The Preterm Prediction Study: Effect of gestational age and cause of preterm birth on subsequent obstetric outcome

Mercer, Brian M.; Goldenberg, Robert L.; Moawad, Atef H.; Meis, Paul J.; Iams, Jay D.; Das, Anita; Caritis, Steve N.; Miodovnik, Menachem; Menard, M. Kathryn; Thurnau, Gary R.; Dombrowski, Mitchell P.; Roberts, James M.; McNellis, Donald

doi:10.1016/s0002-9378(99)70111-0

Cited by 424 publications

(253 citation statements)

References 19 publications

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“…[1][2][3][4][5] Risk factors for preterm birth include a history of preterm birth, [6][7][8][9][10][11][12] excisional treatment for cervical dysplasia [13][14][15] and presence of a uterine anomaly. [16][17][18][19] Cervical length measured by transvaginal ultrasonography has been shown to predict preterm birth in these asymptomatic high-risk women.…”

Section: Introductionmentioning

confidence: 99%

Follow-up cervical length in asymptomatic high-risk women and the risk of spontaneous preterm birth

Crane

Hutchens

2010

J Perinatol

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Objective: To determine whether further cervical length shortening by transvaginal ultrasonography in asymptomatic high-risk women with a short cervical length adds additional predictive value for spontaneous preterm birth and perinatal morbidity.Study Design: Women with a history of spontaneous preterm birth, loop electrosurgical excision procedure, cone biopsy or uterine anomaly, who were pregnant with singleton gestations and were found by transvaginal ultrasonography to have a cervical length <3.0 cm at 20 to 28 weeks' gestation, and who underwent a follow-up cervical length within 3 weeks were evaluated, comparing those with further cervical length shortening (>10%) to those without further shortening. Primary outcomes were spontaneous preterm birth <35 weeks' gestation and perinatal morbidity. Secondary outcomes included spontaneous preterm birth <37 weeks, <34 weeks, <32 weeks, birth weight <2500 g, maternal and other neonatal outcomes.Result: Compared with women without further cervical shortening, those with further shortening were found by univariate analyses to have higher rates of spontaneous preterm birth <35 weeks (34.8 versus 8.5%, P ¼ 0.014), <37 weeks (56.5 versus 21.3%, P ¼ 0.003), <34 weeks (30.4 versus 2.1%, P ¼ 0.001), <32 weeks (21.7 versus 0%, P ¼ 0.003), birth weight <2500 g (60.9 versus 17.0%, P<0.0001), neonatal intensive care unit admission (47.8 versus 17.0%, P ¼ 0.006) and composite perinatal morbidity (43.5 versus 14.9%, P ¼ 0.009). Logistic regression revealed the only independent predictors of spontaneous preterm birth <35 weeks were further cervical length shortening (adjusted odds ratio (aOR) 5.73; 95% confidence interval (CI) 1.31 to 24.43) and gestational age at short cervical length (aOR 0.95; 95% CI 0.91 to 0.99). Conclusion:Further cervical length shortening in asymptomatic high-risk women with a short cervical length is an important independent predictor of spontaneous preterm birth <35 weeks and perinatal morbidity.

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Section: Introductionmentioning

confidence: 99%

Follow-up cervical length in asymptomatic high-risk women and the risk of spontaneous preterm birth

Crane

Hutchens

2010

J Perinatol

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“…These infants often exhibit a deficiency of surfactant production that leads to insufficient gas exchange. Due primarily to a higher rate of multiple gestations, the overall number of premature live births (Mercer et al, 1999) has increased by 26% during the last three decades. This has lead to a significant increase in neonatal respiratory disease, including Respiratory Distress Syndrome (RDS) and Bronchopulmonary Dysplasia (BPD) (Clark et al, 2001;Jobe and Ikegami, 2000).…”

