No abstract available.
Cervical Length Measurement ; Female ; Incidence ; Obstetric Labor, Premature* ; Parturition* ; Pregnancy ; Pregnancy, High-Risk ; Reproductive History

Short cervical length measured by transvaginal sonography is the one of the best predictor of preterm birth. A cervical length of less than 25 mm between 16 and 24 weeks is known as the reliable threshold for an increase risk of preterm birth in all populations including singleton and multiple gestations, women with or without risk factors for preterm birth, asymptomatic women, as well as those with preterm labor or preterm premature rupture of membranes. Furthermore, measurement of cervical length is a readily learned skill for obstetrical sonographers and transvaginal ultrasonography is acceptable to pregnant women and does not cause discomfort in the vast majority. However, the measurement of cervical length is not yet recommended as routine screening method, especially for those who are at low risk for preterm birth, because there are insufficient treatment methods to prevent preterm birth once short cervix is diagnosed. Recently, not a few researches on short cervix have been focused on the development of treatment strategy. In this article, we will review relevant studies and recent advances in the use of cervical length in the prediction of preterm birth and clinical application including the use of cervical cerclage.
Cerclage, Cervical ; Cervical Length Measurement ; Cervix Uteri ; Female ; Humans ; Mass Screening ; Membranes ; Obstetric Labor, Premature ; Pregnancy ; Pregnant Women ; Premature Birth ; Risk Factors ; Rupture

PURPOSE: To investigate the usefulness of transvaginal ultrasonographic measurement of cervical length in patients with preterm labor for prediction of preterm delivery within 7 days. METHODS: Cervical length was measured by transvaginal ultrasound in 140 women with singleton pregnancies presenting with preterm labor and intact membranes from 24(+0) to 33(+6) weeks of gestation. Other potential predictive factors, such as Bishop score, previous history of preterm delivery, and parity were assessed. RESULTS: The mean gestational age at presentation was 30.5+/-14.7 (range, 24.0 to 33.6) weeks and the mean cervical length was 29.0+/-0.9 (range, 31.0 to 52.1) mm. Delivery within 7 days occurred in 7.9% (11/140). Receiver-operating characteristics (ROC) curves established a cervical length of 25 mm as the most relevant cut off level for prediction of delivery within 7 days. Interval between admission and delivery was significantly short when ultrasonographic cervical length was less than or equal to 25 mm. Logistic regression analysis demonstrated that the significant independent risk factors were cervical length < or =25 mm (OR: 24.64, 95% Cl: 2.97~204.20, P=0.003). CONCLUSION: Ultrasonographic cervical length measurement is a useful tool for prediction of progression to preterm delivery within 7 days with patients with preterm labor.
Cervical Length Measurement ; Female ; Gestational Age ; Humans ; Lipids ; Logistic Models ; Membranes ; Obstetric Labor, Premature ; Parity ; Pregnancy ; Quaternary Ammonium Compounds ; Risk Factors

To establish reference values for the cervical length (CL) measurement by transvaginal ultrasound between 20 and 24+6 weeks of gestation in a large Brazilian population. A retrospective cross-sectional study was performed with 996 singleton pregnancies. The CL measurement (mm) using the transvaginal ultrasound was obtained in a sagittal view and the calipers positioned to measure the linear distance between the triangular area of echodensity at the external os and the internal os. The median±standard deviation and ranges for the CL measurement (mm) was 37.0±10.7 (range, 8 to 51). CL measurement did not modify significantly with gestational age. The observed percentiles for the CL measurement (mm) considering all number case were the following: 5th, 28 mm; 50th, 37 mm; and 95th, 45 mm. Reference values for the CL measurement by transvaginal ultrasound between 20 and 24+6 weeks of gestation in a large heterogeneous Brazilian population were established.
Cervical Length Measurement* ; Cervix Uteri ; Cross-Sectional Studies ; Female ; Gestational Age ; Humans ; Pregnancy ; Pregnancy Trimester, Second* ; Pregnancy* ; Reference Values* ; Retrospective Studies ; Ultrasonography*

