36% and 94% at 25 mm, and 30% and 94% at 20 mm. These findings show that assessment of second-trimester Cervical Length in women with multiple pregnancies is a strong predictor of preterm birth.

  • Additional effects of the Cervical Length Measurement in women with preterm contractions: a systematic review
    Archives of Gynecology and Obstetrics, 2011
    Co-Authors: Rosanna A Kuin, William A Grobman, Patrick M M Bossuyt, Brent C Opmeer
    Abstract:

    Purpose Transvaginal Cervical Length Measurement in women with symptoms of preterm labor has been used to decide if treatment is necessary. Cervical Length Measurement may also have additional effects on patients, such as providing reassurance, although the evidence to support this is unclear. We explored and summarized to what extent additional effects of Cervical Length Measurement in women with threatened preterm labor have been reported in the clinical literature and what the magnitude of these effects was. Methods We performed a systematic review of the literature to identify articles reporting on Cervical Length Measurements in women with symptoms of preterm labor. We assessed whether these articles reported patient outcomes other than preterm delivery. Results The electronic and hand search resulted in 764 articles, of which 172 met initial criteria for further eligibility assessment. We found 12 articles that reported additional effects of Cervical Length Measurement in symptomatic women, such as the reassurance or the sensory consequences related to the transvaginal procedure. None of the articles quantified such additional effects. Conclusions There appears to be a gap between the presumed effects of Cervical Length Measurement on patient outcomes, such as patients’ reassurance, and the actual assessment of these effects during test evaluations. We suggest that future evaluations of prognostic preterm labor tests include a comprehensive assessment of patient outcomes.

Jason K Baxter - One of the best experts on this subject based on the ideXlab platform.

  • Gestational age at Cervical Length Measurement and incidence of preterm birth.
    Obstetrics and gynecology, 2020
    Co-Authors: Vincenzo Berghella, Amanda Roman, Constantine Daskalakis, Amen Ness, Jason K Baxter
    Abstract:

    To estimate the risk of spontaneous preterm birth based on transvaginal ultrasound Cervical Length and gestational age at which Cervical Length was measured. Women at high risk for spontaneous preterm birth and with transvaginal ultrasound Cervical Length Measurements between weeks 12 and 32 were identified at one institution between July 1995 and June 2005. Inclusion criteria for women at high risk for spontaneous preterm birth were prior spontaneous preterm birth at 14 to 35 weeks, cone biopsy, müllerian anomaly, or two or more dilation and evacuations. Women with multiple gestations, cerclage, indicated preterm birth, or fetal anomalies were excluded. Logistic regression was used to estimate the spontaneous preterm birth risk before 35, 32, and 28 weeks. Seven hundred five women received 2,601 transvaginal ultrasound Measurements for Cervical Length. The incidences of spontaneous preterm birth before 35, 32, and 28 weeks were 17.7, 10.6, and 6.7%, respectively. The risk of spontaneous preterm birth before 35 weeks decreased by approximately 6% for each additional millimeter of Cervical Length (odds ratio 0.94, 95% confidence interval, 0.92-0.95, P=.001) and by approximately 5% for each additional week of pregnancy at which the Cervical Length was measured (odds ratio 0.95, 95% confidence interval 0.92-0.98, P=.004). Similar results were obtained for spontaneous preterm birth before 32 and 28 weeks. Gestational age at which transvaginal ultrasound Cervical Length is measured significantly affects the calculation of risk of spontaneous preterm birth. The spontaneous preterm birth risk increases as the Length of the cervix declines and as the gestational age decreases. These spontaneous preterm birth risks are important for counseling and management for women with various degrees of short Cervical Length at different gestational ages. II.

  • gestational age at Cervical Length Measurement and incidence of preterm birth
    Obstetrics & Gynecology, 2007
    Co-Authors: Vincenzo Berghella, Amanda Roman, Constantine Daskalakis, Amen Ness, Jason K Baxter
    Abstract:

    OBJECTIVE:To estimate the risk of spontaneous preterm birth based on transvaginal ultrasound Cervical Length and gestational age at which Cervical Length was measured.METHODS:Women at high risk for spontaneous preterm birth and with transvaginal ultrasound Cervical Length Measurements between weeks