Skip to main content
Erschienen in: Archives of Gynecology and Obstetrics 5/2019

14.03.2019 | Maternal-Fetal Medicine

Can myometrial thickness/cervical length ratio predict preterm delivery in singleton pregnancies with threatened preterm labor? A prospective study

verfasst von: Selen Gürsoy Erzincan, N. Cenk Sayin, Selcuk Korkmaz, Havva Sutcu, Cihan Inan, Isil Uzun Cilingir, Fusun G. Varol

Erschienen in: Archives of Gynecology and Obstetrics | Ausgabe 5/2019

Einloggen, um Zugang zu erhalten

Abstract

Objective

To investigate whether myometrial thickness (MT) to cervical length (CL) ratio could be used in the prediction of preterm birth (PTB) in singleton pregnancies presented with threatened preterm labor (TPL).

Methods

After 48 h of successful tocolysis, MT was measured transabdominally from the fundal, mid-anterior walls and the lower uterine segment (LUS) in 46 pregnancies presented with TPL. MT measurements were divided into CL, individually. The main outcome was PTB before 37 weeks of gestation.

Results

The patients were divided into two groups as women delivered ≥ 37 weeks (38.68 ± 1.01 weeks) (n = 25) and those delivered < 37 weeks (34.28 ± 2.53 weeks) (n = 21). The mean ± SD CL in the preterm delivery group was significantly shorter than the term delivery group (23.77 ± 9.23 vs 29.91 ± 7.03 mm, p < 0.05). Fundal, mid-anterior or LUS MT values were similar in both groups. However, in those who delivered preterm, the ratios of fundal MT-to-CL (p = 0.026) and mid-anterior MT-to-CL (p = 0.0085) were significantly different compared to those delivered at term. The optimal cutoff values for CL, fundal MT-to-CL and mid-anterior MT-to-CL ratios in predicting PTB were calculated as 31.1 mm, 0.19 and 0.20, respectively. Fundal MT-to-CL ratio predicted preterm delivery with 71% sensitivity, 72% specificity, 68% positive and 75% negative predictive values. For mid-anterior MT-to-CL ratio, respective values were 76, 76, 73 and 79%.

