Teresa Higueras

Cervical pessary in pregnant women with a short cervix (PECEP): an open-label randomised controlled trial

BACKGROUND Most previous studies of the use of cervical pessaries were either retrospective or case controlled and their results showed that this intervention might be a preventive strategy for women at risk of preterm birth; no randomised controlled trials have been undertaken. We therefore undertook a randomised, controlled trial to investigate whether the insertion of a cervical pessary in women with a short cervix identified by use of routine transvaginal scanning at 20-23 weeks of gestation reduces the rate of early preterm delivery. METHODS The Pesario Cervical para Evitar Prematuridad (PECEP) trial was undertaken in five hospitals in Spain. Pregnant women (aged 18-43 years) with a cervical length of 25 mm or less were randomly assigned according to a computer-generated allocation sequence by use of central telephone in a 1:1 ratio to the cervical pessary or expectant management (without a cervical pessary) group. Because of the nature of the intervention, this study was not masked. The primary outcome was spontaneous delivery before 34 weeks of gestation. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00706264. FINDINGS 385 pregnant women with a short cervix were assigned to the pessary (n=192) and expectant management groups (n=193), and 190 were analysed in each group. Spontaneous delivery before 34 weeks of gestation was significantly less frequent in the pessary group than in the expectant management group (12 [6%] vs 51 [27%], odds ratio 0·18, 95% CI 0·08-0·37; p<0·0001). No serious adverse effects associated with the use of a cervical pessary were reported. INTERPRETATION Cervical pessary use could prevent preterm birth in a population of appropriately selected at-risk women previously screened for cervical length assessment at the midtrimester scan. FUNDING Instituto Carlos III.

Prevalence of neurological damage in monochorionic twins with selective intrauterine growth restriction and intermittent absent or reversed end-diastolic umbilical artery flow

To assess the incidence of parenchymal lesions on early and late neonatal brain scans and its association with the presence or absence of intermittent absent or reversed end‐diastolic umbilical artery flow velocity (A/REDV) in monochorionic twins complicated by selective intrauterine growth restriction (IUGR), as compared to dichorionic twins and monochorionic twins without selective IUGR.

Incidence and characteristics of umbilical artery intermittent absent and/or reversed end-diastolic flow in complicated and uncomplicated monochorionic twin pregnancies.

To evaluate the incidence and clinical relevance of intermittent absent and/or reversed diastolic flow on umbilical artery Doppler in different groups of monochorionic twin pregnancies.

Sonographic cervical length measurement in pregnant women with a cervical pessary.

The aims of this study were to describe and assess the feasibility of measuring cervical length by standard transvaginal sonography (TVS) and transperineal sonography (TPS) in women with a cervical pessary and compare these measurements with those obtained with a new transvaginal technique.

Curvas de normalidad de la longitud cervical ecográfica según edad gestacional en población española

Resumen Objetivo Obtener curvas de normalidad de la longitud cervical uterina en poblacion espanola, en gestacion unica y gemelar. Sujetos y metodos Gestantes derivadas a nuestro centro para control ecografico rutinario entre las 12 y 36 semanas. Se realizaron 285 ecografias transvaginales en gestaciones unicas y 281 en multiples. Se calculo la media y los percentiles 5 y 95 de la longitud cervical para cada semana de gestacion, y se obtuvieron las curvas de normalidad. Resultados La longitud cervical media disminuyo de forma progresiva durante el embarazo. Tanto en gestaciones unicas como multiples, el percentil 5 al inicio del segundo trimestre se situo en 25 mm. Sin embargo, en el tercer trimestre se observo una disminucion muy marcada especialmente en gestaciones multiples, que llego a ser de 15 mm en gestaciones unicas e inferior a 10 mm en multiples. Conclusiones Nuestros resultados aportan puntos de corte para la evaluacion de la utilizacion clinica o en investigacion de la longitud cervical ecografica. Las diferencias observadas en gestacion unica y multiple justifican la utilizacion de curvas diferenciadas.

