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Summary We conducted a critical appraisal of published Phase 2 and 3 efficacy trials in relation to the prevention of cervical cancer in women. Our analysis shows the trials themselves generated significant uncertainties undermining claims of efficacy in these data. There were 12 randomised control trials (RCTs) of Cervarix and Gardasil. The trial populations did not reflect vaccination target groups due to differences in age and restrictive trial inclusion criteria. The use of composite and distant surrogate outcomes makes it impossible to determine effects on clinically significant outcomes. It is still uncertain whether human papillomavirus (HPV) vaccination prevents cervical cancer as trials were not designed to detect this outcome, which takes decades to develop. Although there is evidence that vaccination prevents cervical intraepithelial neoplasia grade 1 (CIN1) this is not a clinically important outcome (no treatment is given). Trials used composite surrogate outcomes which included CIN1. High efficacy against CIN1+ (CIN1, 2, 3 and adenocarcinoma in situ (AIS)) does not necessarily mean high efficacy against CIN3+ (CIN3 and AIS), which occurs much less frequently. There are too few data to clearly conclude that HPV vaccine prevents CIN3+. CIN in general is likely to have been overdiagnosed in the trials because cervical cytology was conducted at intervals of 6–12 months rather than at the normal screening interval of 36 months. This means that the trials may have overestimated the efficacy of the vaccine as some of the lesions would have regressed spontaneously. Many trials diagnosed persistent infection on the basis of frequent testing at short intervals, i.e. less than six months. There is uncertainty as to whether detected infections would clear or persist and lead to cervical changes.

Background Cervical cancer is an issue of global health concern, and it seems to be the next epidemic in Sub-Saharan Africa after Human Immunodeficiency Virus (HIV). This study compared the perceptions of susceptibility to cervical cancer and benefits of cervical cancer screening among women diagnosed and those with unknown HIV status and determined the association between socio-demographic factors and HIV status. Methods A cross-sectional study was conducted with 600 women diagnosed with HIV and 600 women with unknown HIV status in the Central Region of Ghana. Convenience sampling was used and a structured interview schedule was the main data collection instrument. Data were analysed using frequencies, percentages, chi-square test and independent samples t-test. Results A high proportion of women diagnosed with HIV 94.8% (n = 569) and those with unknown HIV status 93.5% (n = 561) agreed that “screening can find cervical changes”. Also, 58.0% (n = 348) of women diagnosed with HIV agreed that they have been in polygamous relationships so they may get cervical cancer. There was a statistically significant association between marital status (X2 = 167.071, p = 0.001), religion (X2 = 57.720, p = 0.001), level of education (X2 = 118.997, p = 0.001), employment status (X2 = 782.646, p = 0.001) and HIV status. A comparison of the mean difference for women diagnosed and those with unknown HIV status in relation to perceived benefits of cervical cancer screening showed a statistically significant difference (t = 7.418, df = 1198, p = 0.001). Nonetheless, there was no statistically significant difference in the means for women diagnosed and those with unknown HIV status regarding perceived susceptibility to cervical cancer (t = 0.935, df = 1198, p = 0.351). Conclusions Women with HIV perceived higher benefits of cervical cancer screening. Perception of susceptibility to cervical cancer by women with and those without HIV need to be addressed in efforts to improve their health. Furthermore, interventions for women with HIV should consider some important sociodemographic factors.

Background: Cervical insufficiency is a well documented etiological factor in preterm delivery. This study was conducted to evaluate the efficacy and safety of Emergency cervical cerclage in women who presented with advanced cervical changes such as cervical dilatation and bulging fetal membranes. Materials and Methods: The study was prospective observational study performed in the department of obstetrics and gynaecology CSI Kalyani General Hospital, Chennai, Tamil Nadu over a duration of 18 months. This study included all women who presented in late second trimester with advanced cervical dilatation (2 to 4cms) for whom emergency cervical cerclage was done by McDonald technique. Results: Out of the 15 patients for whom emergency cerclage was performed, 3 had spontanous abortion after cerclage, 6 had PROM and 5 of these patients had term delivery. The time interval between emergency cervical cerclage and delivery was 11 weeks. No surgical complications were reported. The mean gestational age at delivery was 32 weeks. 11 fetuses were live born after the period of viability. 3 of these babies were admitted to NICU. Conclusion: Post emergency cervical cerclage, the outcomes in terms of prolongation of pregnancy, live births and neonatal survival are better. Keywords: Cervical insufficiency, Cervical dilatation, Emergency cerclage, McDonald.

Preterm labor is the leading cause of neonatal mortality and the most common cause for antenatal hospitalization. Approximately 15 million babies are born preterm each year worldwide. Of those, one million babies die before the age of 5, which is 18% of all deaths of children at this age. 35% of early and late neonatal mortality (under 28 days of age) is associated with preterm birth.The pathophysiology of preterm labor includes at least four major pathogenetic mechanisms. The studied components of this process are premature activation of the maternal or fetal hypothalamic-pituitary-adrenal system, inflammation or infection, decidual hemorrhage and pathological overdistension of the uterus. The diagnosis of preterm labor is based on the determination of concomitant regular uterine contractions and cervical changes. Vaginal bleeding and/or rupture of the amniotic membranes only increase the likelihood of this diagnosis. To improve the accuracy of diagnosis and assess the potential risk of preterm birth in the presence of symptoms in pregnant women, it is proposed to use such diagnostic tests as transvaginal ultrasound to measure cervical length; detection in vaginal fluids of fetal fibronectin (fFN), phosphorylated protein-1, which binds insulin-like growth factor (IGFBP-1), placental alpha-microglobulin, the ratio of insulin-like growth factorebinding protein 4 (IBP4) and sex hormoneebinding globulin (SHBG) – PreTRM-test.Correct identification of women in the true preterm labor allows performing appropriate actions, which results in better outcomes for the newborn. These are using of corticosteroids to prevent respiratory distress syndrome (RDS) of the newborn; prevention of group B streptococcal infection; magnesium sulfate to protect the baby’s nervous system; transportation to the institution of the third level of perinatal care, which can provide a newborn with appropriate medical care. Preventative and therapeutic measures for women, which have a high risk of preterm labor, include taking progesterone, cervical cerclage and an application of obstetric pessary.

