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Rev Bras Ginecol Obstet. 2015;37(1):10-15
DOI 10.1590/SO100-720320140005202
To determine if the presence of infectious agents in vaginal or cervical content can alter the results of the insulin-like growth factor binding protein-1 (phIGFBP-1) test and the measurement of cervical length (CC) by transvaginal ultrasonography.
A total of 107 pregnant women with a history of spontaneous preterm birth were submitted to the phIGFBP-1 test and to measurement of CC by transvaginal ultrasonography every 3 weeks, between 24 and 34 weeks of gestation. Genital infections were determined immediately before testing. The patients were distributed into four groups (GA, GB, GC, and GD) and the correlation between genital infection and changes in the tests was determined within each group based on the odds ratio (OR) and the Pearson correlation coefficient.
In each group, over 50% of the patients had genital infections (GA 10/17; GB 28/42; GC 15/24; GD 35/53), with bacterial vaginosis being the main alteration of the vaginal flora. Positive results for phIGFBP-1(GA 10/10; GB 18/28; GC 15/15; GD 19/35) and CC≤20 mm (GA 10/10; GB 20/28; GC 10/15; GD 20/35) were obtained more frequently in patients with genital infection in all groups. Nonetheless, when applying the Pearson correlation coefficient we detected a poor correlation between genital infection and positivity for markers.
The presence of changes in the vaginal flora and of other genital infections does not significantly alter the results of phIGFBP-1 and the measurement of cervical length when compared to cases without infection. However, more studies with larger samples are necessary to confirm these results.
Summary
Rev Bras Ginecol Obstet. 2015;37(1):10-15
DOI 10.1590/SO100-720320140005202
To determine if the presence of infectious agents in vaginal or cervical content can alter the results of the insulin-like growth factor binding protein-1 (phIGFBP-1) test and the measurement of cervical length (CC) by transvaginal ultrasonography.
A total of 107 pregnant women with a history of spontaneous preterm birth were submitted to the phIGFBP-1 test and to measurement of CC by transvaginal ultrasonography every 3 weeks, between 24 and 34 weeks of gestation. Genital infections were determined immediately before testing. The patients were distributed into four groups (GA, GB, GC, and GD) and the correlation between genital infection and changes in the tests was determined within each group based on the odds ratio (OR) and the Pearson correlation coefficient.
In each group, over 50% of the patients had genital infections (GA 10/17; GB 28/42; GC 15/24; GD 35/53), with bacterial vaginosis being the main alteration of the vaginal flora. Positive results for phIGFBP-1(GA 10/10; GB 18/28; GC 15/15; GD 19/35) and CC≤20 mm (GA 10/10; GB 20/28; GC 10/15; GD 20/35) were obtained more frequently in patients with genital infection in all groups. Nonetheless, when applying the Pearson correlation coefficient we detected a poor correlation between genital infection and positivity for markers.
The presence of changes in the vaginal flora and of other genital infections does not significantly alter the results of phIGFBP-1 and the measurement of cervical length when compared to cases without infection. However, more studies with larger samples are necessary to confirm these results.
Summary
Rev Bras Ginecol Obstet. 2016;38(3):117-119
Summary
Rev Bras Ginecol Obstet. 2016;38(3):117-119
Summary
Rev Bras Ginecol Obstet. 2009;31(4):203-209
DOI 10.1590/S0100-72032009000400008
Among the clinical factors for preterm birth, some confer substantial increased risk, including a history of preterm birth, multiple gestation and vaginal bleeding in the second trimester. However, these factors are present only in a minority of women who ultimately deliver preterm and thus have low sensitivity. Cervical dilatation, effacement and position as determined by manual examination have been related to an increased risk of preterm birth but also suffer from low sensitivity and positive predictive values. Cervical length measured with transvaginal ultrasound has also been related to an increased risk of preterm birth as cervical length decreases. The reported sensitivity is better than other tests, but positive predictive value is low. The principal utility of the fetal fibronectin assay lies in its negative predictive value in symptomatic women. Increased sensitivity has been reported when cervical length is used in combination with fetal fibronectin.
Summary
Rev Bras Ginecol Obstet. 2009;31(4):203-209
DOI 10.1590/S0100-72032009000400008
Among the clinical factors for preterm birth, some confer substantial increased risk, including a history of preterm birth, multiple gestation and vaginal bleeding in the second trimester. However, these factors are present only in a minority of women who ultimately deliver preterm and thus have low sensitivity. Cervical dilatation, effacement and position as determined by manual examination have been related to an increased risk of preterm birth but also suffer from low sensitivity and positive predictive values. Cervical length measured with transvaginal ultrasound has also been related to an increased risk of preterm birth as cervical length decreases. The reported sensitivity is better than other tests, but positive predictive value is low. The principal utility of the fetal fibronectin assay lies in its negative predictive value in symptomatic women. Increased sensitivity has been reported when cervical length is used in combination with fetal fibronectin.
