- Email: [email protected]
362: Intramuscular progesterone slows the rate of cervical shortening
Poster Session II
Clinical Obstetrics, Diabetes, Labor, Medical-Surgical-Disease, Physiology/Endocrinology, Prematurity
distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, early onset sepsis, or neonatal demise. Receiver operating characteristic (ROC) curves of AC, FL, HC and EFW discordances cut-offs were developed for the prediction of composite perinatal outcomes. RESULTS: 180 twin pregnancies met inclusion criteria. Mean gestational age at delivery was 33 ⫾ 3.4 weeks. 26.1% and 32% of pregnancies were found to have adverse composite obstetrical and neonatal outcomes, respectively. Adverse obstetrical outcome included: TTTS in 14 (7.7%), IUGR in 19 (10.5%), IUFD in 13 (7.2%) and preterm birth (ⱕ28 weeks) in 14 (7.7%). Area under the ROC curve (AUC) of AC, FL, HC and EFW discordance for the prediction of composite obstetrical and neonatal outcomes are shown in the Table. CONCLUSION: In our population, AC and EFW discordances in monochorionic-diamniotic twin pregnancies were fairly accurate in predicting of adverse composite obstetrical outcome.
www.AJOG.org
Rate of cervical shortening
Early second trimester ultrasound biometric discordance for the prediction of adverse composite obstetrics and neonatal outcomes 363 Universal transvaginal and transabdominal cervical length screening for short cervix Carmen Beamon1, Alison Stuebe1, Robert Strauss1 1 University of North Carolina, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Chapel Hill, NC
362 Intramuscular progesterone slows the rate of cervical shortening Cara Pessel1, Saila Moni1, Noelia Zork1, Sara Brubaker1, Samantha Do1, Joy Vink1, Karin Fuchs1, Chia-Ling Nhan-Chang1, Cande Ananth1, Cynthia Gyamfi1 1 Columbia University Medical Center, Obstetrics and Gynecology, New York, NY
OBJECTIVE: To evaluate if 17-alpha-hydroxyprogesterone caproate (17OHPC) exposure is associated with the rate of cervical shortening. STUDY DESIGN: Women with a history of spontaneous PTB (⬍ 37 0/7 weeks) who had serial cervical length (CL) measurements in 2011-12 were identified. 17-OHPC administration and outcome data were collected. We excluded multiple gestations, patients lacking outcome data, medically indicated PTBs, and pregnancies with major fetal anomalies, vaginal progesterone use, and abdominal or vaginal cerclage. CL values from the 2nd and 3rd trimesters were recorded, and the rate of cervical change was modeled based on 17-OHPC status using methods for longitudinal analysis. RESULTS: 103 patients were included, with a total of 555 CL values. 85 (82.5%) patients were exposed to 17-OHPC and 18 (17.5%) were not. Gestational age (GA) and number of previous PTBs, along with timing of CL exams, were similar between these 2 groups, although women that did not receive 17-OHPC were more likely to have delivered multiples in their previous PTB (27.8% vs 4.8%). CL was plotted against GA for every patient starting at 16 weeks. Women were analyzed separately according to whether they delivered at term or preterm. Rate of CL change in women that delivered preterm was modeled using linear terms for GA at CL assessment, while the rate in women that delivered at term was modeled using 2nd degree polynomials. There was no difference in the risk of spontaneous PTB according to 17-OHPC exposure, however among women who delivered preterm the rate of CL shortening was slower in those exposed to 17-OHPC (1mm/wk vs 4mm/wk). CONCLUSION: In women with previous PTB, cervical shortening occurs more gradually when exposed to 17-OHPC. Further studies may evaluate how 17-OHPC influences the cervical remodeling that leads to PTB.
