Prediction of Preterm Birth

Mortensen, Ove Andreas; Franklin, Jonas; Löfstrand, Tord; Svanberg, Bernhard

doi:10.3109/00016348709015725

Cited by 31 publications

(11 citation statements)

References 14 publications

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“…76, 80 Only hospitals from Finland, France, Hong Kong, Sweden, and the UK integrated cervical assessment into routine prenatal service an institutionalized preventive intervention to predict SPTD. 8, 27, 61–65, 75–77, 80, 81 …”

Section: Resultsmentioning

confidence: 99%

“…Four studies screened only once during pregnancy, 62–64, 76 two screened twice, 8, 77 and one screened three times. 65 In studies conducted in the 1980s, obstetricians or midwives performed DE only. Three American studies evaluated DE by obstetricians and nurses 75 or by nurses and standard examiners 8, 77 who had at least 5 years of experience in cervical examinations and were designated as the “standard” to which all cervical examiners were compared.…”

Section: Resultsmentioning

confidence: 99%

“…8, 65, 77 Overall, insufficient standardization exists in terms of methods and definitions to compare performance criteria across studies. For example, the prevalence of CF ranged from 0.7% to 9.1%.…”

Section: Resultsmentioning

confidence: 99%

“…Twelve reports describing ten datasets comprising 22,050 pregnancies met the inclusion criteria. 27, 61–65 …”

Section: Methods For Reviewmentioning

confidence: 99%

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Precocious cervical ripening as a screening target to predict spontaneous preterm delivery among asymptomatic singleton pregnancies: a systematic review

Reeves

Owen

et al. 2015

American Journal of Obstetrics and Gynecology

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Routine second-trimester transvaginal ultrasonographic (TVU) screening for short cervical length (CL) predicts spontaneous preterm delivery (SPTD), albeit with limited sensitivity (35–40%) and moderate positive likelihood ratio (LR+: 4–6). However, CL describes one of multidimensional changes associated with precocious cervical ripening (PCCR), which also include cervical softening, cervical funneling (CF), and dilation. PCCR, a precursor and a strong predictor for SPTD, was proposed as a potential screening target. We hypothesized that screening for composite measures of PCCR (e.g. CL, CF, cervical consistency, and dilation) using either digital exam (DE) or TVU would improve prediction of SPTD compared to screening for short CL alone. We searched PubMed and EMBASE electronic databases for observational cohort studies to evaluate cervical screening in asymptomatic obstetric populations. Multidimensional composite cervical measures were assessed in 10 datasets (n=22,050 pregnancies) and 12 publications. Appreciable heterogeneity in cervical measurements, data quality, and outcomes across studies prevented quantitative meta-analysis. Only one study reported intra- and inter-observer reliability of cervical measurements. The prevalence of CF ranged from 0.7% to 9.1%. Five studies compared composite measures of PCCR (i.e., CL and CF) to short CL alone, and consistently reported improved screening performance. Among three TVU studies, gains in sensitivity ranged from 5% to 27%, and increases in LR+ ranged from 3 to 16. Our findings suggest composite measures of PCCR might serve as valuable screening targets. High-quality interdisciplinary studies integrating epidemiologic approaches are needed to test this hypothesis and accelerate the translation of advances in cervical pathophysioloy into effective preventive interventions.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Twelve reports describing ten datasets comprising 22,050 pregnancies met the inclusion criteria. 27, 61–65 …”

Section: Methods For Reviewmentioning

confidence: 99%

See 2 more Smart Citations

Precocious cervical ripening as a screening target to predict spontaneous preterm delivery among asymptomatic singleton pregnancies: a systematic review

Reeves

Owen

et al. 2015

American Journal of Obstetrics and Gynecology

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“…Problems in recommending this approach to all pregnant women, or indeed Lumley to a subset of them, have been reviewed in detail elsewhere (47), but the difficulties include the very variable proportion of women reported to have high cervical changes (8-38%); the range of associated predictive values (14-28%); the risk of releasing prostaglandins from the cervix; and the finding that pelvic examinations at term are associated with PPROM. A controlled trial that allocated women by birth date to serial cervical assessment was unable to reduce the preterm birth rate using this strategy, but the allocation resulted in very uneven groups and there may have been some bias (67). A randomized trial is currently under way in France.…”

Section: Serial Cervical Assessmentmentioning

confidence: 99%

Preventing and Managing Prematurity

Lumley

1991

Int J Technol Assess Health Care

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In the past decade the prevention and management of prematurity have begun to be addressed with more appropriate designs. A few strategies-very few-can now be recommended. A few, some widely implemented, can be abandoned. The risks and benefits of most interventions still require clarification.It is commonly agreed among clinicians, researchers, and health policy makers in industrialized countries that the crucial perinatal problem is prematurity. One response to this recognition has been an emphasis on the need for a better understanding of the pathophysiology of prematurity as the key to prevention. Eastman's (19) classic comments-"only when the factors causing prematurity are clearly understood can any intelligent attempt at prevention be made"-is still quoted by those who hold this view, and it could still be regarded as largely true.In contrast, several recent articles call for a greater sense of urgency, exhorting clinicians to stop worrying about causes and to implement preventive programs instead (32;33;36). It is tempting, in the face of stable prematurity rates and the insatiable demand for more neonatal intensive care facilities, to respond enthusiastically to the call. The only trouble with this advice is its lack of clarity about preventive programs: What is the scope of prevention and what components of which programs actually work?First, the scope for prevention is limited by the fact that more than 60% of preterm deaths occur before labor or in infants with lethal malformations (86;87). Even when the infant is alive and not malformed at the onset of labor, some preterm deliveries are elective and others are complicated by factors that contraindicate delaying the delivery (e.g., bleeding). The remaining cases of preterm birth involving spontaneous uncomplicated preterm labor or preterm premature rupture of the membranes (PPROM) with a healthy fetus offer the widest scope for prevention; in some cases, however, delivery is already inevitable at the time of hospital admission. Potential preventive efforts in the uncomplicated group include true primary prevention, early identification of preterm labor or its premonitory signs, and inhibition of preterm labor.Though it is often blurred in practice, the distinction between prevention and inhibition of preterm labor is an important one because the potential for net negative outcomes is even greater with prophylactic interventions. These interventions are used in women at risk, rather than in ones with an established problem, and are used for a greater proportion of the pregnancy.

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