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Ultrasonic cervical length in early second-trimester triplet pregnancies as a predictor of preterm labor
SMFM Abstracts S167
Volume 189, Number 6 Am J Obstet Gynecol 388
CERCLAGE FOR PREVENTION OF PRETERM BIRTH IN WOMEN WITH A SHORT CERVIX ON TRANSVAGINAL ULTRASOUND: A RANDOMIZED TRIAL VINCENZO BERGHELLA1, ANTHONY ODIBO2, JORGE TOLOSA1, 1 Thomas Jefferson University, Department of Obstetrics and Gynecology, Philadelphia, PA 2University of Pennsylvania Medical Center, Department of Obstetrics and Gynecology, Philadelphia, PA OBJECTIVE: To determine if cerclage prevents preterm birth (PTB) in women with a short cervix on transvaginal ultrasound (TVU). STUDY DESIGN: Pregnant women with the following high-risk factors— $1 PTB < 35 weeks, $2 D&C, DES exposure, cone biopsy, or mullerian anomaly—were screened with TVU of the cervix every 2 weeks from 14 0/7 to 23 6/7 weeks between 2/1998 and 5/2003. Asymptomatic high-risk women identified to have a short cervix ( < 25 mm) or significant funneling (>25%) and non-screened low-risk women identified incidentally to have the above TVU criteria were offered enrollment. Consented patients were randomized to receive either McDonald cerclage (CERC) or bed rest only (BR). With the exception of cerclage, all patients received similar management. Multiple gestations were randomized separately. Primary outcome was PTB < 35 weeks. RESULTS: 61 women were randomized, of which 59 have delivered and were analyzed (the other two will deliver by 9/2003), with no loss to follow-up. 45 (76%) women had high-risk factors for PTB, 10 (17%) had no risk factors, and only 4 (7%) were twin gestations. Demographics and risk factors were similar in the two groups. See Table for overall results. In the group of singleton gestations with prior PTB < 35 weeks (n = 33), recurrent PTB < 35 weeks occurred in 6 (35%) in CERC vs 9 (56%) in BR group (RR 0.42; 95% CI 0.10-1.72). CONCLUSION: Cerclage did not prevent PTB in women with a short cervix on TVU. The non-significant reduction in PTB in singleton gestations with prior PTB < 35 weeks deserves further study by larger trials and meta-analysis of existing literature.
390
Rate of preterm delivery by gender in triplets.
MMM MMF MFF FFF
Overall outcome
PTB < 35 w PTB < 32 w GA delivery (w)
389
CERC (n = 30)
BR (n = 29)
RR (95%CI)
13 (43%) 11 (37%) 32.5 ± 7.0
14 (48%) 11 (38%) 32. 7 ± 6.8
0.82 (0.29-2.29) 0.94 (0.33-2.72) .88 (P value)
COMPARISON OF BIOCHEMICAL PROFILES OF VAGINAL FLUID IN BVPOSITIVE PREGNANT U.S. VERSUS EUROPEAN WOMEN SABINA CAUCI1, POUL THORSEN2, JENNIFER CULHANE3, 1University of Udine, Biomedical Sciences and Technologies, Udine, Italy 2University of Aarhus, Epidemiology and Social Medicine, Aarhus, Denmark 3Thomas Jefferson University, Ob-Gyn, Philadelphia, PA OBJECTIVE: The rate of preterm delivery is nearly 2-fold higher in the U.S.A. than in Europe. Bacterial vaginosis (BV) has been consistently associated with a 2-fold increased risk of preterm delivery in the U.S.A., whereas recent findings do not demonstrate a statistically significant association in Europe.1 We determined whether biochemical profiles in vaginal fluid of BV-positive pregnant women differ between U.S. and Danish women. STUDY DESIGN: 165 U.S. and 91 Danish BV-positive pregnant women at 724 weeks’ gestation were enrolled. Two microbial hydrolytic enzymes, sialidase and prolidase, and IgA against G. vaginalis toxin (anti-Gvh IgA) were measured as described.1 Statistical significance was determined by Pearson chi square and Mann-Whitney test. RESULTS: BV-positive U.S. women had 11-fold higher median sialidase activity (P < .001), 2-fold higher prolidase activity (P = .002), and 4-fold lower anti-Gvh IgA levels (P < .001) than BV-positive European women. A higher percentage of U.S. vs Danish women had high sialidase values (>5 nmol methoxyphenol) (33% vs 8%, P < .001) and high prolidase values (>2000 mOD) (11% vs 4%, P = .07). On the contrary, a higher percentage of Danish women had high anti-Gvh IgA values (>784 mOD) (14% vs 6%, P = .03). CONCLUSION: According to recent results, high sialidase and/or high prolidase activity combined with low anti-Gvh IgA are associated with increased risk for preterm birth (1). Among BV-positive pregnant women U.S. vs European patients show biochemical profiles at higher potential risk of pregnancy adverse outcomes.
