Sonographic Cervical Markers at the Second Trimester for the Prediction of Preterm Birth

Background: This study aimed to assess the diagnostic value of novel ultrasonographic markers, Anterior Uterocervical Angle (AUA), Cervical Consistency Index (CCI) and Cervical Glandular Area (CGA) in the Prediction of Preterm Birth (PTB), in a general population. Methods: We conducted a prospective cohort study on singleton gestations between 16 -24 weeks undergoing transvaginal sonography for Cervical Length (CL) screening. AUA, CCI and CGA were evaluated. The primary outcome was prediction of spontaneous PTB before 37 weeks’ gestation by UCA, CCI and CGA. The secondary outcome was evaluating performance of these markers alone and in combination with CL to predict PTB. Results: A total of 310 women were studied. The rate of PTB in this population was 10.6 % for delivery before 37 weeks. In the PTB group, the shorter CL, the wider AUA and the lower CCI were significant, but the CGA width and area were not significantly different in term and PTB groups. The optimal cut-off based on the ROC curve was 33.15 mm for CL (sensitivity: 57%; specificity: 68%), 102.5 degrees for AUA (sensitivity: 50%; specificity: 80%), and 60.3% for CCI (sensitivity: 43%; specificity: 68%). Conclusions: Our data indicate that the combination of CL and CCI (positive likelihood ratio:3; negative likelihood ratio:0.7) and the combination of CL and AUA (positive likelihood ratio:4.8; negative likelihood ratio:0.76) are better methods for the prediction of spontaneous PTB before 37 weeks; and can be used as a screening tool in the second trimester

Which method is best for the induction of labour?: A systematic review, network meta-analysis and cost-effectiveness analysis

Background: More than 150,000 pregnant women in England and Wales have their labour induced each year. Multiple pharmacological, mechanical and complementary methods are available to induce labour. Objective: To assess the relative effectiveness, safety and cost-effectiveness of labour induction methods and, data permitting, effects in different clinical subgroups. Methods: We carried out a systematic review using Cochrane methods. The Cochrane Pregnancy and Childbirth Group’s Trials Register was searched (March 2014). This contains over 22,000 reports of controlled trials (published from 1923 onwards) retrieved from weekly searches of OVID MEDLINE (1966 to current); Cochrane Central Register of Controlled Trials (The Cochrane Library); EMBASE (1982 to current); Cumulative Index to Nursing and Allied Health Literature (1984 to current); ClinicalTrials.gov; the World Health Organization International Clinical Trials Registry Portal; and hand-searching of relevant conference proceedings and journals. We included randomised controlled trials examining interventions to induce labour compared with placebo, no treatment or other interventions in women eligible for third-trimester induction. We included outcomes relating to efficacy, safety and acceptability to women. In addition, for the economic analysis we searched the Database of Abstracts of Reviews of Effects, and Economic Evaluations Databases, NHS Economic Evaluation Database and the Health Technology Assessment database. We carried out a network meta-analysis (NMA) using all of the available evidence, both direct and indirect, to produce estimates of the relative effects of each treatment compared with others in a network. We developed a de novo decision tree model to estimate the cost-effectiveness of various methods. The costs included were the intervention and other hospital costs incurred (price year 2012–13). We reviewed the literature to identify preference-based utilities for the health-related outcomes in the model. We calculated incremental cost-effectiveness ratios, expected costs, utilities and net benefit. We represent uncertainty in the optimal intervention using cost-effectiveness acceptability curves. Results: We identified 1190 studies; 611 were eligible for inclusion. The interventions most likely to achieve vaginal delivery (VD) within 24 hours were intravenous oxytocin with amniotomy [posterior rank 2; 95% credible intervals (CrIs) 1 to 9] and higher-dose (≥ 50 μg) vaginal misoprostol (rank 3; 95% CrI 1 to 6). Compared with placebo, several treatments reduced the odds of caesarean section, but we observed considerable uncertainty in treatment rankings. For uterine hyperstimulation, double-balloon catheter had the highest probability of being among the best three treatments, whereas vaginal misoprostol (≥ 50 μg) was most likely to increase the odds of excessive uterine activity. For other safety outcomes there were insufficient data or there was too much uncertainty to identify which treatments performed ‘best’. Few studies collected information on women’s views. Owing to incomplete reporting of the VD within 24 hours outcome, the cost-effectiveness analysis could compare only 20 interventions. The analysis suggested that most interventions have similar utility and differ mainly in cost. With a caveat of considerable uncertainty, titrated (low-dose) misoprostol solution and buccal/sublingual misoprostol had the highest likelihood of being cost-effective. Limitations: There was considerable uncertainty in findings and there were insufficient data for some planned subgroup analyses. Conclusions: Overall, misoprostol and oxytocin with amniotomy (for women with favourable cervix) is more successful than other agents in achieving VD within 24 hours. The ranking according to safety of different methods was less clear. The cost-effectiveness analysis suggested that titrated (low-dose) oral misoprostol solution resulted in the highest utility, whereas buccal/sublingual misoprostol had the lowest cost. There was a high degree of uncertainty as to the most cost-effective intervention

