Distribution of uterocervical angles in the second trimester of pregnant women at low risk for preterm delivery

The uterocervical angle (UCA) has recently been studied as a parameter to identify women at risk for spontaneous preterm birth (sPTB). This study aimed to investigate the distribution of UCA values by transvaginal sonography (TVS) in the second trimester of women at low risk for sPTB. TVS was performed in 450 low-risk pregnant women at gestational age (GA) 160/7–240/7 weeks. The UCA distribution by GA was visualised using a scatter plot. The range of UCA values and their relationship with GA were assessed using quantile regression analysis. p < .05 was considered statistically significant. A total of 242 participants with anteflexed uterus, no history of caesarean section and term delivery were analysed. The normal range of UCA (5th and 95th percentiles) was from 63.0 degrees (95% CI, 53.1–72.9) to 148.8 degrees (95% CI, 139.5–158.0) with no significant changes during this GA period (–0.3 degrees per week, p = .757).Impact statement What is already known on this subject? Spontaneous preterm birth (sPTB) is a major problem in obstetrics. A screening strategy using history of sPTB and cervical length (CL) measurement is the current standard to identify women at risk for sPTB and provide adequate prevention. However, a third of women who are identified as low risk go on to have sPTB, so a better means needs to be found to more reliably identify women at risk. Various studies have found that a wide uterocervical angle (UCA) was associated with sPTB, and thus the UCA has been proposed as a potential sPTB screening parameter. However, to date there is a lack of prospective studies evaluating this proposal, and no consensus about the proper gestational age to perform UCA measurements to identify women at risk of sPTB. What do the results of this study add? This study reports the distribution of UCA at the GA of 160/7–240/7 weeks of low-risk singleton pregnancy women who delivered at term. The mid-90% values ranged from 63.0 degrees to 148.8 degrees with no significant differences in this GA period. What are the implications of these findings for clinical practice and/or further research? Because of the wide range of UCA values at GA 160/7–240/7 weeks, more studies regarding UCA values in various gestational ages are required to fully understand the trend of UCA values along pregnancy and confirm whether or not the UCA would be a useful parameter for sPTB prediction and if so at what gestational age it would have to be assessed

Combined maternal risk factors and the Quadruple test to predict late-onset preeclampsia in pregnant Thai women

Abstract Background This study aimed to evaluate the predictive power of a model combining maternal risk factors and the Quadruple screen test for late-onset preeclampsia (PE). Methods All pregnant women that received the Quadruple test for Down syndrome at 15+ 0-20+ 6 weeks’ gestation were recruited. Maternal serum α-fetoprotein, β-human chorionic gonadotropin, unconjugated estriol, and inhibin A were measured as multiples of the median. A logistic regression model was used to identify predictors associated with late-onset PE with severe features. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to assess the model’s predictive ability. Results Fifty-five of the 2,000 pregnant women had PE, and 31 of 55 women had late-onset PE. Multivariate analysis identified maternal age ≥ 35 years, inhibin A, history of previous PE, history of infertile, cardiac disease, chronic hypertension, and thyroid disease as significant risk factors. The area under the curve of the receiver operating characteristic curve was 0.78. The likelihood ratio to predict late-onset PE was 49.4 (total score > 60). Conclusions Our model combining serum inhibin A with maternal risk factors was useful in predicting late-onset PE. Close monitoring of these patients is recommended

A predictive model for successfully inducing active labor among pregnant women: Combining cervical status assessment and clinical characteristics

Objective: To develop a predictive model for successfully inducing active labor by using a combination of cervical status and maternal and fetal characteristics. Study design: A retrospective cohort study was conducted among pregnant women who underwent labor induction between January 2015 and December 2019. Successfully inducing active labor was defined as achieving a cervical dilation > 4 cm within 10 h after adequate uterine contractions. The medical data were extracted from the hospital database; statistical analyses were performed using a logistic regression model to identify the predictors associated with the successful induction of labor. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to assess the accuracy of the model. Results: In total, 1448 pregnant women were enrolled; 960 (66.3 %) achieved successful induction of active labor. Multivariate analysis revealed that maternal age, parity, body mass index, oligohydramnios, premature rupture of membranes, fetal sex, dilation, station, and consistency were significant factors associated with successful labor induction. The ROC curve of the logistic regression model had an AUC of 0.7736. For the validated score system to predict the probability of success, we found that a total score > 60 has a 73.0 % (95 % CI 59.0–83.5) probability of successful induction of labor into the active phase stage within 10 h. Conclusions: The predictive model for successfully achieving active labor using the combination of cervical status and maternal and fetal characteristics had good predictive ability

Agreement of three interpretation systems of intrapartum foetal heart rate monitoring by different levels of physicians