Summary
Rev Bras Ginecol Obstet. 2014;36(6):264-268
DOI 10.1590/S0100-720320140004935
The aim of this study was to analize and describe some characteristics related to a false diagnosis of intrauterine growth restriction (IUGR).
We retrospectively included 48 pregnant women referred to our service with a suspected diagnosis of IUGR that was not confirmed after birth and we compared them to another group with confirmed IUGR. We then analyzed the characteristics of the false-positive results. The results of the study were divided into continuous and categorical variables for analysis. The χ2test or Fisher exact test was applied to compare proportions. The level of significance was set at p<0.05 for all tests.
In our sample, pregnant women with a false diagnosis of IUGR had the following characteristics: they were referred earlier (mean gestational age of 32.8 weeks); were submitted to 2 to 6 ultrasound examinations before been registered in our service; in 25% of cases ultrasound examination was performed before 12 weeks; in 66.7% of cases the symphysis-fundal height measurement was normal; in 52.1% of cases they had at least 1 sonographic exam above the 10th percentile; on average, the last ultrasound examination (performed on average at 36 weeks) was above the 18th percentile; the women were submitted to a mean number of 5 ultrasound examinations and to a mean number of 4.6 vitality exams.
The false diagnosis of IUGR involves high hospital costs and higher demand for specialists. The symphysis-fundal height measurement must be valued, and the diagnosis of IUGR must be confirmed with ultrasonography in the last weeks of pregnancy before any obstetric management is taken.
Summary
Rev Bras Ginecol Obstet. 2014;36(6):264-268
DOI 10.1590/S0100-720320140004935
The aim of this study was to analize and describe some characteristics related to a false diagnosis of intrauterine growth restriction (IUGR).
We retrospectively included 48 pregnant women referred to our service with a suspected diagnosis of IUGR that was not confirmed after birth and we compared them to another group with confirmed IUGR. We then analyzed the characteristics of the false-positive results. The results of the study were divided into continuous and categorical variables for analysis. The χ2test or Fisher exact test was applied to compare proportions. The level of significance was set at p<0.05 for all tests.
In our sample, pregnant women with a false diagnosis of IUGR had the following characteristics: they were referred earlier (mean gestational age of 32.8 weeks); were submitted to 2 to 6 ultrasound examinations before been registered in our service; in 25% of cases ultrasound examination was performed before 12 weeks; in 66.7% of cases the symphysis-fundal height measurement was normal; in 52.1% of cases they had at least 1 sonographic exam above the 10th percentile; on average, the last ultrasound examination (performed on average at 36 weeks) was above the 18th percentile; the women were submitted to a mean number of 5 ultrasound examinations and to a mean number of 4.6 vitality exams.
The false diagnosis of IUGR involves high hospital costs and higher demand for specialists. The symphysis-fundal height measurement must be valued, and the diagnosis of IUGR must be confirmed with ultrasonography in the last weeks of pregnancy before any obstetric management is taken.
Summary
Rev Bras Ginecol Obstet. 1998;20(6):350-356
DOI 10.1590/S0100-72031998000600008
Objective: to evaluate the uterine cervix by digital and transvaginal ultrasound examinations in pregnant women at high risk of having premature delivery. Methods: during the period between February 1995 and September 1997, 38 pregnant women at high risk of having premature delivery between the 20th and 36th week of gestation were examined. These patients were submitted weekly to both digital and transvaginal ultrasound examinations. The digital examination evaluated the uterine cervix using two parameters: length and dilation. The transvaginal ultrasound studied the length and the anteroposterior diameter of the uterine cervix. The behavior of these cervical measurements was analyzed throughout the pregnancies. The two methods were compared regarding cervical evaluation and accuracy of premature birth diagnosis. Results: the rate of premature deliveries was 18.4% (7/38). Digital examination resulted in cervical evaluations with variation coefficients of 30.3% for length and 193% for dilation. Transvaginal ultrasound resulted in cervical evaluations with variation coefficients of 14.7% and 26.5% for the anteroposterior diameter and length, respectively. The cervical length measures obtained on ultrasound were always greater than those obtained on digital examination. Through analysis with the hypothesis test, an indirect relationship was observed between the cervical length and the gestational period for digital examination and ultrasound study (p<0.05 and p<0.01, respectively), and a direct relationship between the cervical dilation and the gestational age observed on the digital examination (p<0.01). Conclusions: among the parameters studied by means of the digital and transvaginal ultrasound examinations, the ultrasound cervical length presented the best accuracy in the diagnosis of premature birth, proving to be more reliable for the evaluation of cervical alterations in pregnant women at high risk of premature delivery.