OBJECTIVE: We performed prospective longitudinal study to establish reference range for cervical length and evaluate the change in cervix throughout pregnancy in twin pregnancy. METHODS: Fifty-four women of twin pregnancy without history of preterm labor, preterm delivery, cervix cerclage, that delivered at or after 36 weeks were included in this study. Serial measurements of cervical lengths by transvaginal ultrasound exam were performed at 20 weeks of gestation and every 4 weeks (until 28 weeks), every two weeks (until 36 weeks) and every week until delivery. Linear regression analysis was done for statistical analysis. RESULTS: The reference range for cervical length in twin pregnancy was presented as mean, standard deviation and 95% confidence interval of the mean. Cervical length gradually decreased as the gestational age progressed. There was a significant correlation between cervical length measurements and gestational age (Y=71.361-1.336X, r2=0.384, p<0.05). CONCLUSION: We presented the reference range for cervical length in twin pregnancy and evaluated the association between gestational age and cervical length. These results can be used as reference guideline in consecutive assessments of cervical lengths during twin pregnancy.
Cervical Length Measurement ; Cervix Uteri ; Female ; Gestational Age ; Humans ; Linear Models ; Longitudinal Studies ; Obstetric Labor, Premature ; Pregnancy ; Pregnancy, Twin* ; Prospective Studies ; Reference Values* ; Ultrasonography*

OBJECTIVE: To investigate the clinical efficiency of the cervical cerclage for preventing preterm birth in asymptomatic women who showed a shortened cervix at the second trimester ultrasound METHODS: From January 1996 to December 2005, we retrospectively reviewed the medical records of pregnant women who received routine second trimester ultrasound (16~24 gestational weeks) without abdominal pain or bleeding at Cheil general hospital. Women with a short cervical length < or =25 mm were classified into cerclage and expectant group. Women who received cervical cerclage within 1 week after detection of cervical shortening without any change of cervical length and shape were included in cerclage group. Primary outcome was the frequency of delivery before 34 weeks' gestation. Secondary outcome was the most important risk factor for preterm delivery in pregnant women with short cervix. Chi-square test, t-test, and multiple logistic regression analysis were used for statistical analysis. P<0.05 was considered statistically significant. RESULTS: The mean gestational age at ultrasound was 21.6 weeks' gestation. A total of 111 women had short cervix, including 26 that were treated by cerclage and 85 managed expectantly. The proportion of preterm delivery before 34 weeks' gestation was higher in the cerclage group [38% (10 of 26)] than that of the expectant group [20% (17 of 85)], but there was no significant difference (P=0.069). In the univariate analysis, funneling (38% vs 16%, P=0.012) and cervical length < or =15 mm (47% vs 15%, P=0.069) were associated with preterm delivery before 34 weeks' gestation. In the multiple logistic regression analysis, a cervical length < or =15 mm had an adjusted odd ratio of 3.7 (95% CI 1.3~10.6) for preterm delivery before 34 weeks's gestation. CONCLUSIONS: These data suggest that cerclage in asymptomatic woman with a short cervix in the second trimester ultrasound does not prevent preterm delivery before 34 weeks of gestation. Woman with extremely shortened cervical length < or =15 mm needs intensive management for prevention of preterm delivery.
Abdominal Pain ; Cerclage, Cervical ; Cervical Length Measurement ; Cervix Uteri ; Female ; Gestational Age ; Hemorrhage ; Hospitals, General ; Humans ; Logistic Models ; Medical Records ; Pregnancy ; Pregnancy Trimester, Second ; Pregnant Women ; Premature Birth ; Retrospective Studies ; Risk Factors