Reference 1. Cauci, Thorsen, Schendel et al. J Clin Microbiol 2003;41:435-8.
THE EFFECT OF FETAL GENDER ON PRETERM BIRTH IN TRIPLETS LILLIAN KAMINSKY1, JAMES EGAN1, ELISA GIANFERRARI1, ALAN BOLNICK1, WINSTON CAMPBELL1, ADAM BORGIDA1, 1University of Connecticut, Obstetrics and Gynecology, Farmington, CT OBJECTIVE: Previous studies demonstrated an association between male gender and preterm birth in singletons. Our objective was to determine whether fetal gender had an effect on preterm birth among triplets in the U.S/ population from 1990 to 2001. STUDY DESIGN: Using data from the National Center for Health Statistics from 1990 to 2001, we matched live triplet births based on demographic information. Records with undocumented gestational age at delivery were excluded. Matched records were stratified by fetal gender and gestational age of delivery. The percentage of all gender-specific deliveries was calculated for each gestational week for all males (MMM), all females (FFF), 2 males/1 female (MMF), and 1 male/2 females (MFF) triplets. Data was analyzed for deliveries #28 and #32 weeks’ gestation using descriptive statistics. RESULTS: Out of 60,945 live triplet births, we matched 17,590 triplet sets (86.6% of total). Risk of preterm birth was the highest for all male triplets. Triplets with MMF had a higher rate of preterm birth than MFF triplets. (see Table) CONCLUSION: As with singletons and twins, male fetal gender is associated with an increased risk of preterm birth in triplets. This gender difference may suggest a mechanism for preterm delivery in triplets. Higherorder chorionicity, as indicated by mixed gender pairs, had a protective effect.
391
Total
#28 wks (%)
#32 wks (%)
3073 5821 5645 3051
16.7 14.6 13.7 14.3
45.9 44.4 43.5 43.5
ULTRASONIC CERVICAL LENGTH IN EARLY SECOND-TRIMESTER TRIPLET PREGNANCIES AS A PREDICTOR OF PRETERM LABOR SHARON MASLOVITZ1, GIDEON FAIT1, JOSEPH HARTOOV1, 1Tel Aviv University, Obstetrics and Gynecology, Tel Aviv, Israel OBJECTIVE: To evaluate the predictive value of ultrasonographically determined cervical length during weeks 14-20 in triplet pregnancies in terms of preterm delivery and adverse perinatal outcome. STUDY DESIGN: We evaluated the cervical length of 14 pregnant women with triplets by ultrasound examination during weeks 14-20 and divided the patients into two groups using a cutoff of 25 mm. Data concerning pregnancy outcome including age of gestation at delivery, birthweights, and NICU admission were retrospectively drawn from the patients’ medical files. RESULTS: Four women had a cervical length of < 25 mm during weeks 1420 (group I) and they all delivered at < 32 weeks (mean 28). Four of the remaining 10 women (cervical length >25 mm, group II) also delivered at < 32 weeks (mean 32.8). Infants from group I had lower birthweights (972 g versus 1839 g) and a higher incidence of low Apgar scores and NICU admissions. The sensitivity of a shorter cervix as a predictor of labor before 32 weeks was 50%, specificity 100%, PPV 100%, and NPV 60%. CONCLUSION: Cervical lengths < 25 mm during 14-20 weeks’ gestation in triplet pregnancies are associated with delivery at < 32 weeks and adverse perinatal outcome.
