Objective Parity is one of several parameters used to customise fetal growth norms. However, it is uncertain whether the lower birthweight of babies born to primiparous women reflects physiological or pathological variation. Our aim was to assess the impact of adjusting for parity in identification of small‐for‐gestational‐age (SGA) births.
Design Comparison of two customised definitions of SGA with and without parity.
Setting Routinely collected data in five tertiary maternity hospitals in France.
Population A total of 51 126 singleton births without malformations from 1997 to 2002.
Methods Characteristics of mothers and babies and adverse pregnancy outcomes for SGA and non‐SGA births were compared using customised definitions with and without parity.
Main outcome measures Neonatal morbidity and mortality.
Results SGA births among primiparas increased from 14.9 to 18.0% when parity was excluded. Overall rates of SGA rose from 14.4 to 15.0%. Newly defined cases of SGA were babies of primiparas. They had higher rates of admission to a neonatal unit and caesarean section than babies reclassified as non‐SGA. Perinatal mortality was 9.1‰ (parity included) and 9.7‰ (parity excluded) and did not differ significantly from babies classified as non‐SGA by both standards (5.4‰).
Conclusions Adjustment for parity markedly decreased the proportion of primiparas diagnosed with SGA babies but did not appear to improve the identification of high‐risk babies. Removing parity would simplify the customised definition of SGA and would eliminate the need for the assumption that lower birthweight for primiparous women is normal.
Objectives: To relate preoperative cervical length, operative findings, postoperative cervical length and pregnancy outcome in high risk women treated with ultrasound indicated cervical cerclage to establish if it was possible to determine the most appropriate criteria to offer cervical cerclage. Study design: A prospective observational study of 305 high risk women undergoing serial transvaginal ultrasonographic assessment of cervical length during the second trimester. Fifty-four women met criteria for cerclage (cervical length <15 mm, significant progressive shortening to <25 mm or funneling >50%). Data concerning preoperative cervical length, operative findings, postoperative cervical length and pregnancy outcome was collected, and analyzed data is expressed as median values. Statistical analysis was performed using Fisher's exact and Mann-Whitney U-tests. Results: Gestation at delivery was 37 AE 5 weeks, suture insertion to delivery interval was 115 days and overall fetal survival rate was 85.2%. Median preoperative cervical length was 15.0 mm. Median gestation at suture insertion was 19 AE 5 weeks. There was a significant increase in postoperative cervical length 15.0 vs. 25.0 mm (P < 0.0001). Fetal membranes were visible in 19% of cases at the time of surgery, this occurred in 75, 5, and 0% cases with a cervical length <10, 11-15 and >15 mm, respectively. Overall outcome was considerably worse for those cases with visible membranes at the time of surgery than for those with no visible membranes (gestation at delivery 23 AE 0 vs. 38 AE 2 weeks (P ¼ 0.002), suture insertion to delivery interval 17 vs. 122 days (P < 0.0001), fetal survival rates 50 vs. 93% (P ¼ 0.0005)). This finding was regardless of preoperative cervical length (of all women with preoperative cervical length <15 mm (n ¼ 31) gestation at delivery 25 AE 1 vs. 35 AE 5 (P ¼ 0.008), suture insertion to delivery interval 17 vs. 119 days (P ¼ 0.0005), fetal survival rate 50 vs. 90%). Conclusions: In a high risk population undergoing serial transvaginal ultrasound surveillance of cervical length, regardless of preoperative cervical length, the presence of visible membranes at the time of suture insertion is associated with a poor outcome. Fetal membranes were not visible in any case with a preoperative cervical length >15 mm. These findings support a concept of cervical cerclage at a cervical length of 15 mm.
CEO-02The prediction of spontaneous preterm birth in women with threatened preterm labor using transvaginal ultrasound of the cervixPurpose: This study was to determine if cervical parameters, as assessed by transvaginal ultrasound, were predictive of spontaneous preterm birth in women following an episode of threatened preterm labor (TPL). Methods: Women with a singleton pregnancy (20-34 weeks gestation) and intact membranes were enrolled following admission for TPL. The transvaginal ultrasound assessment of the cervix was performed when uterine activity had ceased. Only the ultrasound relating to the episode of suspected preterm labor is re...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.