Conclusion

Measurement of MT along with CL may offer a promising method in the management of women presented with TPL.
Literatur
2.
Zurück zum Zitat Sotiriadis A, Papatheodorou S, Kavvadias A, Makrydimas G (2010) Transvaginal cervical length measurement for prediction of preterm birth in women with threatened preterm labor: a meta-analysis. Ultrasound Obstet Gynecol 35:54–64CrossRefPubMed Sotiriadis A, Papatheodorou S, Kavvadias A, Makrydimas G (2010) Transvaginal cervical length measurement for prediction of preterm birth in women with threatened preterm labor: a meta-analysis. Ultrasound Obstet Gynecol 35:54–64CrossRefPubMed
3.
Zurück zum Zitat Watson HA, Carter J, Seed PT, Tribe RM, Shennan AH (2017) The QUiPP App: a safe alternative to treat-all strategy for threatened preterm labor. Ultrasound Obstet Gynecol 50:342–346CrossRefPubMed Watson HA, Carter J, Seed PT, Tribe RM, Shennan AH (2017) The QUiPP App: a safe alternative to treat-all strategy for threatened preterm labor. Ultrasound Obstet Gynecol 50:342–346CrossRefPubMed
4.
Zurück zum Zitat van Baaren GJ, Vis JY, Wilms FF, Oudijk MA, Kwee A, Porath MM et al (2018) Cost-effectiveness of diagnostic testing strategies including cervical-length measurement and fibronectin testing in women with symptoms of preterm labor. Ultrasound Obstet Gynecol 51:596–603CrossRefPubMed van Baaren GJ, Vis JY, Wilms FF, Oudijk MA, Kwee A, Porath MM et al (2018) Cost-effectiveness of diagnostic testing strategies including cervical-length measurement and fibronectin testing in women with symptoms of preterm labor. Ultrasound Obstet Gynecol 51:596–603CrossRefPubMed
5.
Zurück zum Zitat Lotfi G, Faraz S, Nasir R, Somini S, Abdeldayem RM, Koratkar R, Alsawalhi N, Ammar A (2017) Comparison of the effectiveness of a PAMG-1 test and standard clinical assessment in the prediction of preterm birth and reduction of unnecessary hospital admissions. J Matern Fetal Neonatal Med 26:1–5 Lotfi G, Faraz S, Nasir R, Somini S, Abdeldayem RM, Koratkar R, Alsawalhi N, Ammar A (2017) Comparison of the effectiveness of a PAMG-1 test and standard clinical assessment in the prediction of preterm birth and reduction of unnecessary hospital admissions. J Matern Fetal Neonatal Med 26:1–5
6.
Zurück zum Zitat Bruijn M, Vis JY, Wilms FF, Oudijk MA, Kwee A, Porath MM et al (2016) Quantitative fetal fibronectin testing in combination with cervical length measurement in the prediction of spontaneous preterm delivery in symptomatic women. BJOG 123:1965–1971CrossRefPubMed Bruijn M, Vis JY, Wilms FF, Oudijk MA, Kwee A, Porath MM et al (2016) Quantitative fetal fibronectin testing in combination with cervical length measurement in the prediction of spontaneous preterm delivery in symptomatic women. BJOG 123:1965–1971CrossRefPubMed
7.
Zurück zum Zitat Bolotskikh V, Borisova V (2017) Combined value of placental alpha microglobulin-1 detection and cervical length via transvaginal ultrasound in the diagnosis of preterm labor in symptomatic patients. J Obstet Gynaecol Res 43:1263–1269CrossRefPubMedPubMedCentral Bolotskikh V, Borisova V (2017) Combined value of placental alpha microglobulin-1 detection and cervical length via transvaginal ultrasound in the diagnosis of preterm labor in symptomatic patients. J Obstet Gynaecol Res 43:1263–1269CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat Roos C, Schuit E, Scheepers HC, Bloemenkamp KW, Bolte AC, Duvekot HJ, APOSTEL-II Study Group et al (2015) Predictive factors for delivery within 7 days after successful 48-hour treatment of threatened preterm labor. AJP Rep 5:e141–e149CrossRefPubMedPubMedCentral Roos C, Schuit E, Scheepers HC, Bloemenkamp KW, Bolte AC, Duvekot HJ, APOSTEL-II Study Group et al (2015) Predictive factors for delivery within 7 days after successful 48-hour treatment of threatened preterm labor. AJP Rep 5:e141–e149CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Hermans FJR, Bruijn MMC, Vis JY, Wilms FF, Oudijk MA, Porath MM et al (2015) Risk stratification with cervical length and fetal fibronectin in women with threatened preterm labor before 34 weeks and not delivering within 7 days. Acta Obstet Gynecol Scand 94:715–721CrossRefPubMed Hermans FJR, Bruijn MMC, Vis JY, Wilms FF, Oudijk MA, Porath MM et al (2015) Risk stratification with cervical length and fetal fibronectin in women with threatened preterm labor before 34 weeks and not delivering within 7 days. Acta Obstet Gynecol Scand 94:715–721CrossRefPubMed
10.