Summary
Rev Bras Ginecol Obstet. 1998;20(6):350-356
DOI 10.1590/S0100-72031998000600008
Objective: to evaluate the uterine cervix by digital and transvaginal ultrasound examinations in pregnant women at high risk of having premature delivery. Methods: during the period between February 1995 and September 1997, 38 pregnant women at high risk of having premature delivery between the 20th and 36th week of gestation were examined. These patients were submitted weekly to both digital and transvaginal ultrasound examinations. The digital examination evaluated the uterine cervix using two parameters: length and dilation. The transvaginal ultrasound studied the length and the anteroposterior diameter of the uterine cervix. The behavior of these cervical measurements was analyzed throughout the pregnancies. The two methods were compared regarding cervical evaluation and accuracy of premature birth diagnosis. Results: the rate of premature deliveries was 18.4% (7/38). Digital examination resulted in cervical evaluations with variation coefficients of 30.3% for length and 193% for dilation. Transvaginal ultrasound resulted in cervical evaluations with variation coefficients of 14.7% and 26.5% for the anteroposterior diameter and length, respectively. The cervical length measures obtained on ultrasound were always greater than those obtained on digital examination. Through analysis with the hypothesis test, an indirect relationship was observed between the cervical length and the gestational period for digital examination and ultrasound study (p<0.05 and p<0.01, respectively), and a direct relationship between the cervical dilation and the gestational age observed on the digital examination (p<0.01). Conclusions: among the parameters studied by means of the digital and transvaginal ultrasound examinations, the ultrasound cervical length presented the best accuracy in the diagnosis of premature birth, proving to be more reliable for the evaluation of cervical alterations in pregnant women at high risk of premature delivery.
Summary
Rev Bras Ginecol Obstet. 2004;26(5):383-389
DOI 10.1590/S0100-72032004000500007
OBJECTIVE: to evaluate the measurement of uterine height in order to predict fetal growth restriction (FGR), according to a local curve. METHODS: from July 2000 to February 2003, 238 high-risk pregnant women were submitted to uterine height measurements between the 20th and the 42nd week of gestation. The gestational age of all the women was well known, confirmed by early ultrasound. Fifty (21%) women gave birth to infants considered small for their gestational age. The measures were performed by a single observer, who took 1617 uterine height measurements, from the upper border of the symphysis pubis to the fundus uteri, using tape measurement. The diagnosis of FGR was confirmed after birth according to the Ramos's curve. The women were divided into two groups according to their infant's birth weight and the data were statistically analyzed by the Fisher's exact test or Kruskal-Wallis's test. The sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) were calculated. The test for two proportions with normal approximation was performed to analyze the continuous variables. RESULTS: one measurement below the 10th percentile, according to gestational age, resulted in SE = 78.0%, SP = 77.1%, PPV = 47.6%, and NPV = 88.8% for the identification of FGR. If one measurement was below the 5th percentile, the SE, SP, PPV, and NPV were 64.0, 89.9, 62.7 and 90.4%, respectively. CONCLUSIONS: one measurement below the 10th percentile for the gestational age, according to the local curve, proved to be a good predictor of FGR.
Summary
Rev Bras Ginecol Obstet. 2004;26(5):383-389
DOI 10.1590/S0100-72032004000500007
OBJECTIVE: to evaluate the measurement of uterine height in order to predict fetal growth restriction (FGR), according to a local curve. METHODS: from July 2000 to February 2003, 238 high-risk pregnant women were submitted to uterine height measurements between the 20th and the 42nd week of gestation. The gestational age of all the women was well known, confirmed by early ultrasound. Fifty (21%) women gave birth to infants considered small for their gestational age. The measures were performed by a single observer, who took 1617 uterine height measurements, from the upper border of the symphysis pubis to the fundus uteri, using tape measurement. The diagnosis of FGR was confirmed after birth according to the Ramos's curve. The women were divided into two groups according to their infant's birth weight and the data were statistically analyzed by the Fisher's exact test or Kruskal-Wallis's test. The sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) were calculated. The test for two proportions with normal approximation was performed to analyze the continuous variables. RESULTS: one measurement below the 10th percentile, according to gestational age, resulted in SE = 78.0%, SP = 77.1%, PPV = 47.6%, and NPV = 88.8% for the identification of FGR. If one measurement was below the 5th percentile, the SE, SP, PPV, and NPV were 64.0, 89.9, 62.7 and 90.4%, respectively. CONCLUSIONS: one measurement below the 10th percentile for the gestational age, according to the local curve, proved to be a good predictor of FGR.
