Transvaginal ultrasound cervical length for prediction of spontaneous labour at term: A systematic review and meta-analysis

BACKGROUND: The possibility to predict the delivery date is a question frequently raised by pregnant women. However, a clinician has currently little to predict when a woman at term will deliver. OBJECTIVE: To evaluate the predictive accuracy of transvaginal ultrasound (TVU) cervical length (CL) for spontaneous onset of labour in singleton gestation enrolled at term by a meta-analysis. SEARCH STRATEGY: We performed a literature search in electronic databases. SELECTION CRITERIA: We included only studies assessing the accuracy of TVU CL in prediction of spontaneous onset of labour in singleton gestations with vertex presentation who were enrolled at term. DATA COLLECTION AND ANALYSIS: The primary outcome was the accuracy of CL for prediction of spontaneous labour within 7 days. Pooled sensitivities and specificities were calculated. MAIN RESULTS: Five studies including 735 singleton gestations were included. For the prediction of spontaneous labour within 7 days for CL <30 mm the pooled sensitivity was 64% and pooled specificity was 60%. The higher the CL, the better the sensitivity; the lower the CL, the better the specificity. A woman with a singleton gestation at term and a TVU CL of 30 mm has a <50% chance of delivering within 7 days, while one with a TVU CL of 10 mm has an over 85% chance of delivery within 7 days. CONCLUSIONS: TVU CL at term has moderate value in predicting the onset of spontaneous labour. A woman with a TVU CL of 10 mm or less has a high chance of delivering within a week. TWEETABLE ABSTRACT: Cervical length at term has moderate value in predicting the onset of spontaneous labour

"One for Sorrow, Two for Joy?": American embryo transfer guideline recommendations, practices and outcomes for gestational surrogate patients

In January 2016, Melissa Cook, a California gestational surrogate experiencing a multiple birth pregnancy following the in vitro fertilization (IVF) transfer of three embryos comprised of donor eggs and sperm provided by the intended father went to the media when the intended father requested that she undergo a fetal reduction because twins were less expensive to raise than triplets. Much of the legal interest in this case to date has centered on the enforceability of surrogacy contracts. However, the Cook case also raises troubling issues about fertility treatment practices involving gestational surrogates, twin preference, and third-party reproduction medical decision-making. This paper focuses on multipleembryo transfers in the context of U.S. surrogacy arrangements. Offering an original analysis of data obtained from the U.S. national assisted reproduction registry, it examines single- and multiple-embryo transfer trends over an eleven-year period (2003 to 2014). Findings reveal that recommended guidelines were followed in less than 42% of cases in 2014. The paper argues that ensuring equitable medical treatment for all recipients of IVF requires the adoption of treatment guidelines tailored to, and offering protections for, specific patient groups, and that, once in place, guidelines must be robustly implemente

Clinical experience with multigene carrier panels in the reproductive setting

What's already known about this topic? Expanded carrier testing is available as an assessment option. Pan‐ethnic–based testing does not rely on ethnicity as a qualification for assessing the presence of specific genetic conditions. What does this study add? This is a report of positivity frequencies for 3 multigene carrier panels offered by a single laboratory ranging from 7.2% to 35.8%. The study includes a list of the most commonly positive conditions on a large expanded carrier panel

Pregnancy Intentions and Happiness Among Pregnant Black Women at High Risk for Adverse Infant Health Outcomes

CONTEXT:Unintended pregnancy is associated with risk behaviors and increased morbidity or mortality for mothers and infants, but a woman\u27s feelings about pregnancy may be more predictive of risk and health outcomes than her intentions. METHODS: A sample of 1,044 black women who were at increased risk were enrolled at prenatal care clinics in the District of Columbia in 2001-2003. Bivariate and multivariate analyses assessed associations between pregnancy intentions or level of happiness about being pregnant and multiple psychosocial and behavioral risk factors, and identified correlates of happiness to be pregnant. RESULTS: Pregnancy intentions and happiness were strongly associated, but happiness was the better predictor of risk. Unhappy women had higher odds than happy women of smoking, being depressed, experiencing intimate partner violence, drinking and using illicit drugs (odds ratios, 1.7-2.6). The odds of being happy were reduced among women who had other children or a child younger than two, who were single or did not have a current partner, who had had more than one sexual partner in the past year and who reported that the baby\u27s father did not want the pregnancy (0.3-0.6). In contrast, the odds of being happy were elevated among women who had better coping strategies (1.03), who had not used birth control at conception (1.6) and who had 1-2 household members, rather than five or more (2.1). CONCLUSIONS: Additional psychosocial screening for happiness about being pregnant and for partner characteristics, particularly the father\u27s desire to have this child, may help improve prenatal care services and prevent adverse health outcomes