INTRODUCTION To investigate changes in first trimester cervical elastography, cervical length and endocervical canal width in pregnant women with a history of cervical insufficiency, and further discuss the possibility of using these markers as predictors of cervical insufficiency in early pregnancy. MATERIAL AND METHODS This was an observational ultrasound study of first trimester cervical changes in singleton pregnancies between January 2016 and June 2018. Cervical elastography, cervical length and endocervical canal width were measured during the first trimester. Strain elastography was used to estimate the softness of anterior and posterior cervical lips and was expressed as percentages (strain rate). RESULTS Of the 339 pregnant women enrolled, 24 had a history of cervical insufficiency. The anterior cervical lip was significantly softer in the cervical insufficiency group (strain rate: 0.19% ± 0.05% vs 0.11% ± 0.04%; P < .001). Cervical length was significantly shorter in the cervical insufficiency group (36.3 ± 4.8 mm vs 38.3 ± 3.8 mm; P = .014). Endocervical canal width was significantly wider in the cervical insufficiency group (5.7 ± 1.1 mm vs 5.2 ± 0.7 mm; P = .001). Receiver operating characteristic curve analyses revealed that the optimal cut-off values of anterior cervical lip, cervical length and endocervical canal width to confirm the diagnosis of cervical insufficiency were 0.15%, 35.5 mm and 5.75 mm, respectively. In multivariate logistic regression analysis, significant differences were still observed in anterior cervical strain rate (adjusted odds ratio [OR] 53.78, 95% [confidence interval [CI] 11-270; P < .001) and endocervical canal width (adjusted OR, 5.41, 95% CI,1.2-24.7; P = .029). CONCLUSIONS First trimester cervical elastography is a valuable tool in the assessment of women with a history of cervical insufficiency. The anterior cervical lip was significantly softer in women with a history of cervical insufficiency, and the sensitivity and specificity of anterior cervical lip strain were better than that of cervical length and endocervical canal width.

Background: Cervical cancer is considered one of the most important health problem affecting women health all over the world also it is preventable cancer as soon as it was discover early by cervical cytology using Papanicolaou (Pap) smears as it is an effective means of screening for cervical premalignant and malignant conditions such as Cervical intra-epithelial neoplasia (CIN). So this study aims to detect abnormal premalignant epithelial changes by liquid base Pap stained cervical smear in Taif city of Saudi Arabia. Methodology: Cross sectional study is based on 100 females patients who attended the out-patient Department of Obstetrics and Gynecology in King Faisal hospital were randomly chosen as cross sectional study. Cervical smears were obtained and Pap smears were prepared from patients presenting with different complaints such as vaginal discharge, abnormal menstrual and vaginal bleeding and pain. After fixation and staining, each smear was carefully examined. Results: showed that epithelial cell abnormalities were found in 7% of smears, age rang of the patients was between 20-50 years old and the main complaint was abnormal vaginal discharge. Also our study established the high frequency of abnormal cervical cytology in females used contraception as well as early marriage as a risk factors. Conclusion: In Taif City, a conservative community, premalignant and malignant cervical lesions are relatively high. Pap smear cervical cytology is an easy, safe and effective test for early detection of pre-malignant and malignant lesions of the cervix, thereby allowing clinicians to treat patients early and more effectively.

Objective To evaluate whether women with protracted active phase labor longer than 6 hours have an increased risk of adverse maternal and neonatal outcomes after the implementation of new labor management guidelines. Methods This was a retrospective study of nulliparous, term, singleton, vertex deliveries at Cedars Sinai Medical Center from August 2016 to September 2017. Women were included if they progressed to active phase labor, defined by cervical dilation of 6 cm or more. Women then were divided into three groups based on the time course of cervical change between 6 and 10 cm: 1) normal active phase: cervical change 1 cm or more within 4 hours throughout active labor; 2) mildly protracted active phase: cervical change 1 cm or less over 4-6 hours; and 3) very protracted active phase: cervical change 1 cm or less over 6 hours. Rate of change was assessed between cervical examinations. Primary outcome was a composite of maternal morbidity by study group. Secondary outcome was a composite of neonatal morbidity. We hypothesized that women with very protracted active phase had higher rates of adverse outcomes when compared with normal active phase. Regression analyses were performed to compare maternal and neonatal outcomes by study group. Results There were 2,559 deliveries, of which 2,378 (90.8%) were vaginal deliveries. Composite maternal and neonatal morbidity was higher with longer labor. Maternal morbidity-very protracted active phase (42.0%) compared with normal active phase (22.6%) adjusted odds ratio (aOR) 2.15 (95% CI 1.62-2.86); mildly protracted active phase (39.5%) compared with normal active phase (22.6%) aOR 2.18 (95% CI 1.67-2.84). Neonatal morbidity: very protracted active phase (19.8%) compared with normal active phase (13.8%) aOR 1.38 (95% CI 0.98-1.96); mildly protracted active phase (19.4%) compared with normal active phase (13.8%) aOR 1.44; (95% CI 1.04-1.99). Composite maternal and neonatal morbidity was not different between mildly protracted and very protracted groups. Conclusion Composite maternal morbidity was greater in women with cervical change consistent with mildly protracted (4-6 hours) and very protracted (more than 6 hours) labor compared with cervical change in the normal active phase (less than 4 hours) group. However, composite maternal and neonatal morbidity was not different between mildly protracted and very protracted groups.