S160
OBJECTIVE: Universal transvaginal cervical length (TVCL) measurement has been recommended by some experts in light of recent evidence supporting interventions to reduce preterm birth in asymptomatic women with a shortened cervix. The sensitivity of transabdominal cervical length (TACL) to detect a shortened cervix remains largely unknown. The purpose of this study was to assess the ability of TACL to detect a TVCL ⱕ25mm. STUDY DESIGN: We performed a prospective evaluation of universal TA and TVCL screening. During a three month period, all women presenting for ultrasound at 16-24 weeks gestation at the UNC Prenatal Diagnostics Unit received both TA and TV cervical length evaluation. A standard protocol for acquisition of TA and TVCL was instituted that included measurement of TACL prior to TVCL. At the end of the three month period, all ultrasounds were reviewed. The shortest TA and TV cervical lengths obtained were used for analysis. The additional time spent acquiring the TVCL was defined as the difference in time between the last TA image and the last TV image. RESULTS: 686 of 1164 women (58.9%) underwent assessment of both TACL and TVCL. Median TACL and TVCL were 38 mm (IQR 33-32) and 41 mm (IQR 36-47), respectively. Mean difference between TA and TVCL was 3.5 mm (95% CI 2.8-4.1). In our sample, 15 women (2.2%) had a TVCL ⱕ25 mm, among whom 7 (47%) had a TACL ⱕ25 mm (Table). 442 women had a TACL ⱕ40 mm. We found that a TACL ⱕ40 mm was 100% sensitive (95% CI 79.4-100%) for detection of a transvaginal CL ⱕ25 mm, with a number needed to screen of 28. The median additional total time required to complete the TVCL was 8.7 minutes (IQR 6.9-10.9). If all women with TACL ⱕ40mm underwent TVCL assessment, we estimated that it would require 4 hours of additional ultrasound time to detect an additional case of CL ⱕ25 mm. CONCLUSION: TACL ⱕ40 mm detected all women with a TVCL ⱕ25 mm in our population. TA evaluation of the cervix may reduce the number of TV scans needed to detect a clinically significant short cervix.
American Journal of Obstetrics & Gynecology Supplement to JANUARY 2013
Clinical Obstetrics, Diabetes, Labor, Medical-Surgical-Disease, Physiology/Endocrinology, Prematurity
distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, early onset sepsis, or neonatal demise. Receiver operating characteristic (ROC) curves of AC, FL, HC and EFW discordances cut-offs were developed for the prediction of composite perinatal outcomes. RESULTS: 180 twin pregnancies met inclusion criteria. Mean gestational age at delivery was 33 ⫾ 3.4 weeks. 26.1% and 32% of pregnancies were found to have adverse composite obstetrical and neonatal outcomes, respectively. Adverse obstetrical outcome included: TTTS in 14 (7.7%), IUGR in 19 (10.5%), IUFD in 13 (7.2%) and preterm birth (ⱕ28 weeks) in 14 (7.7%). Area under the ROC curve (AUC) of AC, FL, HC and EFW discordance for the prediction of composite obstetrical and neonatal outcomes are shown in the Table. CONCLUSION: In our population, AC and EFW discordances in monochorionic-diamniotic twin pregnancies were fairly accurate in predicting of adverse composite obstetrical outcome.