A prospective study was conducted in centre in Southern Thailand, to evaluate agreement in EFM interpretation among various physicians in order to find out the most practical system for daily use. We found strong agreement of very normal FHR tracings among the FIGO, NICHD 3-tier and 5-tier systems. The NICHD 3-tier was more compatible with the FIGO system than 5-tier system. Overall inter-observer agreement was moderate for the NICHD 3-tier system while inter-observer agreement of 5-tier system was fair also the intra-observer agreement was higher in the NICHD 3-tier system. So the 3-tier systems are more suitable than the 5-tier system in general obstetric practice.Impact statement What is already known on this subject: The 3-tier and 5-tier systems were widely used in general obstetrics practice. What the results of this study add: The inter- and intra-observer agreement of NICHD 3-tier system was higher than the 5-tier system. What the implications are of these findings for clinical practice and/or further research: The 3-tier systems were more suitable than the 5-tier systems in general obstetrics practice

Intraoperative blood volume loss according to gestational age at delivery among pregnant women with placenta accreta spectrum (PAS): an 11-year experience in Songklanagarind Hospital

A retrospective study was conducted to evaluate the intraoperative blood volume loss in pregnant women with PAS according to gestational age at delivery. A total of 116 women were enrolled, 39 (33.6%) had an intraoperative massive blood loss (>5000 ml). The massive haemorrhage group had statistically significantly higher percentages of increta and percreta type than the non-massive haemorrhage group (94.9 vs. 67.5%, p < .001). Multiple linear regression analysis showed a decreasing trend of intraoperative blood loss after 34 weeks’ gestation with the nadir period between 35 and 36+6 weeks’ gestation, especially from 36–36+6 weeks’ gestation which was statistically significant, p <.05. The perinatal morbidities from 36–36+6 weeks were not statistically significantly different from 37 weeks’ gestation. Therefore, we recommend that pregnant women with PAS and stable clinical symptoms should be scheduled for caesarean hysterectomy from 36–36+6 weeks’ gestation.Impact statement What is already known on this subject? Massive obstetric haemorrhage from PAS disorders is the main concern for caesarean hysterectomy among these patients as it leads to secondary complications including coagulopathy, multisystem organ failure, and death. What do the results of this study add? The amount of intraoperative blood loss in pregnant women who underwent caesarean hysterectomy due to PAS, was lowest from 36–36+6 weeks’ gestation. What are the implications of these findings for clinical practice and/or further research? We recommend that pregnant women with PAS and stable clinical symptoms should be scheduled for caesarean hysterectomy from 36–36+6 weeks’ gestation

Normative weight-adjusted models for the median levels of first trimester serum biomarkers for trisomy 21 screening in a specific ethnicity

<div><p>Objective</p><p>To establish normative weight-adjusted models for the median levels of first trimester serum biomarkers for trisomy 21 screening in southern Thai women, and to compare these reference levels with Caucasian-specific and northern Thai models.</p><p>Methods</p><p>A cross-sectional study was conducted in 1,150 normal singleton pregnancy women to determine serum pregnancy-associated plasma protein-A (PAPP-A) and free β-human chorionic gonadotropin (β-hCG) concentrations in women from southern Thailand. The predicted median values were compared with published equations for Caucasians and northern Thai women.</p><p>Results</p><p>The best-fitting regression equations for the expected median serum levels of PAPP-A (mIU/L) and free β- hCG (ng/mL) according to maternal weight (Wt in kg) and gestational age (GA in days) were: and Both equations were selected with a statistically significant contribution (p< 0.05). Compared with the Caucasian model, the median values of PAPP-A were higher and the median values of free β-hCG were lower in the southern Thai women. And compared with the northern Thai models, the median values of both biomarkers were lower in southern Thai women.</p><p>Conclusion</p><p>The study has successfully developed maternal-weight- and gestational-age-adjusted median normative models to convert the PAPP-A and free β-hCG levels into their Multiple of Median equivalents in southern Thai women. These models confirmed ethnic differences.</p></div

The relationship between the values of MoM for PAPP-A [A] and free β-hCG [B] using the southern Thai median equation from this study on the X-axis, and the northern Thai equation [9] on the Y-axis (circles).

<p>The line represents the line of equity, i.e., marking the same values on both X and Y-axes.</p

Surface of predicted median PAPP-A level (mIU/L) [A] and predicted median free β -hCG (ng/mL) [B] obtained from quantile regression models against gestational (days) and maternal weight (kg).

<p>In each figure, the left upper side is the result of the quantile regression using the southern Thai data, the right upper side is based on the published equation for median value for a Caucasian population [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0182538#pone.0182538.ref008" target="_blank">8</a>], and the left lower side is based on the published equation for a northern Thai population [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0182538#pone.0182538.ref009" target="_blank">9</a>].</p