Background Human papillomavirus (HPV) infection is the central factor for cervical cancer, whereas epithelial immune mechanisms contribute to the progression of HPV infection and its associated lesions. The authors evaluated the expression of indoleamine 2,3-dioxygenase (IDO) and tryptophan 2,3-dioxygenase (TDO) in cervicovaginal samples from women with normal cervical epithelium or with different degrees of squamous intraepithelial lesions (SILs) and cervical cancer. Methods IDO expression was analyzed by immunocytochemistry in liquid-based cytology samples from 165 women, of whom 42 had cervical changes subclassified as low-grade SIL (n = 6), high-grade SIL (n = 30), or squamous cell carcinoma (SCC) (n = 6), and 123 had negative Papanicolaou smears. IDO and TDO expression also were analyzed by immunohistochemistry, and HPV and other genital pathogens were evaluated by polymerase chain reaction analysis. Results Low IDO expression was observed in normal cervical epithelium irrespective of HPV status. Increased numbers of IDO-positive squamous cells and IDO-positive leukocytes were observed in women with SIL or SCC. TDO expression was detected in leukocytes infiltrating the stroma around intraepithelial or invasive cervical lesions. Higher IDO levels were detected in organotypic epithelial cultures established from keratinocytes transduced with the HPV16 E6/E7 oncoproteins. Conclusions The upregulation of IDO expression in leukocytes and squamous cells in HPV-associated SIL and SCC suggests that immunosuppressive mechanisms involving tryptophan metabolism may have a role in cervical carcinogenesis. Although previous studies have suggested the role of IDO in HPV pathogenesis, this is the first evidence of TDO involvement in the process. Furthermore, the current data emphasize the role of leukocytes, especially neutrophil-like cells, as an IDO source.

Hypothesis: Reciprocal changes in the upper cervical spine correlate with adult TL deformity modifiers. Design: This was a retrospective review. Introduction: The upper cervical spine has remarkable adaptability to wide ranges of thoracolumbar (TL) deformity. Methods: Patients >18 years with adult spinal deformity (ASD) and complete radiographic data at baseline (BL) and 1 year were identified. Patients were grouped into component types of the Roussouly classification system (Type 1: Pelvic incidence [PI] 65°). Patients were categorized by increasing severity of Schwab modifiers at BL (0, +, and ++) and further grouped by regional malalignment moving cranially (P: pelvic only; LP: lumbopelvic; TL: thoracic and LP; C: subaxial and TL). Analysis of variance and Pearson's r assessed changes in BL upper cervical parameters (C0-2, C0 slope, McGregor's Slope [MGS], and CBVA) across groups. Results: A total of 343 ASD patients were analyzed. When grouped by BL Schwab and Roussouly, Group P had the lowest BL disability compared to other Groups, while Roussouley Type 1 correlated with higher BL disability compared to Type 2. Moving cranially up the spine, Group P, Group LP, and Group TL did not differ in C0-2 angle, C0 slope, MGS, or CBVA. Group C had a significantly smaller C0-C2, and more negative MGS, C0 slope, and CBVA than noncervical groups. Type 1 trended slightly higher CBVA and MGS than types 2–4, but no differences in cervical lordosis, C0-C2, or C0S were found. MGS (r = −0.131, P = 0.015), CBVA (r = −0.473, P < 0.001), and C0S (r = −0.099, P = 0.042) correlated most strongly with sagittal vertical axis (SVA) compared to other Schwab modifiers. We found SVA > 34 mm predicted a 1 unit (°°) decrease in MGS (odds ratio [OR]: 0.970 [0.948–0.993], P = 0.010), while cervical SVA >51 mm predicted a 1 unit increase in MGS (OR: 1.25 [1.12–1.38], P < 0.001). Conclusions: Our study suggests that upper cervical alignment remains relatively stable through most broad variations of adult TL deformity. Changes in SVA correlated most with upper cervical changes.

The PROPESS, a controlled-release dinoprostone vaginal delivery system, is a pharmacological cervical ripening intervention and promotes cervical change causing uterine contraction. During insertion of the PROPESS, uterine hyperstimulation could occur and result in fetal heart rate (FHR) abnormality. We report a case of uterine hyperstimulation accompanied with FHR abnormality caused by the PROPESS in a pregnant woman. Postural change, oxygenation, fluid infusion, and the immediate PROPESS removal were ineffective to address the adverse event, so we administered nitroglycerin for acute uterine relaxation. The nitroglycerin resulted in uterine relaxation, and the FHR abnormality was resolved immediately, thereby preventing an emergency cesarean section. Therefore, nitroglycerin could be considered an effective option for uterine hyperstimulation accompanied with FHR abnormality caused by the PROPESS.

The cervix is responsible for maintaining pregnancy, and its timely remodeling is essential for the proper delivery of a baby. Cervical insufficiency, or “weakness”, may lead to preterm birth, which causes infant morbidities and mortalities worldwide. We used a mouse model of pregnancy and term labor, to examine the cervical structure by histology (Masson Trichome and Picrosirius Red staining), immunohistochemistry (Hyaluronic Acid Binding Protein/HABP), and ex-vivo MRI (T2-weighted and diffusion tensor imaging), focusing on two regions of the cervix (i.e., endocervix and ectocervix). Our results show that mouse endocervix has a higher proportion of smooth muscle cells and collagen fibers per area, with more compact tissue structure, than the ectocervix. With advanced gestation, endocervical changes, indicative of impending delivery, are manifested in fewer smooth muscle cells, expansion of the extracellular space, and lower presence of collagen fibers. MRI detected three distinctive zones in pregnant mouse endocervix: (1) inner collagenous layer, (2) middle circular muscular layer, and (3) outer longitudinal muscular layer. Diffusion MRI images detected changes in tissue organization as gestation progressed suggesting the potential application of this technique to non-invasively monitor cervical changes that precede the onset of labor in women at risk for preterm delivery.