Association of congenital hypothalamic hamartoma and hairy polyp

A 30-year-old woman was referred to our center because of a high-risk pregnancy. At 29 years of age she was diagnosed as having antiphospholipid syndrome, after her first pregnancy ended with intrauterine fetal death at 25 weeks’ gestation. Routine ultrasound examination at 17 weeks’ gestation detected two fetal anomalies: a mass measuring 11.8 × 6.8 mm located between the cerebral hemispheres (Figure 1) and another mass of 10 × 6 mm arising from the oral cavity (Figure 2), apparently not related to the tongue. Both masses were homogeneously echogenic and well-defined, and color Doppler evaluation did not show vascular channels. There

Cervical pregnancy complicated with group B streptococcal meningitis

Maternal group B streptococcal infection is an uncommon entity. Herein we describe a case of a 27-year-old-woman who presented life-threateniing group B streptococcus meningitis with an ectopic cervical pregnancy. No other infectious focus have been found. To our knowledge this is the first time that this association has been reported.

The uterocervical angle and its relationship with preterm birth

Abstract Objectives: The objective of this study is to determine whether the uterocervical angle (UCA) correlates with the risk of spontaneous preterm birth (sPTB) < 34 weeks and assess its interobserver variability. Study design: Case–control study of 275 women including 34 who started labor spontaneously and gave birth before 34 weeks of gestation (preterm group) and 241 who gave birth at term (control group). Images used to report cervical length were re-measured for UCA. Results: Mean UCA in the second trimester was wider in the preterm group (105.16°) compared with the control group (94.53°), p = .015. The intraclass correlation coefficient was 0.821 (95% CI: 0.74–0.97) for masked interobserver variability, which implies correct agreement among UCA measurements. Mean UCA increased from the first to the second trimester (84.2° versus 94.5°; p = .019). Conclusions: Wider UCA in the second trimester is related to sPTB. UCA measurement is a reproducible technique. UCA appears to increase from the first to the second trimester. Prospective studies, with ultrasound examinations aimed at measuring UCA in vivo, are needed to accurately assess the characteristics of this marker and its potential as a predictor of sPTB in clinical practice.

P07.07: Predictive value of peak systolic velocity in the middle cerebral artery to detect fetal anemia in red‐cell alloimmunized pregnancies beyond 35 weeks

Results: The colour Doppler derived mean velocity of 59 (SD ± 10.8) mm/s is significantly (P = 0.04) higher than the spectral Doppler derived velocity of 54 (SD ± 9.5) mm/s. Umbilical blood flow derived from the mean flow multiplied by the cross sectional area is 114 ml/min (SD ± 69) and 104 ml/min (SD ± 58), respectively (P = 0.01) (student t test). Conclusion: These preliminary data suggests that colour Doppler derived umbilical venous volume flow is approximately 10% higher than spectral Doppler derived volume flow. This can be explained by less angle dependency of colour Doppler derived velocity.

Fetoscopia y coagulación láser en transfusión feto-fetal: resultados y evolución neonatal

Resumen Objetivo Evaluar los resultados perinatales en los primeros 50 casos de transfusion feto-fetal (TFF) tratados en Espana con coagulacion fetoscopica laser de anastomosis placentarias Sujetos y metodos Estudio prospectivo con 50 casos de TFF grave tratadas con laser. Se evaluo la supervivencia y la evolucion neonatales, las complicaciones obstetricas, y la tasa de lesion neurologica neonatal (28 dias) Resultados La edad gestacional media de tratamiento fue de 19,8 semanas (rango: 16,6–25,8). La supervivencia neonatal global fue del 72% (72/100), con un 86% (43/50) de casos con, al menos, un superviviente. Ocurrio rotura prematura de membranas en 9 pacientes (18%), tres de ellas (6%) precoces (menos de 32 semanas). La edad gestacional media de parto fue de 31,8 semanas (rango: 26,0-38,2), con un 94% (47/50) por encima de las 28 semanas. El peso medio fue de 1.840 g (rango: 640-3.390) para receptores y 1.415 g (rango: 390-2.250) en donantes. Se observo algun grado de lesion neurologica en el 5,5% (4/72) de los supervivientes Conclusion Los resultados presentados se situan en el rango alto de lo previamente reportado por otros grupos. La coagulacion fetoscopica laser permite ofrecer una alternativa terapeutica a una proporcion importante de casos de TFF grave