The relationship between ultrasonic findings of postpartum uterus after normal vaginal delivery and the duration of lochia discharge

Background: Lochia is the slight vaginal bleeding between 24 hour to 12 week after delivery. There isn't any standard definition for difference between normal and abnormal lochia in post-partum period. The aim of this study was to determine the relationship between ultrasonic findings of the postpartum uterus after normal vaginal delivery with the duration of lochia discharge. Methods: In this cross-sectional study was done in Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran, from 2014 to 2015. In this study 160 women with non-complicated vaginal delivery were entered. Inclusion criteria were: Term pregnancy with gestational age > 37, singleton fetus with cephalic presentation. Exclusion criteria were pre-term pregnancies, previous Cesarean section or other uterine surgeries and twin fetuses. Transvaginal ultrasound was done in first 48 hours after delivery, endometrial thickness echogenicity and uterine size was evaluated. Maternal age, parity, duration of labor and neonatal weight were evaluated. Then the mothers were followed for 6 weeks. The quality and the quantity of lochia discharge were asked by the phone. Results: Lochial discharge last more than 6 weeks in 96 out of 160 (60%). One had less than 4 weeks. The uterus length, thickness, height and endometrial length did not show any relationship with the duration of lochial discharge, but endometrial strip thickness significantly correlated with the duration of lochial discharge period (P=0.04). None of clinical variables like the number of gravidity, parity, live birth or child birth weight, were correlated to the duration of lochia discharge period, but the labor time was correlated to the duration of lochia discharge period (P=0.04). Although both endometrial thickness and labor time in univariate analysis were correlated to the lochia duration time but this was true just for endometrial thickness in multivariate analysis. Conclusion: The endometrial thickness in first 48 hours after normal vaginal delivery could predict the duration of lochia discharge, there wasn’t any correlation between lochia discharge period and other ultrasound parameters

Value of 8-hours urine protein measurement in determining proteinuria during pregnancy: evaluation of 50 patients

"nBackground: Preeclampsia, a specific syndrome in pregnancy, may summits mortality or morbidity in mother and fetus. Diagnostic methods are based on 24 hours urine protein measures which may be tedious, thus it is desirable to apply a faster and more applicable method for this goal. In this study we evaluate measurement of 8-hours urine protein in order to estimate 24-hours urine protein measure. "n"nMethods: Fifty pregnant women were entered in a cross sectional study in Vali-e-asr hospital located in Tehran- Iran, during 2008-2009. A urine sample was given after 8-hours and urine volume as well as protein levels were calculated and compared with the same values of 24-hours urine measures. Other necessary data was obtained by history taking and physical examination as well as using patient's medical records. "n"nResults: Mean of age was 27.5±5.4 years and mean of gestational age was 30.5±4 weeks. Mean of urine protein in 8 and 24 hours urine protein were 79±119 and 532±1218 mg respectively. Sensitivity, specificity, positive predictive value and negative predictive value of 8 hours urine protein were 61%, 98%, 88% and 90% respectively, in order to diagnosis of 24 hours urine protein to consider cut off point 105 mg for 8 hours urine protein. Mean protein levels were significantly higher in group with proteinuria ≥300 mg/24h in these two types of urine samples (p< 0.001). "n"nConclusion: Sensitivity of 8-hours urine protein is low but its specificity is suitable for normal mothers. We offer measuring of 8-hours urine protein as a valuable method for diagnosis of preeclampsia

'Perinatal outcome in preterm premature rupture of membranes with Amniotic fluid index < 5 (AFI < 5)

Abstract Background Our purpose was to determine whether AFI Methods We performed a prospective cohort study of 95 singleton pregnancies complicated by preterm premature rupture of the membranes (PPROM) with delivery between 26 and 34 weeks gestation. Patients were categorized in two groups on the basis of amniotic fluid index2 and Fisher exact tests. Continuous data were evaluated for normal distribution and tested for significance with the student t test. All 2-sided p values Results Both groups were similar with respect to selected demographics, gestational age at rupture of the membranes, gestational age at the delivery, birth weight. Both groups were similar with respect to selected variable, latency until delivery, early onset neonatal sepsis, RDS and neonatal death. Patients with AFI Conclusions An AFI<5 cm after PPROM between 26 and 34 weeks gestation is associated with an increased risk of maternal infections and frequency of C/S.</p

Misoprostol for cervical ripening: a clinical trial in 60 pregnant women

&quot;n 800x600 Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman","serif";} Background: Cervical ripening usually begins prior to the labor when there is an unripe cervix. Complications will increase significantly when the cervix is not ripped. Misoprostol is a pharmacologic agent available for cervical ripening and labor induction. The aim of this study was to compare the efficacy and safety of administration of a single dose of 25 mg vaginal Misoprostol (A) with 100 mg Misoprostol (B) for cervical ripening.&quot;n&quot;nMethods: Sixty subjects with pregnancies of at least 40 gestation weeks, and an unfavorable cervix (Bishop Score &amp;lt;6) were randomly assigned to receive one dose oral misoprostol 100 mg or 25 mg vaginal misoprostol. The main dependent variables were mode of delivery, time interval from induction to cervical ripening, need for additional oxytocin, perinatal results and maternal side effects. &quot;n&quot;nResults: The mean time from the indication of induction to cervical ripening was the same in the two groups (3.63 h in oral group and 3.9 h in vaginal group). Two groups did not differ statistically in the percent of patients who were delivered vaginally or with cesarean section during 24 hours (20% in group A versus 10% in group B).&quot;n&quot;nConclusion: Based on the results of our study, Misoprostol is an effective drug for the cervical ripening and labor induction in the term pregnancies. 25 mg vaginal tablet of Misoprostol is as effective as 100 mg oral misoprostol for cervical ripening

Induction of Labor Using Native (OXYTIP) in Comparison to Foreign Oxytocin (SYNTOCINON).