Recommendations for cervical cancer screening have had remarkable agreement from a number of medical societies, including the American College of Obstetricians and Gynecologists (ACOG), American Cancer Society (ACS), American Society of Cervical Colposcopy and Pathology (ASCCP), and the US Preventative Services Task Force (USPSTF). Reference to the recommended age for screening may need to be re-examined, in light of current data regarding the comparative age-related incidence of cervical malignancy, especially when recognizing the past utility of screening with exfoliative cytology in reducing subsequent mortality. Age and Cervical Cancer Screening Recommendations The recommendations for cervical cancer screening from the US Preventative Services Task Force (USPSTF), 1 the American College of Obstetricians and Gynecologists (ACOG), 2 the American Society of Colposcopy and Cervical Pathology (ASCCP), and the American Cancer Society (ACS) provide for discontinuation of screening for women over 65 years of age, provided that no previous dysplasia was detected in the past 10 years. However, there may be some important findings in the Surveillance, Epidemiology and End Results (SEER) database, which may be worth examining. For example, according to SEER data, from 2004 -2015, the incidence of cervical cancer in patients aged 65 or over was significantly higher than that of young patients (P

The cervix acts as a dynamic barrier between the uterus and vagina, retaining the fetus during pregnancy and allowing birth at term. Critical to this function, the physical properties of the cervix change, or remodel, but dysfunctional remodeling can lead to preterm birth (PTB). Although cervical remodeling has been studied, the complex 3D cervical microstructure has not been well-characterized. In this complex, dynamic, and heterogeneous tissue microenvironment, the microstructural changes are likely also heterogeneous. Using quantitative, 3D, second-harmonic generation microscopy, we demonstrate that cervical remodeling is not uniform across the cervix; during pregnancy, the collagen fibers orient progressively more perpendicular to the cervical canals in the inner cervical zone, but do not reorient in other regions. Furthermore, regions that are microstructurally distinct early in pregnancy become more similar as pregnancy progresses. We use a finite element simulation to show that heterogeneous regional changes influence cervical funneling, an important marker of increased risk for PTB; the proximal portion of the cervix shows ~6.5x larger radial displacement when fibers in the inner cervical zone are parallel to the cervical canals compared to when fibers are perpendicular to the canals. Our results provide new insights into the microstructural and tissue-level cervical changes that have been correlated with PTB and provide a new explanation for a possible origin of cervical funneling. Funding Information: Kimani C. Toussaint, Ph.D., holds a 2017 Preterm Birth Research Grant from the Burroughs Wellcome Fund (#1017300). Research reported in this publication was partly supported by the National Institute of Biomedical Imaging and Bioengineering of the National Institutes of Health under Award Number T32EB019944. Declaration of Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Ethics Approval Statement: All procedures were approved by the Institutional Animal Care and Use Committee at the University of Illinois at Urbana-Champaign.

Maternal and neonatal outcomes associated with duration of arrest of dilation beyond 4 hours are not well known. In addition, the current definition of arrest does not consider the degree of cervical dilation (6 cm vs 7 cm vs 8 cm vs 9 cm) when arrest occurs.We sought to examine maternal and neonatal outcomes in nulliparous women who achieved the active phase of labor according to the duration they required to achieve a cervical change of at least 1 cm (4 hours vs 4-5.9 hours vs ≥6 hours) beginning at 6, 7, 8 and 9 cm.This was a retrospective cohort study of nulliparous women with term singleton cephalic pregnancies in spontaneous or induced active labor (≥6 cm). To evaluate the effect of labor duration on maternal and fetal outcomes at different degrees of cervical dilation, we categorized women based on time intervals they required to achieve a cervical change of at least 1 cm after membrane rupture ("4 hours," "4-5.9 hours," and "≥6 hours"), and we correlated each time interval with referent cervical dilation status (6 cm, 7 cm, 8 cm, and 9 cm). Maternal and neonatal outcomes were analyzed according to the duration to progress at least 1 cm starting from each degree of cervical dilation. Our primary outcome was a composite of neonatal outcomes, including intensive care unit admission, neonatal death, seizure, ventilator use, birth injury, and neonatal asphyxia. In addition, we examined maternal outcomes. Adjusted odds ratios with 95% confidence intervals were calculated, controlling for predefined covariates.Of 31,505 nulliparous women included in this study, 13,142 (42%), 10,855 (34%), 11,761 (37%), and 17,049 (54%) reached documented cervical dilation of 6, 7, 8, and 9 cm, respectively. At cervical dilation of 6 or 7 cm, the arrest of dilation of4 hours compared with arrest of dilation of 4 to 5.9 hours was associated with decreased risks of adverse maternal outcomes. When cervical dilation was 8 or 9 cm, arrest of dilation of4 hours compared with arrest of dilation of 4 to 5.9 hours was associated with decreased risks of adverse maternal and neonatal outcomes. For example, women starting at a cervical dilation of 8 cm who required4 hours to achieve a cervical change of 1 cm compared with those who required 4 to 5.9 hours had lower rates of cesarean delivery (adjusted odds ratio, 0.40; 95% confidence interval, 0.28-0.55), chorioamnionitis (adjusted odds ratio, 0.42; 95% confidence interval, 0.29-0.60), and the neonatal composite outcome (adjusted odds ratio, 0.51; 95% confidence interval, 0.36-0.72).When cervical dilation is 6 or 7 cm, allowing arrest of dilation of ≥4 hours is reasonable because it was not associated with increased risks of adverse neonatal outcomes. When cervical dilation is 8 or 9 cm, the benefit of allowing arrest of dilation of ≥4 hours should be balanced against the risk of adverse maternal and neonatal outcomes.