OBJECTIVE: To assess the predictive capacity of cervical length (CL) measurement underwent during the second trimester ultrasound for prediction preterm birth <32, 34, and 37 weeks of gestation in an unselected risk population. METHODS: A retrospective cohort study was performed with 751 singleton pregnancies between 20 and 24+6 weeks of gestation. The CL measurement (mm) using the transvaginal route was obtained in a sagittal view and the calipers positioned to measure the linear distance between the triangular area of echodensity at the external os and the internal os. To compare the preterm (<37 weeks) and term births (≥37 weeks), we used unpaired t test. We assessed whether the CL measurement was dependent of gestational age by performing a linear regression and assessing the coefficient of determination (R²). We additionally assessed the accuracy of CL measurement to predict preterm birth by assessing the area under receiver operating characteristics curves with its respective confidence intervals (CIs) 95%. RESULTS: Preterm birth <37 weeks was found in 13.6% (102/751) of pregnant women. Short cervix (≤25 mm) was found in 2.7% (20/751) of pregnancies. Only 30% (6/20) of pregnant women with short cervix have used progesterone to prevent preterm birth. There was a weak correlation between CL measurement and gestational age at delivery (R²=0.01, P=0.002). Receiver operating characteristics curve analysis of the ability of CL measurement to predict preterm birth <32, 34, and 37 weeks, showed an area under the curve of 0.693 (95% CI, 0.512 to 0.874), 0.472 (95% CI, 0.353 to 0.591), 0.490 (95% CI, 0.426 to 0.555), respectively. CONCLUSION: There was a weak correlation between CL measurement and gestational age at delivery. In an unselected population, CL measurement screening at 20 to 24+6 weeks of gestation does not seem to be a good predictor of preterm birth.
Cervical Length Measurement* ; Cervix Uteri ; Cohort Studies ; Female ; Gestational Age ; Humans ; Linear Models ; Mass Screening ; Pregnancy ; Pregnancy Trimester, Second* ; Pregnant Women ; Premature Birth* ; Progesterone ; Retrospective Studies ; ROC Curve ; Term Birth ; Ultrasonography

PURPOSE: The aim of this study was to determine the influence of various factors on preterm labor symptoms (PLS) and preterm birth (PB). METHODS: This prospective cohort study included 193 women in the second stage of pregnancy. Multiple characteristics including body mass index (BMI), smoking, and pregnancy complications were collected through a self-report questionnaire. Pregnancy stress and PLS were each measured with a related scale. Cervical length and birth outcome were evaluated from medical charts. Multiple regression was used to predict PLS and logistic regression was used to predict PB. RESULTS: Multiple regression showed smoking experience, pregnancy complications and pregnancy specific stress were predictors of PLS and accounted for 19.2% of the total variation. Logistic regression showed predictors of PB to be twins (OR=13.68, CI=3.72~50.33, p<.001), shorter cervix (<25mm) (OR=5.63, CI=1.29~24.54, p<.05), BMI >25 (kg/m²) (OR=3.50, CI=1.35~9.04, p<.01) and a previous PB (OR=4.15, CI=1.07~16.03, p<.05). CONCLUSION: The results of this study show that the multiple factors affect stage II pregnant women can result in PLS or PB. And preterm labor may predict PB. These findings highlight differences in predicting variables for pretrm labor and for PB. Future research is needed to develop a screening tool to predict the risk of preterm birth in pregnant women.
Body Mass Index ; Cervical Length Measurement ; Cervix Uteri ; Cohort Studies ; Female ; Humans ; Logistic Models ; Mass Screening ; Obstetric Labor, Premature* ; Parturition ; Pregnancy ; Pregnancy Complications ; Pregnancy Trimester, Second* ; Pregnancy* ; Pregnant Women ; Premature Birth* ; Prospective Studies ; Smoke ; Smoking ; Twins

Posterior cervical foraminotomy is an effective surgical technique for the treatment of radicular pain caused by foraminal stenosis or posterolateral herniated discs. The present study was performed to compare the clinical parameters and surgical outcomes of open foraminotomy/discectomy (OF/OFD) and tubular retractor assisted foraminotomy/discectomy (TAF/TAFD) in the treatment of cervical radiculopathy. A total of 41 patients were divided into two groups: 19 patients in Group 1 underwent OF/OFD and 22 patients in Group 2 underwent TAF/TAFD. Among the various clinical parameters, skin incision size, length of hospital stay, analgesic using time, and postoperative neck pain (for the first 4 weeks after the operation) were favorable in Group 2. Surgical outcomes were not different between the two groups. In conclusion, TAF/TAFD should increase patient's compliance and is as clinically effective as much as the OF/OFD.
Adult ; Aged ; Analgesics/therapeutic use ; Cervical Vertebrae/*surgery ; Diskectomy ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Pain Measurement ; Radiculopathy/*surgery/therapy ; Surgical Procedures, Minimally Invasive ; Tomography, X-Ray Computed ; Treatment Outcome