Section: Introductionmentioning

confidence: 99%

Differentiation of xenografted human fetal lung parenchyma

Pavlović

Floros

Phelps

et al. 2008

Early Human Development

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The goal of this study was to characterize xenografted human fetal lung tissue with respect to developmental stage-specific cytodifferentiation. Human fetal lung tissue (pseudoglandular stage) was grafted either beneath the renal capsule or the skin of athymic mice (NCr-nu). Tissues were analyzed from 3 to 42 days post-engraftment for morphological alterations by light and electron microscopy (EM), and for surfactant protein mRNA and protein by reverse transcription-polymerase chain reaction (RT-PCR) and immunocytochemistry (ICC), respectively. The changes observed resemble those seen in human lung development in utero in many respects, including the differentiation of epithelium to the saccular stage. Each stage occurred over approximately one week in the graft in contrast to the eight weeks of normal in utero development. At all time points examined, all four surfactant proteins (SP-A, SP-B, SP-C, and SP-D) were detected in the epithelium by ICC. Lamellar bodies were first identified by EM in 14 day xenografts. By day 21, a significant increase in lamellar body expression was observed. Cellular proliferation, as marked by PCNA ICC and elastic fiber deposition resembled those of canalicular and saccular in utero development. This model in which xenografted lung tissue in different stages of development is available may facilitate the study of human fetal lung development and the impact of various pharmacological agents on this process.

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“…Если предыдущая беременность преры-валась в сроке 23-28 недели, то в 25 % случаев и последующая беременность прервется в сроке до 28-й недели без коррекции причин [10]. А по-сле прерывания беременности во II триместре риск потери последующей возрастает в 10 раз [11].…”

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Selection of the method for correction of cervical incompetence

et al. 2017

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■ Истмико-цервикальная недостаточность (ИЦН) является одной из важных проблем современного акушерства.Перед практикующим акушером-гинекологом стоит сложная задача своевременной диагностики, выбора метода коррекции, сроков наложения и удаления серкляжа. Проблема несостоятельности шейки матки при беремен-ности известна с XIX в., но еще в XI в. выдающийся ученый Абу Али Ибн Сина (Авиценна) писал об этой пато-логии. Согласно классическому определению ИЦН -это размягчение, расширение и укорочение шейки матки до 37-й недели гестации при отсутствии угрозы прерывания. Для ИЦН характерна неспособность женщины доносить беременность до доношенного срока из-за функционального или структурного дефекта шейки матки. На настоящее время не существует объективных диагностических тестов для выявления пациенток высоко-го риска развития ИЦН ни до и ни во время беременности. Высокой диагностической значимостью во время беременности обладает трансвагинальное ультразвуковое исследование шейки матки. Разработанная ультра-звуковая шкала L.J. Salomon позволяет оценить длину шейки матки в зависимости от срока гестации и сделать врачу правильный выбор для коррекции короткой шейки. Выбор метода коррекции ИЦН зависит от клиниче-ской ситуации, анамнеза, сроков гестации, числа плодов, данных цервикометрии, гинекологического осмотра, угрозы прерывания беременности, опыта врача. Существует два основных метода коррекции ИЦН: консерва-тивный и хирургический. К хирургическим методам относятся трансвагинальный и трансабдоминальный сер-кляж, а к консервативным -соблюдение постельного режима, токолитическая, гормональная терапия, приме-нение акушерского пессария. Установка акушерских пессариев является перспективным безопасным простым методом лечения и профилактики ИЦН и угрозы прерывания беременности во II и III триместрах. Стратегия широкого использования пессариев у беременных из групп высокого риска позволяет снизить частоту прежде-временных родов и улучшить перинатальные исходы.■ Ключевые слова: истмико-цервикальная недостаточность (ИЦН); серкляж; трансвагинальный серкляж; трансабдоминальный серкляж; акушерский пессарий Arabin; трансвагинальное УЗИ; преждевременные роды. ■ Cervical incompetence (CI) is one of the challenges of modern obstetrics. The practicing obstetrician-gynecologist faces a complex task of timely diagnosis, selection of correction method, timing of application and removal of cerclage. The problem of CI in pregnancy is known from the XIX century, but in the XI century, the outstanding scientist Abu Ali Ibn Sina (Avicenna) wrote about this pathology. According to the classical definition, CI is the softening, widening and shortening of the cervix prior to the 37th week of gestation in the absence of thretening termination of pregnancy. CI is characterized by inability to carry a pregnancy to full-term due to functional or structural abnormalities of the uterine cervix. To date, no objective diagnostic tests exists to identify patients at high risk of developing CI, not before and not during pregnancy. A high diagnostic accuracy d...

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The Preterm Prediction Study: Effect of gestational age and cause of preterm birth on subsequent obstetric outcome

Cited by 424 publications

References 19 publications

Follow-up cervical length in asymptomatic high-risk women and the risk of spontaneous preterm birth

Follow-up cervical length in asymptomatic high-risk women and the risk of spontaneous preterm birth

Differentiation of xenografted human fetal lung parenchyma

Selection of the method for correction of cervical incompetence

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