Progesterone and oestrogen play important roles during parturition; however, their roles in the uterine cervix during preterm labour and delivery are unknown. We evaluated the serum progesterone and oestrogen levels and changes in their receptors (PR and ER) in the cervix in a cervical excision-associated preterm delivery mouse model. Adult female C57BL/6 mice were divided into four groups: sham, cervical excision (Ex), lipopolysaccharide (LPS) and Ex + LPS. Mating was permitted at 3 weeks post-Ex. On gestation day 16, mice were administered LPS intrauterine (100 µg/100 µL/mouse) or physiological saline (100 µL)

Norms used to describe and evaluate the first stage of labor have been historically based upon data from the middle of the twentieth century. More recent data has characterized the normal first stage of labor differently including that the latent phase of labor is longer not transitioning from latent to active labor until about 6 cm of cervical dilation in a majority of women, regardless of parity or whether labor was spontaneous or induced. Additionally, the amount of time that can take for progress to be made in active labor be longer than previously understood. These two factors would lead to a change in management with the diagnosis of arrest of the first stage of labor being made at 6 cm cervical dilation or beyond in the setting of ruptured membranes and no cervical change for at least 4 h of adequate contractions or 6 h of inadequate contractions.

Rescue cervical cerclage can effectively prolong a nonviable gestation to viability, if done correctly in chosen patients after appropriate counseling. Here, we present a case study of an antenatal woman with advanced cervical changes at 24 weeks who benefited from the rescue cervical cerclage procedure to have a successful pregnancy outcome.

Prematurity is a primary cause of neonatal mortality worldwide. The survivors also suffer long term complications and significant permanent neurodevelopmental disability. It contributes to about 70% of neonatal deaths and 36% of infant mortality. Neonatal mortality can be reduced by appropriate diagnosis, administration of corticosteroids, judiciary use of tocolytics and timely transfer to a centre with neonatal intensive care unit. Only about 10%-30% of cases with symptoms of preterm labor proceed to preterm delivery. Hence, it is necessary to differentiate between true preterm labor and threatened preterm labor (TPTL). The latter is diagnosed with onset of regular uterine contractions (at least one in ten minutes) with minimal or no cervical changes and intact membranes. There is no exact definition of TPTL and it varies between various institutions and countries. Over the last decade, there has been a tremendous development to aid in the prediction of preterm labor. Recently, transvaginal cervical length measurement and presence of fetal fibronectin (ffn) and/or phosphorylated insulin growth factor binding protein - 1 (phIGFBP - 1) in cervical fluid can be used to delineate between true and threatened preterm labor.

Cervical spondylosis(CS), a most common orthopedic diseases, is mainly identified by the doctor’s judgment from the clinical symptoms and cervical change provided by expensive instruments in hospital. Owing to the development of the surface electromyography(sEMG) technique and artificial intelligence, we proposed a convenient non-harm CS intelligent identify method EasiCNCSII, including the sEMG data acquisition and the CS identification. For the convenience and efficiency of data acquisition with the limited testable muscles provided by the sEMG technology, we proposed a data acquisition method based on the relationship between muscle activity pattern, the tendons theory and CS etiology. It is easily performed in less than 20 minutes, even outside the hospital. Faced with the challenge of high-dimension and the weak availability, the 3-tier model EasiAI is developed to intelligently identify CS. The common features and new features are extracted from raw sEMG data in first tier. The EasiRF is proposed in second tier to further reduce the data dimension and improve the performance. With the limited and weakly available data, the gradient boosted regression tree is developed in third tier to effectively identify CS. The EasiAI achieve the best performance with 91.02% in accuracy, 97.14% in sensitivity, and 81.43% in specificity compared with 4 common machine learning classification model, validating the EasiCNCSII effectiveness.

Background: Preterm labor is a major cause of perinatal morbidity and mortality and it might be predicted by assessing the cervical change. Objective: To assess the association between absence of cervical gland area (CGA) and spontaneous preterm labor (SPTL). Materials and Methods: This prospective cohort study was performed on 200 singleton pregnant women with a history of SPTL, second-trimester abortion in the previous pregnancy or lower abdominal pain in current pregnancy. Each patient underwent one transvaginal ultrasound examination between 14-28 wk of gestation. Cervical length was measured and CGA was identified and their relationship with SPTL before 35 and 37 wk gestation was evaluated using STATA software version 10. Results: The mean of cervical length was 36.5 mm (SD=8.4), the shortest measurement was 9 mm, and the longest one was 61 mm. Short cervical length (≤18mm) was significantly associated with SPTL before 35 and 37 wk gestation. Cervical gland area (the hypoechogenic or echogenic area around the cervical canal) was present in 189 (94.5%) patients. Absent of CGA had a significant relationship with SPTL before 35 and 37 wk gestation (p=0.01 and p