Zurück zum Zitat Patwardhan M, Hernandez-Andrade E, Ahn H, Korzeniewski SJ, Schwartz A, Hassan SS, Romero R (2015) Dynamic changes in the myometrium during the third stage of labor, evaluated using two-dimensional ultrasound, in women with normal and abnormal third stage of labor and in women with obstetric complications. Gynecol Obstet Invest 80:26–37CrossRefPubMedPubMedCentral Patwardhan M, Hernandez-Andrade E, Ahn H, Korzeniewski SJ, Schwartz A, Hassan SS, Romero R (2015) Dynamic changes in the myometrium during the third stage of labor, evaluated using two-dimensional ultrasound, in women with normal and abnormal third stage of labor and in women with obstetric complications. Gynecol Obstet Invest 80:26–37CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Palacio M, Caradeux J, Sánchez M, Cobo T, Figueras F, Coll O, Gratacós E, Cararach V (2018) Uterine cervical length measurement to reduce length of stay in patients admitted for threatened preterm labor: a randomized trial. Fetal Diagn Ther 43:184–190CrossRefPubMed Palacio M, Caradeux J, Sánchez M, Cobo T, Figueras F, Coll O, Gratacós E, Cararach V (2018) Uterine cervical length measurement to reduce length of stay in patients admitted for threatened preterm labor: a randomized trial. Fetal Diagn Ther 43:184–190CrossRefPubMed
12.
Zurück zum Zitat Kagan KO, Sonek J (2015) How to measure cervical length. Ultrasound Obstet Gynecol 45:358–362CrossRefPubMed Kagan KO, Sonek J (2015) How to measure cervical length. Ultrasound Obstet Gynecol 45:358–362CrossRefPubMed
13.
Zurück zum Zitat Degani S, Leibovitz Z, Shapiro I, Gonen R, Ohel G (1998) Myometrial thickness in pregnancy: longitudinal sonographic study. J Ultrasound Med 17:661–665CrossRefPubMed Degani S, Leibovitz Z, Shapiro I, Gonen R, Ohel G (1998) Myometrial thickness in pregnancy: longitudinal sonographic study. J Ultrasound Med 17:661–665CrossRefPubMed
14.
Zurück zum Zitat Durnwald CP, Mercer BM (2008) Myometrial thickness according to the uterine site, gestational age and prior cesarean delivery. J Matern Fetal Neonatal Med 21:247–250CrossRefPubMed Durnwald CP, Mercer BM (2008) Myometrial thickness according to the uterine site, gestational age and prior cesarean delivery. J Matern Fetal Neonatal Med 21:247–250CrossRefPubMed
15.
Zurück zum Zitat Sfakianaki AK, Buhimschi IA, Pettker CM, Magloire LK, Turan OM, Hamar BD, Buhimschi CS (2008) Ultrasonographic evaluation of myometrial thickness in twin pregnancies. Am J Obstet Gynecol 198:530.e1–530.e10CrossRef Sfakianaki AK, Buhimschi IA, Pettker CM, Magloire LK, Turan OM, Hamar BD, Buhimschi CS (2008) Ultrasonographic evaluation of myometrial thickness in twin pregnancies. Am J Obstet Gynecol 198:530.e1–530.e10CrossRef
16.
Zurück zum Zitat Buhimschi CS, Buhimschi IA, Norwitz ER, Sfakianaki AK, Hamar B, Copel JA, Saade GR, Weiner CP (2005) Sonographic myometrial thickness predicts the latency interval of women with preterm premature rupture of the membranes and oligohydramnios. Am J Obstet Gynecol 193(3 Pt 1):762–770CrossRefPubMed Buhimschi CS, Buhimschi IA, Norwitz ER, Sfakianaki AK, Hamar B, Copel JA, Saade GR, Weiner CP (2005) Sonographic myometrial thickness predicts the latency interval of women with preterm premature rupture of the membranes and oligohydramnios. Am J Obstet Gynecol 193(3 Pt 1):762–770CrossRefPubMed
17.
Zurück zum Zitat Buhimschi CS, Buhimschi IA, Malinow AM, Weiner CP (2003) Myometrial thickness during human labor and immediately postpartum. Am J Obstet Gynecol 188:553–559CrossRefPubMed Buhimschi CS, Buhimschi IA, Malinow AM, Weiner CP (2003) Myometrial thickness during human labor and immediately postpartum. Am J Obstet Gynecol 188:553–559CrossRefPubMed
18.
Zurück zum Zitat Hiersch L, Melamed N, Aviram A, Bardin R, Yogev Y, Ashwal E (2016) Role of cervical length measurement for preterm delivery prediction in women with threatened preterm labor and cervical dilatation. J Ultrasound Med 35:2631–2640CrossRefPubMed Hiersch L, Melamed N, Aviram A, Bardin R, Yogev Y, Ashwal E (2016) Role of cervical length measurement for preterm delivery prediction in women with threatened preterm labor and cervical dilatation. J Ultrasound Med 35:2631–2640CrossRefPubMed
19.
Zurück zum Zitat Wagner P, Sonek J, Heidemeyer M, Schmid M, Abele H, Hoopmann M, Kagan KO (2016) Repeat measurement of cervical length in women with threatened preterm labor. Geburtshilfe Frauenheilkd 76:779–784CrossRefPubMedPubMedCentral Wagner P, Sonek J, Heidemeyer M, Schmid M, Abele H, Hoopmann M, Kagan KO (2016) Repeat measurement of cervical length in women with threatened preterm labor. Geburtshilfe Frauenheilkd 76:779–784CrossRefPubMedPubMedCentral
