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

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

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

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

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

Median values of PAPP-A (mIU/L) [A] and free β -hCG (ng/mL) [B] according to gestational age (days).

<p>The circles represent the daily median value of the raw data. In each graph, the line is the predicted median from quantile regression against gestational age. The regression line is not adjusted for maternal weight.</p

Demographic characteristics of the study population (1,150 women).

<p>Demographic characteristics of the study population (1,150 women).</p

MoM PAPP-A and MoM free β -hCG by our model compared with the Caucasian model in the four women with fetal trisomy 21.

<p>MoM PAPP-A and MoM free β -hCG by our model compared with the Caucasian model in the four women with fetal trisomy 21.</p