Frederik J. R. Hermans

Risk stratification with cervical length and fetal fibronectin in women with threatened preterm labor before 34 weeks and not delivering within 7 days

To stratify the risk of spontaneous preterm delivery using cervical length (CL) and fetal fibronectin (fFN) in women with threatened preterm labor who remained pregnant after 7 days.

Prevention of preterm parturition.

This article reviews risk factors for preterm delivery, with special attention to previous preterm birth and a short cervix. Strategies for minimizing the risk of preterm birth among high-risk women, including progesterone supplementation and cerclage, are discussed.In the United States, the annual rate of preterm births (before 37 weeks of gestation) reached a peak of 12.8% in 2006 and was 11.7% in 2011.1 The rate in the United States remains nearly twice the rate in European nations.2 Premature birth in the United States accounts for 35% of deaths in the first year of life3,4 and estimated annual costs exceeding

Population differences and the effect of vaginal progesterone on preterm birth in women with threatened preterm labor

26 billion.5 Rates of death in the first year of life and long-term morbidity such as neurobehavioral impairment are inversely related to gestational age at birth. Neonates born before 24 weeks of gestation rarely survive without serious handicaps. Among neonates born at or after 24 weeks of gestation, mortality and morbidity decline with advancing weeks of gestation. Serious neurodevelopmental complications are uncommon after 32 weeks of gestation; however, neonates born before 36 weeks of gestation often have difficulties with respiration, thermoregulation, and feeding, as well as increased risks of health problems and death in childhood.6 Approximately 25% of preterm births in developed nations are iatrogenic, reflecting cases in which maternal or fetal conditions make early delivery a safer choice than continued pregnancy, for the mother, the fetus, or both. Multifetal pregnancies account for about one fifth of all preterm births; 50% of twin births and more than 90% of triplet births are preterm. Most singleton preterm births occur after the spontaneous early onset of the parturitional process. This article focuses on strategies to prevent preterm birth.Since publication of their article, the authors report no further potential conflict of interest. 1. Chan CY, Sun HS, Shah SM, Agovic MS, Friedman E, Banerjee SP. Modes of direct modulation by taurine of the glutamate NMDA receptor in rat cortex. Eur J Pharmacol 2014;728:167-75. 2. Kleindienst N, Engel RR, Greil W. Which clinical factors predict response to prophylactic lithium? A systematic review for bipolar disorders. Bipolar Disord 2005;7:404-17.

Three‐dimensional saline infusion sonohysterography for the diagnosis of focal intracavitary lesions

Abstract Objective: Threatened preterm labor (tPTL) is a complication of pregnancy. Identification of women and clinical definition differs between countries. This study investigated differences in tPTL and effectiveness of vaginal progesterone to prevent preterm birth (PTB) between two countries. Methods: Secondary analysis of a randomized controlled trial (RCT) from Argentina and Switzerland comparing vaginal progesterone to placebo in women with tPTL (n = 379). Cox proportional hazards analysis was performed to compare placebo groups of both countries and to compare progesterone to placebo within each country. We adjusted for baseline differences. Iatrogenic onset of labor or pregnancy beyond gestational age of interest was censored. Results: Swiss and Argentinian women were different on baseline. Risks for delivery <14 days and PTB < 34 and < 37 weeks were increased in Argentina compared to Switzerland, HR 3.3 (95% CI 0.62–18), 54 (95% CI 5.1–569) and 3.1 (95% CI 1.1–8.4). In Switzerland, progesterone increased the risk for delivery <14 days [HR 4.4 (95% CI 1.3–15.7)] and PTB <37 weeks [HR 2.5 (95% CI 1.4–4.8)], in Argentina there was no such effect. Conclusion: In women with tPTL, the effect of progesterone may vary due to population differences. Differences in populations should be considered in multicenter RCTs.

Repeated cervical length measurements for the verification of short cervical length

This is the protocol for a review and there is no abstract. The objectives are as follows: To evaluate the diagnostic accuracy of 3D SIS in comparison to 2D SIS in the diagnosis of focally growing lesions (polyps or fibroids) in women with abnormal uterine bleeding or subfertility with hysteroscopy as a reference test. In addition we will evaluate the diagnostic accuracy of 2D+3D SIS (compared to 2D SIS) in the diagnosis of focally growing lesions (polyps or fibroids) in women with abnormal uterine bleeding or subfertility with hysteroscopy as a reference test. In this case, any abnormality on any of the two modalities will be regarded as a positive result (‘OR’ approach). The secondary objective is, where possible, to evaluate the diagnostic accuracy of 3D SIS in comparison to 2D SIS in type of abnormality (to differentiate between polyps and fibroids) in women with abnormal uterine bleeding or subfertility using histology as a reference. In addition we will evaluate, where possible, the diagnostic accuracy of 2D+3D SIS in type of abnormality (to differentiate between polyps and fibroids) in women with abnormal uterine bleeding or subfertility using histology as a reference.

At 15-20 weeks of pregnancy, various modifiable factors are associated with increased likelihood of a subsequent uncomplicated pregnancy

To determine if the verification of short cervical length with a repeated measurement improved the identification of patients with short cervical length at increased risk of preterm delivery.

Indicators for Cervical Length in Twin Pregnancies

Commentary on: Chappell LC, Seed PT, Myers J, et al. Exploration and confirmation of factors associated with uncomplicated pregnancy in nulliparous women: prospective cohort study. BMJ 2013;347:f6398.[OpenUrl][1][Abstract/FREE Full Text][2] Traditional approaches in research and obstetric care focus on identifying risk indicators for adverse pregnancy outcomes rather than the prediction of uncomplicated pregnancy. A focus on identifying indicators of uncomplicated pregnancy may help women and their healthcare providers to select appropriate antenatal care, for example change in lifestyle factors or intensified monitoring, thus reducing the risk of pregnancy … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fbmj.f6398%26rft_id%253Dinfo%253Apmid%252F24270055%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=bmj&resid=347/nov21_3/f6398&atom=%2Febnurs%2F18%2F1%2F25.atom

Effectiveness of a cervical pessary for women who did not deliver 48 h after threatened preterm labor (Assessment of perinatal outcome after specific treatment in early labor: Apostel VI trial)

OBJECTIVE Cervical length (CL) is associated with the risk of preterm birth (PTB) in multiple pregnancies. However, the position of CL within the pathophysiological pathway of PTB is unclear, and it is unknown which factors are predictive for CL. This study aims to investigate whether in twin pregnancies baseline maternal and obstetrical characteristics are potential indicators for CL, to improve insight in the pathophysiological pathway of PTB. STUDY DESIGN Secondary analysis of data on twin pregnancies and CL measurement between 16 and 22 weeks. A set of 10 potential indicators, known to be associated with an increased risk of PTB and/or which have a plausible mechanism resulting in a change of CL were selected. We used multivariable linear regression with backward selection to identify independent indicators for CL. RESULTS A total of 1,447 women with twin pregnancies were included. Mean CL was 43.7 (±8.9) mm. In multivariable analysis, age (0.27 mm/y; 95% confidence interval [CI] 0.16 to 0.39), use of assisted reproductive technologies (ART) (-1.42 mm, 95% CI -2.6 to -0.25), and having delivered at term in a previous pregnancy (1.32 mm, 95% CI 0.25 to 2.39) were significantly associated with CL. CONCLUSION This study shows that in twin pregnancies, age, use of ART and having delivered term in a previous pregnancy has an association with CL.