The 2019 novel coronavirus disease (COVID-19) spreads outside China rapidly and became a global pandemic. Recognising its severity and with experiences from the Severe Acute Respiratory Syndrome coronavirus (SARS-CoV) outbreak in 2003, the Singapore government promptly and decisively implemented measures to contain the disease. Many of them have direct effects on our healthcare workers (HCW), and our graduate medical education, which is modelled after the US residency training system, has invariably been impacted to a large degree. Strategies aimed at minimising unnecessary contact between HCW, and directives to step up on human resources as healthcare institutions prepare to cope with a disease outbreak called for modifications to residents' training routine. Residents are affected by curtailment of leave and reallocation of manpower to meet the demands at various frontlines and have to cope with significant physical and emotional stress from anxiety and even pessimism as the situation unfolds with unpredictability. Nevertheless, the pandemic also presents a rare opportunity for residents to learn about healthcare in an international and interdisciplinary context, and develop qualities like resilience, adaptability and solidarity in the face of a medical crisis.
Background Diagnosis of preterm labour is difficult because initial symptoms and signs are often mild and may occur in continuing pregnancies. This study aims to investigate the utility of measuring cervical length, using transvaginal ultrasound, in women presenting to the delivery suite with symptoms of preterm labour. Methods This was a prospective cohort study performed in KK Women’s and Children’s Hospital, Singapore from September 2017 to July 2018. Women with singleton pregnancies, presenting with symptoms of contraction pain, between 24+ 0 to 36+ 6 weeks gestation, were included. Transvaginal ultrasound cervical length measurements were done at presentation to the labour ward, after four hours and in the following morning. The primary outcome of the study was delivery within 1 week. All statistical analyses were conducted with Microsoft Excel and Statistical Package for the Social Sciences. Results A total of 95 subjects were included. A one-millimeter increase in the 1st cervical length increases scan-to-delivery time by 0.802 days (p-value 0.003, CI 0.280–1.323). Receiver Operator Characteristic (ROC) curve analysis for prediction of delivery within 1 week showed an Area Under Curve (AUC) of 0.667, optimal cut-off value of 27.5mm (sensitivity 77.8 %, specificity 61.6 %). A one-millimetre increase in the 3rd cervical length increases scan-to-delivery time by 0.770 days (p-value 0.023, CI 0.108–1.432). ROC curve analysis for prediction of delivery within 1 week showed an AUC of 0.915, optimal cut-off value of 25.5mm (sensitivity 100 %, specificity 73.6 %). However, the change in cervical length over a period of 1 day was not significant in predicting delivery within 1 week. Conclusions Our results indicate that by using a cervical length cut off of 27.5mm at presentation, we would have predicted 77.8 % of deliveries within 1 week. If we were to repeat the cervical length scan the next day, with the same cut-off of 27.5mm, we would have predicted 100 % of deliveries within 1 week. In our study, measuring the transvaginal ultrasound cervical length is a reliable diagnostic test for delivery within 1 week. However, the results are limited by the small sample size. Further studies should be conducted with a larger sample size.
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