Introduction/Background According to the World Health Organization classification, cervical intraepithelial neoplasia (CIN) is a premalignant condition that subdivides into a low-grade (LSIL) and high-grade squamous intraepithelial lesion (HSIL), depending on the degree of involvement of the multi-layer epithelium of the cervix. HSIL progression in invasive cervical cancer is seen in 10% to 40% of patients, which determines the need for accurate diagnosis and subsequent treatment. Methodology We have reviewed the data in the medical literature and summarized the results. Results The treatment of premalignant cervical conditions is determined by various factors such as age, parity, lesion size. Histological verification is a gold standard in the diagnosis of cervical dysplasia. There are a number of benign cervical changes such as atrophy and immaturity of the flat epithelium that can mimic cervical intraepithelial dysplasia. This necessitates the detection of additional diagnostic markers for the differentiation of high-grade intraepithelial changes from benign cervical changes.Differential differentiation resulting from age-induced atrophic processes uses immunohistochemical markers such as p16 and Ki67. Immunohistochemical expression of p16 is associated with dysplastic/neoplastic cells and is not detected in normal cervical epithelium. The extent of expression is dependent on the severity of cervical dysplasia. It is characterized by high sensitivity in the diagnosis of CIN 2 and CIN 3, but not of CIN 1.Quantitation of Ki-67 in the cells located in the two-thirds of the epithelium is specific in the detection of CIN. Atrophic changes affecting the uterine cervix Ki-67 only show sporadic staining of the basal/parabasal cells. Conclusion Morphological analysis remains the gold standard in the diagnosis and determination of the degree of CIN. Concomitant use of the immunohistochemical marker along with the morphological assessment of biopsy material from the cervix increases the diagnostic value and thus the efficacy of the treatment. Disclosure Nothing to disclose.

Delivery progresses while contractions take place and the cervical canal ripens. This phenomenon can be compared to two wheels of a car. Contractions are induced by oxytocic substances, including prostaglandin (PG) F2α and oxytocin, while increased collagen degrading enzyme activity in the cervical canal promotes cervical ripening. These processes are positioned as deliberately programmed physiological inflammatory reactions in normal delivery. Intermediate modulators, including inflammatory cytokines, play the role of upstream regulators. Changes in endocrine profiles and extensive stimulation induce these intermediate modulators. In principle, the mechanism of premature delivery is the same as that of normal delivery. In premature delivery, however, the stimulation of intermediate modulators may cause infection/inflammation, such as chorioamnionitis and uteroplacental insufficiency. Recently, researchers have pointed out that decreased progesterone might induce premature delivery. Infection/inflammation, uteroplacental circulation insufficiency, and changes in hormone profiles that overwhelm the pregnancy-sustaining mechanism are factors that induce premature delivery.

Transvaginal sonography (TVS) is widely used in clinical settings to measure cervical length. The procedure is minimally invasive, and provides objective measurements that can predict the risk of preterm delivery. There are mainly two reasons to perform TVS to measure cervical length during pregnancy. First, it can be used to identify women who are at high risk of preterm delivery during the second trimester. Second, it can be used to evaluate the progression of threatened preterm delivery over time in women who are considered at high risk of preterm delivery based on her obstetric history. As a result, TVS enables early intervention for threatened preterm delivery. However, the measurement of cervical length for threatened preterm delivery has a high negative predictive value and low positive predictive value, particularly for low-risk women. As a result, patients may be overtreated if interventions are performed simply based on the observation of short cervical length. It is therefore important to perform additional examinations to accurately identify women at risk of preterm delivery.

Preterm birth is the leading cause of neonatal mortality and morbidity, as well as the most common reason for antenatal maternal hospitalization. Preterm labor is defined as regular uterine contractions associated with cervical changes (cervical dilatation ≥2 cm and effacement) that start before 37 weeks of gestation. However, the diagnosis of threatened preterm labor is imprecise to identify women who will give birth preterm infants in near future. In the last few decades, more subjective parameters are used, which include cervical length measured by transvaginal ultrasonography, fetal fibronectin concentrations of the cervicovaginal secretions, and the combination of the two tests. Prospective studies show that shorter cervical length (15–30 mm or less) is significantly associated with spontaneous preterm delivery. Systematic reviews show that fetal fibronectin measurement combined with shorter cervical length has a high negative predictive value (>98%) for delivery within 7 days but a low positive predictive value (30–50%). The prenatal caregivers should take full advantage of the high negative predictive value of the combined test for women with threatened preterm birth.

AIM To assess the reproducibility of a semiautomatic quantification tool for cervical stiffness and evaluate the normal changes in cervical elasticity during the three trimesters of pregnancy. METHODS This longitudinal prospective pilot study evaluated cervical elasticity during the three trimesters of pregnancy (11-14, 20-24 and 28-32 weeks) in women with singleton pregnancies. Women with a history of conization, cerclage, cervical Naboth cysts (diameter > 10 mm), cervical tumors, or uterine malformation were excluded. A semiautomatic tool was used to evaluate the stiffness of the whole cervix and the internal and external cervical os with multiple quantitative elasticity parameters and the cervical length (CL) on the sagittal view via transvaginal elastography. Intraclass correlation coefficients (ICC) and Bland-Altman analysis were used to assess intra- and interobserver variability. E-Cervix parameters during the three trimesters were compared using the Friedman test. RESULTS In total, 217 women with 651 strain examinations during the three trimesters were included. The intra- and interobserver ICC for the E-Cervix parameters ranged from 0.947 to 0.991 and 0.855 to 0.989, respectively. There were significant differences in all parameters among the three trimesters. Cervical elasticity showed significant softening and became heterogeneous during the three trimesters. The median CL was significantly shorter in the first trimester than in the second and third trimesters (P = 0.004, P

Preterm birth can be medically-indicated or spontaneous. Almost half of spontaneous preterm deliveries are preceded by preterm labor. Preterm labor is a clinical diagnosis characterized by regular uterine contractions (painful or painless) with concomitant cervical change. This article discusses the prevention and treatment of spontaneous preterm labor utilizing progesterone and tocolytic agents and provides management recommendations in patients with and without a history of prior spontaneous preterm birth.