Objective: This study was conducted with the aim to investigate and compare Iranian produced and foreign oxytocin for use in induction of labor. Materials and methods:This random clinical trial was conducted on a population of 198 pregnant women with live fetus and cephalic presentation and conditions conducive to induction of labor, monitored by obstetricians and gynecologists. They were randomly divided into group A (n = 99) received 10 units of Syntocinon (Novartis Pharma Canada) in 500 cc Ringer lactate, and group B (n = 99) received 10 units of Oxytip (Caspian Tamin Company Iran) in 500 cc serum, who entered the study to commence induction, by signing written consent. Study variables such as induction indications (post-term, ruptured membranes, diabetes, and..), induction duration, duration of the 1(st) and the 2(nd) stages of labor, and delivery method; as well as labor outcomes like hyper-stimulation of uterine, postpartum bleeding, 5-minute Apgar score, and infant's birth weight; and neonatal outcomes (admission to NICU, oxygen and intubation) were assessed for the two groups by a trained midwife and registered in the patient's questionnaire. Data were analyzed in SPSS software using statistical tests: t-test, Chi-square, and Mann-Whitney. Results:Two groups were similar in demographic variables such as; age, BMI, parity, education. There was no significant difference regarding to obstetric and gynecologic characteristics such as: gestational age, dilatation, effacement, and fetal positioning, as well as the indication for labor induction when the study began. After intervention, variables including: induction duration, duration of the 1(st) and the 2(nd) stages of labor, delivery method; and labor outcomes such as: hyper-stimulation of uterine, postpartum bleeding, 5-minute Apgar score, and infant's birth weight; and neonatal outcomes (admission to NICU, oxygen and intubation), in the two groups, were found to be the same (P < 0.05). Mean oxytip dosage needed was less than that of oxytocin to reach for appropriate pain (P = 0.042). Conclusion: The two drugs in terms of labor induction and neonatal complications had similar outcomes and the locally made drug with a lower dosage appears to produce the desired outcome

Evaluation of cardiac sphericity index among intrauterine growth restriction and normal fetuses

Foetal growth restriction (FGR) describes the pregnancy complications of pathological reduced foetal growth, leading to significant perinatal mortality and morbidity, and subsequent long-term cardiovascular outcomes. This prospective case-control study was performed on pregnant women referred to the hospitals of Tehran University of Medical Sciences in 2017–2019. All pregnant women underwent ultrasound scan and doppler sonography. FGR was defined as a sonographic estimation of foetal weight below the tenth percentile for a given gestational age. Cardiac sphericity index, including basal-apical length (BAL), transverse length (TL), global sphericity index (GSI), umbilical artery pulsatility index (PI), middle cerebral artery (MCA) PI and cerebroplacental ratio (CPR) were assessed. Mean gestational age in FGR and control groups were 233.90 ± 22.00 days and 229.00 ± 25.02 days, respectively. Foetal size index and estimated foetal weight in FGR foetuses were significantly lower than the control group (p < .05). BAL, TL and GSI were significantly affected by FGR (p = .0001, p = .018 and p = .0001, respectively). Abnormal GSI, MCA PI, umbilical artery PI and CPR were significantly more prevalent among FGR foetuses (p = .017, p = .0001, p = .0001 and p = .0001, respectively). Cardiac sphericity index, as well as uterine PI, MCA PI and CPR, were the determinants of FGR in foetuses with normal Doppler and abnormal GSI.IMPACT STATEMENT What is already known on this subject? Foetal growth restriction (FGR) describes the foetus that does not grow to its expected biological potential in utero, and is a relatively common complication of pregnancy. FGR is accosted with negative birth outcomes and long-term cardiovascular outcomes. One of the indicators of FGR is cardiac sphericity. What do the results of this study add? The findings of this study revealed that the cardiac sphericity index as well as umbilical PI, MCA PI and CPR ratio change in FGR foetuses. What are the implications of these findings for clinical practice and/or further research? It is recommended that more studies be performed to follow FGR foetuses longitudinally and evaluate the long-term cardiac abnormalities in infancy and childhood and compare it between FGR foetuses and normal foetuses

Termination of pregnancy for maternal medical indications: Failings in delivery of contraceptive advice?

Background: The majority of therapeutic terminations of pregnancy occur for maternal psychological, social or fetal reasons. Available data on maternal medical indications, rather than social, are sparse