Screening by maternal factors and biomarkers at 11-13 weeks' gestation can identify a high proportion of pregnancies that develop early and preterm PE. © 2018 Crown copyright. Ultrasound in Obstetrics & Gynecology © 2018 ISUOG.

Objective To test the hypothesis that the performance of first-trimester screening for pre-eclampsia (PE) by a method that uses Bayes' theorem to combine maternal factors with biomarkers is superior to that defined by current National Institute for Health and Care Excellence (NICE) guidelines.Methods This was a prospective multicenter study (screening program for pre-eclampsia (SPREE)

National Institute for Health Research and Medical Research Council.

Objective To define the potential value of endocervical length at 11 to 13 weeks' gestation in the prediction of spontaneous early delivery. MethodThe lengths of the endocervix and cervico-isthmic complex were measured by transvaginal ultrasound at 11 to 13 weeks in singleton pregnancies, including 1492 that subsequently delivered after 34 weeks and 16 (1.1%) who had spontaneous delivery before 34 weeks. In 1320 of the cases, the measurements were repeated at 20 to 24 weeks.Results There were significant associations in the length of the endocervix and cervico-isthmic complex between 11 to 13 and 20 to 24 weeks (r = 0.548, p < 0.0001 and r = 0.194, p < 0.0001), and the respective median lengths were 32.4 and 32.2 mm for the endocervix and 45.3 and 40.4 mm for the cervico-isthmic complex. At 11 to 13 weeks in the early delivery group, compared to unaffected pregnancies, the median endocervical length was shorter (27.5 vs 32.5 mm, p < 0.0001), but there was no significant difference in the length of the cervico-isthmic complex (41.4 vs 45.4 mm, p = 0.054). ConclusionIn the measurement of cervical length, the endocervix should be distinguished from the isthmus. The endocervical length at 11 to 13 weeks is shorter in pregnancies resulting in spontaneous delivery before 34 weeks than in those delivering after 34 weeks.

First-trimester screening for PE by the combined test identifies a high proportion of cases of preterm SGA that can be prevented by the prophylactic use of aspirin. © 2018 Crown copyright. Ultrasound in Obstetrics & Gynecology © 2018 ISUOG.

Objective: It was the aim of this study to examine the potential value of cervical length at 11–13 weeks’ gestation in the prediction of spontaneous preterm delivery. Methods: This was a screening study for spontaneous preterm delivery in singleton pregnancies from cervical length measured by transvaginal ultrasound at 11–13 weeks’ gestation. The performance of screening for preterm delivery by cervical length alone and with maternal characteristics was estimated. Results: In the 9,974 pregnancies included in the study, spontaneous delivery before 34 weeks occurred in 104 (1.0%) cases. Multivariate regression analysis in the term delivery group demonstrated that for the log₁₀ cervical length, significant independent contributions were provided by fetal crown-rump length, maternal height, age, racial origin and parity. The median cervical length multiple of the median (MoM), corrected for maternal characteristics, was significantly lower in the preterm (0.892 MoM, 95% CI 0.829–0.945) than in the term delivery group (0.994 MoM, 95% CI 0.919–1.082; p < 0.0001). In screening by a combination of maternal characteristics and cervical length, the estimated detection rate of preterm delivery was 54.8% (95% CI 44.7–64.6), at a false-positive rate of 10%. Conclusions: Effective first-trimester screening for spontaneous early preterm delivery can be provided by a combination of maternal characteristics and cervical length.

Adhesions resulting from gynaecological endoscopic procedures are a major clinical, social and economic concern, as they may result in pelvic pain, infertility, bowel obstruction and additional surgery to resolve such adhesion-related complications. Although the minimally invasive endoscopic approach has been shown to be less adhesiogenic than traditional surgery, at least with regard to selected procedures, it does not totally eliminate the problem. Consequently, many attempts have been made to further reduce adhesion formation and reformation following endoscopic procedures, and a wide variety of strategies, including surgical techniques, pharmacological agents and mechanical barriers have been advocated to address this issue. The present review clearly indicates that there is no single modality proven to be unequivocally effective in preventing post-operative adhesion formation either for laparoscopic or for hysteroscopic surgery. Furthermore, the available adhesion-reducing substances are rather expensive. Since excellent surgical technique alone seems insufficient, further research is needed on an adjunctive therapy for the prevention and/or reduction of adhesion formation following gynaecological endoscopic procedures.

word count: 677, Main text word count: 3604. CONDENSATIONIn women with twin pregnancies universal treatment with vaginal progesterone did not reduce the incidence of spontaneous birth between 24 +0 and 33 +6 weeks' gestation. Short version of article title:Vaginal progesterone in unselected twin pregnancies. AJOG AT A GLANCE• Randomized controlled trial testing the hypothesis that in women with twin pregnancies, vaginal progesterone at a dose of 600 mg per day from 11-14 until 34 weeks' gestation, as compared with placebo, would result in a significant reduction in the incidence of spontaneous preterm birth between 24 +0 and 33 +6 weeks.• In women with twin pregnancies universal treatment with vaginal progesterone did not reduce the incidence of spontaneous birth between 24+0 and 33+6 weeks' gestation. Post hoc time to event analysis led to the suggestion that progesterone may reduce the risk of spontaneous birth <32 weeks in women with cervical length <30 mm and it may increase the risk for those with cervical length ≥30 mm.• In women with twin pregnancies universal treatment with vaginal progesterone does not reduce the incidence of early spontaneous birth.