Prevention of spontaneous preterm birth: universal cervical length assessment and vaginal progesterone in women with a short cervix: time for action!

Campbell, Stuart

doi:10.1016/j.ajog.2017.12.222

Cited by 36 publications

(41 citation statements)

References 81 publications

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“…To add a more objective measure of risk for PTB, we also formed groups based on cervical length which has been previously associated with spontaneous PTB [49,50].…”

Section: Methodsmentioning

confidence: 99%

Human Milk Oligosaccharides modulate the risk for preterm birth in a microbiome dependent and independent manner

Pausan

Kolovetsiou-Kreiner

Richter

et al. 2019

Preprint

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BackgroundPreterm birth is one of the leading causes of neonatal mortality. The causes for spontaneous preterm birth (PTB) are multifactorial and remain often unknown. In this study, we tested the hypothesis that human milk oligosaccharides (HMOs) in blood and urine modulate the maternal urinary and vaginal microbiome and influence the risk for PTB. We analyzed the vaginal and urinary microbiome of a cross-sectional cohort of women with and without preterm labor and correlated our findings with measurements of metabolites and HMOs in urine and blood. ResultsWe identified several microbial signatures associated with short cervix, PTB and/or preterm contractions such as Lactobacillus jensenii, L. gasseri, Ureaplasma sp. and Gardnerella sp..Additionally, we observed associations between sialylated HMOs, in particular 3'-sialyllactose, with PTB, short cervix and increased inflammation and confirmed an influence of HMOs on the microbiome profile. ConclusionsIdentifying serum and urinary HMOs and several key microorganisms associated with PTB, our findings point at two distinct processes modulating the risk for PTB. One process seems to be driven by sterile inflammation, characterized by increased concentrations of sialylated HMOs in serum.Another process might be microbiome-mediated, potentially driven by secretor-active HMOs in urine. Our results support current efforts to improve diagnostics and therapeutic strategies.

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“…To add a more objective measure of risk for PTB, we also formed groups based on cervical length which has been previously associated with spontaneous PTB [49,50].…”

Section: Methodsmentioning

confidence: 99%

Human Milk Oligosaccharides modulate the risk for preterm birth in a microbiome dependent and independent manner

Pausan

Kolovetsiou-Kreiner

Richter

et al. 2019

Preprint

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“…70,81,127–129 With regard to long-term childhood outcomes, current evidence suggests that in utero exposure to vaginal progesterone, administered in a singleton or twin gestation for the prevention of preterm birth, has no harmful effect on neurodevelopmental outcomes at least until 8 years of age. 91,130–134 No studies have reported on long-term neurodevelopmental outcomes in children whose mothers received a cerclage.…”

Section: Commentmentioning

confidence: 99%

“…Vaginal progesterone administration 70–81 and the placement of a cervical cerclage 71,75,82–88 have been proposed for preventing preterm birth in patients with a singleton gestation, previous spontaneous preterm birth, and a sonographic short cervix. In 2011, an individual patient data (IPD) meta-analysis evaluated the efficacy of cerclage for the prevention of preterm birth and perinatal morbidity and mortality in asymptomatic women with a singleton gestation, previous spontaneous preterm birth, and a cervical length <25 mm before 24 weeks of gestation.…”

mentioning

confidence: 99%

Vaginal progesterone is as effective as cervical cerclage to prevent preterm birth in women with a singleton gestation, previous spontaneous preterm birth, and a short cervix: updated indirect comparison meta-analysis

Conde-Agudelo

Romero

Fonseca

et al. 2018

American Journal of Obstetrics and Gynecology

120

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“…Profılaktik serklajı değerlendiren fakat örneklem büyüklükleri küçük olan sadece iki randomize, kontrollü çalışma olduğu için obstetrideki uzun tarihine rağmen, servikal serklajın preterm doğumu önlemedeki rolü tartışmalıdır [7][8][9] .…”

Section: Discussionunclassified

Factors Affecting Prophylactic Cervical Cerclage Success

Çilgin¹

2018

Kafkas J Med Sci

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Aim: We aimed to determine the factors affecting the success of prophylactic cerclage the role of which is controversial in preventing preterm labor in singleton pregnant women. Material and Method: In this study main criterion of which for the failure of cerclage was early preterm delivery before the 32 week cases with prophylactic cerclage in one center were examined retrospectively. As an indication for prophylactic cerclage, patients with two or more late miscarriage history or in patients with story of early preterm delivery while the ultrasound scan of the cervix was shorter than 25 mm in the current pregnancy. Age, BMI, uterine intervention story, miscarriage story in second trimester, history of the conization, positive vaginal culture before cerclage, gestational week during cerclage, CRP levels one week after cerclage and changes in cervical length in ultrasonography two weeks after cerclage were tested. Descriptive statistics and binary logistic regression analyzes were performed. Results: Cervical cerclage was applied to 152 women between 2011 and 2018.54 singleton pregnancies whose clinical follow-up was regular, McDonald's prophylactic cerclage was administered and thus meet the study criteria were included in the study. The multivariate analyzes in our study showed that following factors were independent prognostic factors for the failure of cerclage; history of cerclage in previous pregnancy [OR=2.124 (1.846-4.111) p=0.016], administration of cerclage after the 20th gestational week [OR=1.126 (1.020-1.232) p=0.04] and the uterus instrumentation story [OR=1.342 (1.214, 7.873) p=0.015]. Conclusion: This study showed that past uterine interventions, presence of cerclage anamnesis and intervention after 20 weeks of gestation were independent risk factors for cerclage success. Uterine instrumentation has significant clinical consequences therefore, women who are considered for surgical curettage should be informed about potential risks and medical management or cervical ripening should be considered.

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Prevention of spontaneous preterm birth: universal cervical length assessment and vaginal progesterone in women with a short cervix: time for action!

Cited by 36 publications

References 81 publications

Human Milk Oligosaccharides modulate the risk for preterm birth in a microbiome dependent and independent manner

Human Milk Oligosaccharides modulate the risk for preterm birth in a microbiome dependent and independent manner

Vaginal progesterone is as effective as cervical cerclage to prevent preterm birth in women with a singleton gestation, previous spontaneous preterm birth, and a short cervix: updated indirect comparison meta-analysis

Factors Affecting Prophylactic Cervical Cerclage Success

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