Introduction: In Brazil, cervical cancer is the fourth leading cause of cancer death. It reached 5,430 deaths in the year 2013, with estimated 16,370 new cases by 2018. Its occurrence has been associated with previous human papillomavirus (HPV) infection for the development of intraepithelial lesions; however, several factors can influence this appearance, including number of sexual partners and infections by other microorganisms. Objective: The profile of women from the city of Caruaru, Pernambuco, Brazil, with atypia, cervical intraepithelial lesions and cancer, was verified. Material and method: Documentary, analytical, retrospective study, carried out through the collection of information in the database of the State Department of Health of Pernambuco, by TabNet, referring to the tests in the laboratory of the municipality of Caruaru, Pernambuco, Brazil. Results: During the study period, 18,466 tests were evaluated. From the samples evaluated, 735 (4.31%) were squamous and glandular atypia, 167 (0.98%) intraepithelial lesions, and one (0.005%) cancer. Coccus, Gardnerella vaginalis and Lactobacilli were the most evident agents in cervical alterations. Discussion: Studies demonstrate the intimate relationship between infectious agents and the development of cervical lesions and cancers. Gardnerella vaginalis was the most frequent agent in the presence of abnormalities was identified as a facilitator of HPV penetration. Conclusion: Women infected by Gardnerella vaginalis and older than 30 years of age are more exposed to the development of alterations. Guidelines on prevention and screening should be continuous strategies in public services. Understanding these risk factors is a paramount concern because they are involved in the prevention and etiology process of cervical lesions and cancer. RESUMEN Introducción: En Brasil, el cáncer de cuello de útero es la cuarta causa de muertepor cáncer, con 5.430 muertes en 2013 y previsión de 16.370 nuevos casos para 2018. Su aparición se asocia a la infección previa por el virus delpapiloma humano (VPH) para el desarrollo de lesiones intraepiteliales; no obstante, diversos factores pueden influenciarle, por ejemplo, número de companeros sexuales e infeccionespor otros microrganismos. Objetivo: Se ha comprobado el perfil de mujeres del municipio de Caruaru, Pernambuco, Brasil, que tenían atipias, lesiones intraepiteliales cervicales y cáncer. Material y método: Investigación documental, analítica, retrospectiva, realizada mediante una encuesta en la base de datos del departamento de salud de Pernambuco, a través de TabNet, relativas a los exámenes en el laboratorio del municipio de Caruaru, Pernambuco, Brasil. Resultados: En el período del análisis, 18.466 exámenes han sido evaluados. De las muestras analizadas, 735 (4,31%) han sido de atipias escamosas y glandulares; 167 (0,98%) de lesiones intraepiteliales; y una (0,005%) de cáncer. Cocos, Gardnerella vaginalis y lactobacilos han sido los agentes más evidentes en las alteraciones cervicales. Discusión: Investigaciones comprueban una relación directa entre agentes infecciosos y el desarrollo de lesiones y cáncer cervical. Gardnerella vaginalis ha sido aquel más frecuente en presencia de anormalidades, pues facilita la invasión por el VPH. Conclusión: Mujeres mayores de 30 anos infectadas por Gardnerella vaginalis representan una exposición importante al desarrollo de alteraciones. Recomendaciones de prevención y tamizaje deben ser estrategias constantes en el serviciopúblico. Conocer estos factores de riesgo es crucial, porque ellos envuelven el proceso de prevención y etiología de las lesiones y del cáncer de cérvix. RESUMO Introdução: No Brasil, o câncer do colo do útero é a quarta causa de morte por câncer. Atingiu 5.430 mortes no ano de 2013, com estimativa de 16.370 novos casos para 2018. Sua ocorrência tem sido associada à infecção prévia pelo papilomavírus humano (HPV) para o desenvolvimento de lesões intraepiteliais, no entanto, vários fatores podem influenciar esse aparecimento, por exemplo, número de parceiros sexuais e infecções por outros microrganismos. Objetivo: Verificou-se o perfil das mulheres do município de Caruaru, Pernambuco, Brasil, com atipias, lesões intraepiteliais cervicais e câncer. Material e método: Estudo documental, analítico, retrospectivo, realizado por meio do levantamento de informações no banco de dados da Secretaria Estadual de Saúde de Pernambuco, pelo TabNet, referentes aos exames no laboratório do município de Caruaru, Pernambuco, Brasil. Resultados: No período do estudo foram avaliados 18.466exames. Das amostras avaliadas, 735 (4,31%) foram atipias escamosas e glandulares; 167 (0,98%), lesões intraepiteliais; e uma (0,005%), câncer. Cocos, Gardnerella vaginalis e lactobacilos foram os agentes mais evidentes nas alterações cervicais. Discussão: Estudos comprovam relação íntima dos agentes infecciosos com o desenvolvimento de lesões e cânceres cervicais. Gardnerella vaginalisfoi o agente mais frequente na presença de anormalidades, sendo identificada como facilitadora da penetração do HPV. Conclusão: Mulheres infectadas por Gardnerella vaginalis com idade acima de 30 anos representam maior exposição ao desenvolvimento de alterações. Orientações quanto à prevenção e ao rastreamento devem ser estratégias constantes nos serviços públicos. Entender esses fatores de risco é primordial, porque eles envolvem o processo de prevenção e etiologia das lesões e do câncer cervical.

