Comprehensive Amniotic Fluid Cytokine Profile Evaluation in Women with a Short Cervix: which Cytokine(s) Correlates Best with Outcome?

OBJECTIVE: The objective of this study was to determine whether an expanded amniotic fluid cytokine profile predicts spontaneous preterm birth in patients with short cervix in the midtrimester. STUDY DESIGN: Amniocentesis was performed on singleton gestations between 16-24 weeks with a cervical length RESULTS: Forty-four amniotic fluid samples were analyzed. After stepwise regression, only monocyte chemotactic protein-1 remained significant and was the most predictive of early delivery. With a cutoff of 1320 pg/mL, monocyte chemotactic protein-1 had a 69% sensitivity, 83% specificity, 36% positive predictive value, and 87% negative predictive value to predict spontaneous preterm birth within 1 week of amniocentesis (P = .015). CONCLUSION: Among 25 cytokines, monocyte chemotactic protein-1 was most predictive of spontaneous preterm birth

Fetal Fibronectin Testing in Patients with Short Cervix in the Midtrimester: Can it Identify Optimal Candidates for Ultrasound-Indicated Cerclage?

OBJECTIVE: The objective of the study was to determine the relationship between fetal fibronectin (fFN) testing prior to ultrasound-indicated cerclage and obstetric outcome. STUDY DESIGN: Singleton pregnancies between 18 and 24 weeks\u27 gestation with an ultrasound-diagnosed short cervix (\u3c 25 mm) and funneling (\u3e 25%) of the chorioamniotic membranes into the endocervical canal were analyzed. The fFN testing was performed and patients were randomized to cerclage or no-cerclage. Groups were stratified by fFN result. Cerclage patients were compared with no-cerclage patients. The primary outcome was delivery prior to 35 weeks\u27 gestation. RESULTS: Spontaneous preterm birth prior to 35 weeks\u27 gestation occurred in 15 (44.1%) fFN-positive-cerclage patients and 16 (55.2%) fFN-positive no-cerclage patients (P = .45). Similarly, it occurred in 16 (17.8%) fFN-negative cerclage patients and 11 (17%) fFN-no-cerclage patients (P = .99). CONCLUSION: fFN did not identify optimal candidates for cerclage. However, fFN testing before an ultrasound-indicated cerclage aids in counseling patients, anticipating the outcome of pregnancies complicated by cervical shortening

A Randomized Trial of Cerclage vs. 17 Alpha-Hydroxyprogesterone Caproate for Treatment of Short Cervix.

OBJECTIVE: To determine pregnancy outcome in patients with short cervix on transvaginal ultrasound between 16 and 24 weeks\u27 gestation treated with McDonald cerclage compared to weekly intramuscular injections of 17 alpha-hydroxyprogesterone caproate (17OHP-C). METHODS: From November 2003 through December 2006, asymptomatic, singleton pregnancies were screened with transvaginal ultrasound between 16-24 weeks\u27 gestation. Patients with a cervical length (CL) \u3c or =25 mm were offered enrollment. Patients were randomly assigned to treatment with McDonald cerclage or weekly intramuscular injections of 17OHP-C. The primary outcome was spontaneous preterm birth (PTB) prior to 35 weeks\u27 gestation. RESULTS: Seventy-nine patients met inclusion criteria; 42 were randomly assigned to the cerclage and 37 to 17OHP-C. Spontaneous PTB prior to 35 weeks\u27 gestation occurred in 16/42 (38.1%) of the cerclage group and in 16/37 (43.2%) of the 17OHP-C group (relative risk, 1.14 95% CI, 0.67, 1.93). A post hoc analysis of patients with a prior PTB showed no difference in spontaneous PTBCL\u3c or =15 mm showed a reduction in spontaneous PTB CONCLUSION: Women with CL \u3c or =25 mm in the second-trimester appear to have similar risks of delivering prior to 35 weeks\u27 gestation when treated with 17OHP-C or McDonald cerclage. However, cerclage may be more effective in preventing spontaneous PTB in women with CL\u3c or =15 mm

Is Midtrimester Short Cervix a Sign of Intraamniotic Inflammation?

OBJECTIVE: We sought to determine the relationship between the degree of cervical shortening and intraamniotic inflammation in patients presenting with a midtrimester short cervix. STUDY DESIGN: Amniocentesis was performed on singleton pregnancies between 16-24 weeks\u27 gestation with a sonographic cervical length (CL) RESULTS: In all, 109 amniotic fluid samples were analyzed. Most (21 of 25) cytokines were inversely correlated to CL. Monocyte chemotactic protein (MCP)-1 was the most significant by stepwise regression. Using a cutoff of MCP-1 \u3e 1500 pg/mL, CL of 5 mm had an 86% sensitivity, 85% specificity, 58% positive predictive value, and 96% negative predictive value to predict elevated MCP-1 levels. After excluding patients with intraamniotic infection or labor, findings were similar. CONCLUSION: C