20.
Zurück zum Zitat Berghella V, Palacio M, Ness A, Alfirevic Z, Nicolaides KH, Saccone G (2017) Cervical length screening for prevention of preterm birth in singleton pregnancy with threatened preterm labor: systemic review and meta-analysis of randomized controlled trials using individual patient-level data. Ultrasound Obstet Gynecol 49:322–329CrossRefPubMed Berghella V, Palacio M, Ness A, Alfirevic Z, Nicolaides KH, Saccone G (2017) Cervical length screening for prevention of preterm birth in singleton pregnancy with threatened preterm labor: systemic review and meta-analysis of randomized controlled trials using individual patient-level data. Ultrasound Obstet Gynecol 49:322–329CrossRefPubMed
21.
Zurück zum Zitat Crane JM, Van den Hof M, Armson BA, Liston R (1997) Transvaginal ultrasound in the prediction of preterm delivery: singleton and twin gestations. Obstet Gynecol 90:357–363CrossRefPubMed Crane JM, Van den Hof M, Armson BA, Liston R (1997) Transvaginal ultrasound in the prediction of preterm delivery: singleton and twin gestations. Obstet Gynecol 90:357–363CrossRefPubMed
22.
Zurück zum Zitat Rozenberg P, Rudant J, Chevret S, Boulogne AI, Ville Y (2004) Repeat measurement of cervical length after successful tocolysis. Obstet Gynecol 104(5 Pt 1):995–999CrossRef Rozenberg P, Rudant J, Chevret S, Boulogne AI, Ville Y (2004) Repeat measurement of cervical length after successful tocolysis. Obstet Gynecol 104(5 Pt 1):995–999CrossRef
23.
Zurück zum Zitat Sotiriadis A, Kavvadias A, Papatheodorou S, Paraskevaidis E, Makrydimas G (2010) The value of serial cervical length measurements for the prediction of threatened preterm labour. Eur J Obstet Gynecol Reprod Biol 148:17–20CrossRefPubMed Sotiriadis A, Kavvadias A, Papatheodorou S, Paraskevaidis E, Makrydimas G (2010) The value of serial cervical length measurements for the prediction of threatened preterm labour. Eur J Obstet Gynecol Reprod Biol 148:17–20CrossRefPubMed
24.
Zurück zum Zitat Van Baaren GJ, Vis JY, Wilms FF, Oudijk MA, Kwee A, Porath MM et al (2014) Predictive value of cervical length measurement and fibronectin testing in threatened preterm labor. Obstet Gynecol 123:1185–1192CrossRefPubMed Van Baaren GJ, Vis JY, Wilms FF, Oudijk MA, Kwee A, Porath MM et al (2014) Predictive value of cervical length measurement and fibronectin testing in threatened preterm labor. Obstet Gynecol 123:1185–1192CrossRefPubMed
25.
Zurück zum Zitat Nikolova T, Bayev O, Nikolova N, Di Renzo GC (2015) Comparison of a novel test for placental alpha microglobulin-1 with fetal fibronectin and cervical length measurement for the prediction of imminent spontaneous preterm delivery in patients with threatened preterm labor. J Perinat Med 43:395–402CrossRefPubMed Nikolova T, Bayev O, Nikolova N, Di Renzo GC (2015) Comparison of a novel test for placental alpha microglobulin-1 with fetal fibronectin and cervical length measurement for the prediction of imminent spontaneous preterm delivery in patients with threatened preterm labor. J Perinat Med 43:395–402CrossRefPubMed
26.
Zurück zum Zitat Akins ML, Luby-Phelps K, Mahendroo M (2010) Second harmonic generation imaging as a potential tool for staging pregnancy and predicting preterm birth. J Biomed Opt 15:026020CrossRefPubMedPubMedCentral Akins ML, Luby-Phelps K, Mahendroo M (2010) Second harmonic generation imaging as a potential tool for staging pregnancy and predicting preterm birth. J Biomed Opt 15:026020CrossRefPubMedPubMedCentral
27.
Zurück zum Zitat Guo Y, Long X, Yao S (2015) Correlation between the myometrial thickness in the second trimester and preterm delivery in a prospective study. Zhonghua Fu Chan Ke Za Zhi 50:108–111 (abstract) PubMed Guo Y, Long X, Yao S (2015) Correlation between the myometrial thickness in the second trimester and preterm delivery in a prospective study. Zhonghua Fu Chan Ke Za Zhi 50:108–111 (abstract) PubMed
Metadaten
Titel
Can myometrial thickness/cervical length ratio predict preterm delivery in singleton pregnancies with threatened preterm labor? A prospective study
verfasst von
Selen Gürsoy Erzincan
N. Cenk Sayin
Selcuk Korkmaz
Havva Sutcu
Cihan Inan
Isil Uzun Cilingir
Fusun G. Varol
Publikationsdatum
14.03.2019
Verlag
Springer Berlin Heidelberg
Erschienen in
Archives of Gynecology and Obstetrics / Ausgabe 5/2019
Print ISSN: 0932-0067
Elektronische ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-019-05109-9

Weitere Artikel der Ausgabe 5/2019

Archives of Gynecology and Obstetrics 5/2019 Zur Ausgabe

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.