Volume 189, Number 6 Am J Obstet Gynecol 388
CERCLAGE FOR PREVENTION OF PRETERM BIRTH IN WOMEN WITH A SHORT CERVIX ON TRANSVAGINAL ULTRASOUND: A RANDOMIZED TRIAL VINCENZO BERGHELLA1, ANTHONY ODIBO2, JORGE TOLOSA1, 1 Thomas Jefferson University, Department of Obstetrics and Gynecology, Philadelphia, PA 2University of Pennsylvania Medical Center, Department of Obstetrics and Gynecology, Philadelphia, PA OBJECTIVE: To determine if cerclage prevents preterm birth (PTB) in women with a short cervix on transvaginal ultrasound (TVU). STUDY DESIGN: Pregnant women with the following high-risk factors— $1 PTB < 35 weeks, $2 D&C, DES exposure, cone biopsy, or mullerian anomaly—were screened with TVU of the cervix every 2 weeks from 14 0/7 to 23 6/7 weeks between 2/1998 and 5/2003. Asymptomatic high-risk women identified to have a short cervix ( < 25 mm) or significant funneling (>25%) and non-screened low-risk women identified incidentally to have the above TVU criteria were offered enrollment. Consented patients were randomized to receive either McDonald cerclage (CERC) or bed rest only (BR). With the exception of cerclage, all patients received similar management. Multiple gestations were randomized separately. Primary outcome was PTB < 35 weeks. RESULTS: 61 women were randomized, of which 59 have delivered and were analyzed (the other two will deliver by 9/2003), with no loss to follow-up. 45 (76%) women had high-risk factors for PTB, 10 (17%) had no risk factors, and only 4 (7%) were twin gestations. Demographics and risk factors were similar in the two groups. See Table for overall results. In the group of singleton gestations with prior PTB < 35 weeks (n = 33), recurrent PTB < 35 weeks occurred in 6 (35%) in CERC vs 9 (56%) in BR group (RR 0.42; 95% CI 0.10-1.72). CONCLUSION: Cerclage did not prevent PTB in women with a short cervix on TVU. The non-significant reduction in PTB in singleton gestations with prior PTB < 35 weeks deserves further study by larger trials and meta-analysis of existing literature.
390
Rate of preterm delivery by gender in triplets.
MMM MMF MFF FFF
Overall outcome
PTB < 35 w PTB < 32 w GA delivery (w)
389
CERC (n = 30)
BR (n = 29)
RR (95%CI)
13 (43%) 11 (37%) 32.5 ± 7.0
14 (48%) 11 (38%) 32. 7 ± 6.8
0.82 (0.29-2.29) 0.94 (0.33-2.72) .88 (P value)
COMPARISON OF BIOCHEMICAL PROFILES OF VAGINAL FLUID IN BVPOSITIVE PREGNANT U.S. VERSUS EUROPEAN WOMEN SABINA CAUCI1, POUL THORSEN2, JENNIFER CULHANE3, 1University of Udine, Biomedical Sciences and Technologies, Udine, Italy 2University of Aarhus, Epidemiology and Social Medicine, Aarhus, Denmark 3Thomas Jefferson University, Ob-Gyn, Philadelphia, PA OBJECTIVE: The rate of preterm delivery is nearly 2-fold higher in the U.S.A. than in Europe. Bacterial vaginosis (BV) has been consistently associated with a 2-fold increased risk of preterm delivery in the U.S.A., whereas recent findings do not demonstrate a statistically significant association in Europe.1 We determined whether biochemical profiles in vaginal fluid of BV-positive pregnant women differ between U.S. and Danish women. STUDY DESIGN: 165 U.S. and 91 Danish BV-positive pregnant women at 724 weeks’ gestation were enrolled. Two microbial hydrolytic enzymes, sialidase and prolidase, and IgA against G. vaginalis toxin (anti-Gvh IgA) were measured as described.1 Statistical significance was determined by Pearson chi square and Mann-Whitney test. RESULTS: BV-positive U.S. women had 11-fold higher median sialidase activity (P < .001), 2-fold higher prolidase activity (P = .002), and 4-fold lower anti-Gvh IgA levels (P < .001) than BV-positive European women. A higher percentage of U.S. vs Danish women had high sialidase values (>5 nmol methoxyphenol) (33% vs 8%, P < .001) and high prolidase values (>2000 mOD) (11% vs 4%, P = .07). On the contrary, a higher percentage of Danish women had high anti-Gvh IgA values (>784 mOD) (14% vs 6%, P = .03). CONCLUSION: According to recent results, high sialidase and/or high prolidase activity combined with low anti-Gvh IgA are associated with increased risk for preterm birth (1). Among BV-positive pregnant women U.S. vs European patients show biochemical profiles at higher potential risk of pregnancy adverse outcomes.