www.AJOG.org
Rate of cervical shortening
Early second trimester ultrasound biometric discordance for the prediction of adverse composite obstetrics and neonatal outcomes 363 Universal transvaginal and transabdominal cervical length screening for short cervix Carmen Beamon1, Alison Stuebe1, Robert Strauss1 1 University of North Carolina, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Chapel Hill, NC
362 Intramuscular progesterone slows the rate of cervical shortening Cara Pessel1, Saila Moni1, Noelia Zork1, Sara Brubaker1, Samantha Do1, Joy Vink1, Karin Fuchs1, Chia-Ling Nhan-Chang1, Cande Ananth1, Cynthia Gyamfi1 1 Columbia University Medical Center, Obstetrics and Gynecology, New York, NY
OBJECTIVE: To evaluate if 17-alpha-hydroxyprogesterone caproate (17OHPC) exposure is associated with the rate of cervical shortening. STUDY DESIGN: Women with a history of spontaneous PTB (⬍ 37 0/7 weeks) who had serial cervical length (CL) measurements in 2011-12 were identified. 17-OHPC administration and outcome data were collected. We excluded multiple gestations, patients lacking outcome data, medically indicated PTBs, and pregnancies with major fetal anomalies, vaginal progesterone use, and abdominal or vaginal cerclage. CL values from the 2nd and 3rd trimesters were recorded, and the rate of cervical change was modeled based on 17-OHPC status using methods for longitudinal analysis. RESULTS: 103 patients were included, with a total of 555 CL values. 85 (82.5%) patients were exposed to 17-OHPC and 18 (17.5%) were not. Gestational age (GA) and number of previous PTBs, along with timing of CL exams, were similar between these 2 groups, although women that did not receive 17-OHPC were more likely to have delivered multiples in their previous PTB (27.8% vs 4.8%). CL was plotted against GA for every patient starting at 16 weeks. Women were analyzed separately according to whether they delivered at term or preterm. Rate of CL change in women that delivered preterm was modeled using linear terms for GA at CL assessment, while the rate in women that delivered at term was modeled using 2nd degree polynomials. There was no difference in the risk of spontaneous PTB according to 17-OHPC exposure, however among women who delivered preterm the rate of CL shortening was slower in those exposed to 17-OHPC (1mm/wk vs 4mm/wk). CONCLUSION: In women with previous PTB, cervical shortening occurs more gradually when exposed to 17-OHPC. Further studies may evaluate how 17-OHPC influences the cervical remodeling that leads to PTB.
S160
OBJECTIVE: Universal transvaginal cervical length (TVCL) measurement has been recommended by some experts in light of recent evidence supporting interventions to reduce preterm birth in asymptomatic women with a shortened cervix. The sensitivity of transabdominal cervical length (TACL) to detect a shortened cervix remains largely unknown. The purpose of this study was to assess the ability of TACL to detect a TVCL ⱕ25mm. STUDY DESIGN: We performed a prospective evaluation of universal TA and TVCL screening. During a three month period, all women presenting for ultrasound at 16-24 weeks gestation at the UNC Prenatal Diagnostics Unit received both TA and TV cervical length evaluation. A standard protocol for acquisition of TA and TVCL was instituted that included measurement of TACL prior to TVCL. At the end of the three month period, all ultrasounds were reviewed. The shortest TA and TV cervical lengths obtained were used for analysis. The additional time spent acquiring the TVCL was defined as the difference in time between the last TA image and the last TV image. RESULTS: 686 of 1164 women (58.9%) underwent assessment of both TACL and TVCL. Median TACL and TVCL were 38 mm (IQR 33-32) and 41 mm (IQR 36-47), respectively. Mean difference between TA and TVCL was 3.5 mm (95% CI 2.8-4.1). In our sample, 15 women (2.2%) had a TVCL ⱕ25 mm, among whom 7 (47%) had a TACL ⱕ25 mm (Table). 442 women had a TACL ⱕ40 mm. We found that a TACL ⱕ40 mm was 100% sensitive (95% CI 79.4-100%) for detection of a transvaginal CL ⱕ25 mm, with a number needed to screen of 28. The median additional total time required to complete the TVCL was 8.7 minutes (IQR 6.9-10.9). If all women with TACL ⱕ40mm underwent TVCL assessment, we estimated that it would require 4 hours of additional ultrasound time to detect an additional case of CL ⱕ25 mm. CONCLUSION: TACL ⱕ40 mm detected all women with a TVCL ⱕ25 mm in our population. TA evaluation of the cervix may reduce the number of TV scans needed to detect a clinically significant short cervix.
American Journal of Obstetrics & Gynecology Supplement to JANUARY 2013