Cerclage placement for cervical length ≤2.5 cm in twin gestations did not decrease the rate of preterm birth at <35 weeks; however, cerclage placement for cervical length ≤1.5 cm was associated with a significantly decreased rate of preterm birth <35 weeks when compared to patients managed without cerclage.
Triplet gestations are associated with high perinatal morbidity. Dichorionic-diamniotic triplet pregnancies with growth discordance, polyhydramnios and structural anomalies carry a significantly increased risk of fetal morbidity and mortality from the baseline risks of high-order multiple pregnancies. Intrauterine fetal death of one fetus of a monochorionic pregnancy may cause neurological injury to the surviving fetus. We present a case where an innovative technique was created combining use of the fetoscopic laser and miniature laparoscopic instruments to selectively reduce and disentangle the umbilical cord of the acranial growth-restricted fetus from the structurally normal fetus's umbilical cord in a dichorionic-diamniotic triplet pregnancy.
Untreated fetal pleural effusion can cause significant perinatal morbidity and mortality. Treatment of pleural effusions with pleuro-amniotic shunting has been shown to improve outcomes. Pleuro-amniotic shunting is associated with complications including ruptured membranes, preterm labor and shunt dislodgement into either the amniotic cavity or the fetal thorax. Shunt dislodgement into the thoracic cavity can cause prenatal complications from the shunt itself or may necessitate neonatal surgery for removal. We present a case where a novel ultrasound-guided technique was used to replace the dislodged pleural shunt in utero, thereby effectively draining the effusion while simultaneously obviating the need for neonatal surgery and decreasing possible perinatal complications.
factors to be characterized and presented in Table 1, titled: Comparison of demographic and obstetric variables for true vs false labor patients. The different distribution of these specific clinical characteristics, painful frequent contraction and Bishop score, between the false and true labor groups could theoretically predict better the progress to active labor than measurement of cervical length by sonography. In such case, measurement of cervical length by sonography is pointless. Furthermore, there are some basic methodological flaws in the study that could affect the study's conclusion. First, Kunzier and colleagues 1 enrolled 47 primiparous and 30 multiparous participants and were underpowered to conclude that the difference of the area under the receiver operating characteristic curves between primiparous and multiparous groups was nonsignificant. The sample size needed to detect a significant difference of 0.88 vs 0.76 requires 90 participants in each curve. 2 Combining the 2 curves to one is inappropriate and can lead to misleading results. Second, the study enrolled 101 nonconsecutive cases in 2013 through 1016. According to Winthrop University Hospital World Wide Web site 3 there are 5000 annual deliveries, ie, 15,000 deliveries during the study period. Although not all parturients who ultimately delivered were eligible for enrollment, a significant number were qualified and not enrolled. There is a need to compare between the latter and the study group to verify lack of selection bias issues. We are concerned that these methodologic limitations impact the validity of the study's findings and conclusions.
Based on a previously developed model, which included maternal age, BMI and cervical exam on admission, gestational age, race/ ethnicity, any prior preterm or term VD, type of labor and PROM, we calculated the predicted probability of VD for each woman, and estimated the prevalence of maternal and neonatal morbidity according to this predicted probability. RESULTS: The 45,997 women in this analysis met eligibility criteria and had all variables needed to calculate probability of VD. More than 75% of the study population had a predicted probability of VD >90%. Maternal and neonatal morbidity became less frequent as the predicted probability of VD increased. For example, when the probability of VD was > 95%, less than 4% of women experienced severe morbidity compared to approximately 20% when the probability was < 80% (Table). CONCLUSION: A model to predict VD in women at term with singleton gestations is also associated with maternal and neonatal morbidity. If validated, this VD calculator may be clinically useful in stratifying patients according to their probability of VD and perinatal morbidity, which may be useful to direct staffing and to adjust for case-mix when comparing rates of morbidity between various systems.
OBJECTIVE: We aimed to determine whether sonographic cervical length is an effective predictive tool in women with threatened preterm labor (PTL) and cervical dilatation. STUDY DESIGN: A retrospective cohort study of all women with singleton pregnancies who presented with PTL at less than 34+0 weeks and underwent sonographic measurement of cervical length in a tertiary medical center (2009-2014). The accuracy of cervical length in predicting preterm delivery (PTD), defined as delivery <37, <35 or <32 weeks of gestation or within 14 days from examination, was compared between women with (0.5-3cm) and without cervical dilatation. RESULTS: 1) 1,068 women were eligible for the study, of them 276 (25.8%) with cervical dilatation (study group) and 792 (74.2%) with closed cervix (control group). 2) The rate of PTD was significantly higher for women in the study group (33.7% vs. 22.5%, p<0.001). 3) Cervical length was significantly correlated with the examination to delivery interval in the controls (r¼0.22, p<0.001) and in women with cervical dilatation (r¼0.31, p<0.001). 4) On multivariable analysis, cervical length was independently associated with the risk of preterm delivery for women in both groups (Table). 5) For women with cervical dilatation, cervical length <25mm was significantly associated with lower proportion of women undelivered at any given interval from the time of examination (p<0.001, Figure). CONCLUSION: Even in women presenting with threatened PTL and cervical dilatation, cervical length can be used for PTD prediction.
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