Summary
Rev Bras Ginecol Obstet. 2013;35(9):394-400
DOI 10.1590/S0100-72032013000900003
PURPOSE: To investigate the usefulness of the measurement of cervical length and of the test for phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) performed sequentially in the prediction of preterm birth and the correlation between tests. METHODS: We analyzed data from 101 asymptomatic pregnant women with a history of premature delivery. The ultrasound measurement of cervical length and phIGFBP-1 test were performed in parallel every three weeks, between 24 and 34 week. The best cutoff value for each cervical evaluation was established by the ROC curve, and the two tests were compared using nonparametric tests. We determined the sensitivity, specificity and predictive values of each test and of the association of the exams for the occurrence of delivery before the 37th weeks. RESULTS: There were 25 preterm births (24.8%). The cervix length showed the highest sensitivity and was able to predict preterm birth in all evaluations, with similar accuracy at different gestational ages. The test for phIGFBP-1 was not helpful at 24 weeks, but was able to predict prematurity when performed at 27, 30 and 33 weeks. The combination of tests increased the sensitivity (81.8%) and negative predictive value (93.7%) when compared to the separate use of each test. The mean cervical length was lower in women with a positive test. CONCLUSIONS: Both cervical length and the test for phIGFBP-1 were able to predict premature delivery, and sequential combination of both tests showed a high sensitivity and high negative predictive value.
Summary
Rev Bras Ginecol Obstet. 2013;35(9):394-400
DOI 10.1590/S0100-72032013000900003
PURPOSE: To investigate the usefulness of the measurement of cervical length and of the test for phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) performed sequentially in the prediction of preterm birth and the correlation between tests. METHODS: We analyzed data from 101 asymptomatic pregnant women with a history of premature delivery. The ultrasound measurement of cervical length and phIGFBP-1 test were performed in parallel every three weeks, between 24 and 34 week. The best cutoff value for each cervical evaluation was established by the ROC curve, and the two tests were compared using nonparametric tests. We determined the sensitivity, specificity and predictive values of each test and of the association of the exams for the occurrence of delivery before the 37th weeks. RESULTS: There were 25 preterm births (24.8%). The cervix length showed the highest sensitivity and was able to predict preterm birth in all evaluations, with similar accuracy at different gestational ages. The test for phIGFBP-1 was not helpful at 24 weeks, but was able to predict prematurity when performed at 27, 30 and 33 weeks. The combination of tests increased the sensitivity (81.8%) and negative predictive value (93.7%) when compared to the separate use of each test. The mean cervical length was lower in women with a positive test. CONCLUSIONS: Both cervical length and the test for phIGFBP-1 were able to predict premature delivery, and sequential combination of both tests showed a high sensitivity and high negative predictive value.
Summary
Rev Bras Ginecol Obstet. 2009;31(8):415-422
DOI 10.1590/S0100-72032009000800008
The main purpose of using uterulytic in preterm delivery is to prolong gestation in order to allow the administration of glucocorticoid to the mother and/or to accomplish the mother's transference to a tertiary hospital center. Decisions on uterolytic use and choice require correct diagnosis of preterm delivery, as well as the knowledge of gestational age, maternal-fetal medical condition, and medicine's efficacy, side-effects and cost. All the uterolytics have side-effects, and some of them are potentially lethal. Studies suggest that beta-adrenergic receptor agonists, calcium blockers and cytokine receptor antagonists are effective to prolong gestation for at least 48 hours. Among these three agents, atosiban (a cytokine receptor antagonist) is safer, though it presents a high cost. Magnesium sulfate is not efficient to prolong gestation and presents significant side-effects. Cyclooxygenase inhibitors also present significant side-effects. Up till now, there is not enough evidence to recommend the use of nitric oxid donors to inhibit preterm delivery. There is no basis for the use of antibiotics to avoid prematurity in face of preterm labor.
Summary
Rev Bras Ginecol Obstet. 2009;31(8):415-422
DOI 10.1590/S0100-72032009000800008
The main purpose of using uterulytic in preterm delivery is to prolong gestation in order to allow the administration of glucocorticoid to the mother and/or to accomplish the mother's transference to a tertiary hospital center. Decisions on uterolytic use and choice require correct diagnosis of preterm delivery, as well as the knowledge of gestational age, maternal-fetal medical condition, and medicine's efficacy, side-effects and cost. All the uterolytics have side-effects, and some of them are potentially lethal. Studies suggest that beta-adrenergic receptor agonists, calcium blockers and cytokine receptor antagonists are effective to prolong gestation for at least 48 hours. Among these three agents, atosiban (a cytokine receptor antagonist) is safer, though it presents a high cost. Magnesium sulfate is not efficient to prolong gestation and presents significant side-effects. Cyclooxygenase inhibitors also present significant side-effects. Up till now, there is not enough evidence to recommend the use of nitric oxid donors to inhibit preterm delivery. There is no basis for the use of antibiotics to avoid prematurity in face of preterm labor.