Reference 1. Cauci, Thorsen, Schendel et al. J Clin Microbiol 2003;41:435-8.
THE EFFECT OF FETAL GENDER ON PRETERM BIRTH IN TRIPLETS LILLIAN KAMINSKY1, JAMES EGAN1, ELISA GIANFERRARI1, ALAN BOLNICK1, WINSTON CAMPBELL1, ADAM BORGIDA1, 1University of Connecticut, Obstetrics and Gynecology, Farmington, CT OBJECTIVE: Previous studies demonstrated an association between male gender and preterm birth in singletons. Our objective was to determine whether fetal gender had an effect on preterm birth among triplets in the U.S/ population from 1990 to 2001. STUDY DESIGN: Using data from the National Center for Health Statistics from 1990 to 2001, we matched live triplet births based on demographic information. Records with undocumented gestational age at delivery were excluded. Matched records were stratified by fetal gender and gestational age of delivery. The percentage of all gender-specific deliveries was calculated for each gestational week for all males (MMM), all females (FFF), 2 males/1 female (MMF), and 1 male/2 females (MFF) triplets. Data was analyzed for deliveries #28 and #32 weeks’ gestation using descriptive statistics. RESULTS: Out of 60,945 live triplet births, we matched 17,590 triplet sets (86.6% of total). Risk of preterm birth was the highest for all male triplets. Triplets with MMF had a higher rate of preterm birth than MFF triplets. (see Table) CONCLUSION: As with singletons and twins, male fetal gender is associated with an increased risk of preterm birth in triplets. This gender difference may suggest a mechanism for preterm delivery in triplets. Higherorder chorionicity, as indicated by mixed gender pairs, had a protective effect.
391
Total
#28 wks (%)
#32 wks (%)
3073 5821 5645 3051
16.7 14.6 13.7 14.3
45.9 44.4 43.5 43.5
ULTRASONIC CERVICAL LENGTH IN EARLY SECOND-TRIMESTER TRIPLET PREGNANCIES AS A PREDICTOR OF PRETERM LABOR SHARON MASLOVITZ1, GIDEON FAIT1, JOSEPH HARTOOV1, 1Tel Aviv University, Obstetrics and Gynecology, Tel Aviv, Israel OBJECTIVE: To evaluate the predictive value of ultrasonographically determined cervical length during weeks 14-20 in triplet pregnancies in terms of preterm delivery and adverse perinatal outcome. STUDY DESIGN: We evaluated the cervical length of 14 pregnant women with triplets by ultrasound examination during weeks 14-20 and divided the patients into two groups using a cutoff of 25 mm. Data concerning pregnancy outcome including age of gestation at delivery, birthweights, and NICU admission were retrospectively drawn from the patients’ medical files. RESULTS: Four women had a cervical length of < 25 mm during weeks 1420 (group I) and they all delivered at < 32 weeks (mean 28). Four of the remaining 10 women (cervical length >25 mm, group II) also delivered at < 32 weeks (mean 32.8). Infants from group I had lower birthweights (972 g versus 1839 g) and a higher incidence of low Apgar scores and NICU admissions. The sensitivity of a shorter cervix as a predictor of labor before 32 weeks was 50%, specificity 100%, PPV 100%, and NPV 60%. CONCLUSION: Cervical lengths < 25 mm during 14-20 weeks’ gestation in triplet pregnancies are associated with delivery at < 32 weeks and adverse perinatal outcome.