Almost all cases of cervical cancer are caused by the human papilloma virus (HPV). Detection of pre-cancerous cervical changes provides a window of opportunity for cure of an otherwise lethal disease when metastatic. With a greater understanding of the biology and natural course of high-risk HPV infections, screening methods have shifted beyond subjective Pap smears toward more sophisticated and objective tactics. This has led to a substantial growth in the breadth and depth of HPV-based cervical cancer screening tests, especially in developed countries without constrained resources. Many low- and middle-income countries (LMICs) have less access to advanced laboratories and healthcare resources, so new point-of-care (POC) technologies have been developed to provide test results in real time, improve the efficiency of techniques, and increase screening adoption. In this Review, we will discuss how novel decentralized screening technologies and computational strategies improve upon traditional methods and how their realized promise could further democratize cervical cancer screening and promote greater disease prevention.

Cervical softness is a critical parameter in pregnancy. Clinically, preterm birth is associated with premature cervical softening and postdates birth is associated with delayed cervical softening. In practice, the assessment of softness is subjective, based on digital examination. Fortunately, objective, quantitative techniques to assess softness, and other parameters associated with microstructural cervical change are emerging. One of these is shear wave speed (SWS) estimation. In principle, this allows objective characterization of stiffness because waves travel more slowly in softer tissue. We are studying SWS in humans and rhesus macaques, the latter in order to accelerate translation from bench to bedside. For the current study, we estimated SWS in ex vivo cervices of rhesus macaques, $n=24$ nulliparous (never given birth) and $n=9$ multiparous (delivered at least one baby). Misoprostol (a prostaglandin used to soften human cervices prior to gynecological procedures) was administered to 13 macaques prior to necropsy (nulliparous: 7; multiparous: 6). SWS measurements were made at predetermined locations from the distal to proximal end of the cervix on both the anterior and posterior cervix, with five repeat measures at each location. The intent was to explore macaque cervical microstructure, including biological and spatial variability, to elucidate the similarities and differences between the macaque and the human cervix in order to facilitate future in vivo studies. We found that SWS is dependent on location in the normal nonpregnant macaque cervix, as in the human cervix. Unlike the human cervix, we detected no difference between ripened and unripened rhesus macaque cervix samples, nor nulliparous versus multiparous samples, although we observed a trend toward stiffer tissue in nulliparous samples. We found rhesus macaque cervix to be much stiffer than human, which is important for technique refinement. These findings are useful for guiding study of cervical microstructure in both humans and macaques.

The diagnosis of cervical insufficiency can be made in women with or without prior pregnancy losses. Cervical insufficiency has been defined by transvaginal ultrasound cervical length

Purpose: The goal of this study was to objectively quantify cervical stiffness in misoprostol users prior to IUC insertion and at follow-up consultation to evaluate the feasibility of assessing cervical stiffness and to study the influence of misoprostol on cervical softening. Materials and Methods: This was a cross-sectional study that evaluated 40 women who wished to use the LNG IUS. These women were evaluated immediately before LNG IUS insertion and 6 weeks later at follow-up consultation. Participants received 200 μg of misoprostol combined with 75 mg of diclofenac in a single tablet orally (Arthrotec forte 75/200®, Pfizer, USA) 6–12 h prior to insertion in “off label” use. On both occasions, cervical stiffness was determined using a novel medical device based on the aspiration technique. The Wilcoxon rank-sum and the Wilcoxon signed-rank test were applied to compare cervical stiffness assessments at insertion of the IUD and at follow-up. Results: For the first time, cervical stiffness was quantitatively assessed in misoprostol users prior to IUD insertion, proving that the aspiration technique enables detection of pharmacologically induced cervical changes, and also that misoprostol has a detectable softening effect on cervical tissue. Conclusion: The clinical value of the detected cervical softening after misoprostol administration remains unclear. Aspiration measurements could be helpful in searching for the ideal candidate, the appropriate route, dosage and interval of misoprostol intake prior to IUC insertion., Ultrasound International Open, 2 (2), ISSN:2199-7152

OBJECTIVE: To assess the association of cervical effacement with the rate of intrapartum cervical change among nulliparous women. METHODS: We conducted a secondary analysis of a prospective trial of intrapartum fetal pulse oximetry. For women who had vaginal deliveries, interval-censored regression was used to estimate the time to dilate at 1-cm intervals. For each given centimeter of progressive cervical dilation, women were divided into those who had achieved 100% cervical effacement and those who had not. The analysis was performed separately for women in spontaneous labor and those who were given oxytocin. RESULTS: A total of 3,902 women were included in this analysis, 1,466 (38%) who underwent labor induction, 1,948 (50%) who underwent labor augmentation (combined for the analysis), and 488 (13%) who labored spontaneously. For women in spontaneous labor, the time to dilate 1 cm was shorter for those who were 100% effaced starting at 4 cm of cervical dilation (P=.01 to

The article presents data about the frequency of the human papilloma virus associated pathology in the world, Europe and the RF increasing each year. The most frequently occurring pathologic states caused by human papilloma virus are provided. It was stated that the problem of HPV-associated diseases concerns not only women but men. The most frequent types of oncogenic viruses causing the malignant pathology of the reproductive system are Type 16 and 18 viruses. Vaccines providing prevention of the cervical cancer are developed for these two types of viruses. The quadrilent vaccine is effective with respect to lesions of the female genital organs and of the vagina in the form of condylomas. The article demonstrates the first results of HPVvaccines in various countries of the world that testify about its high effectiveness for anogenital condylomas and precancer cervical changes, that considerably reduced in populations of such countries as Australia, Germany, Sweden etc. Issues on side effects related to application of both vaccines are discussed. Currently according to the conducted survey studies no safety problems were established for women and men when using quardilent as well as bivalent vaccines. Currently vaccination against HPV is included in national immunization programs in 60 countries of the world, including 6 countries where vaccination of boys is implemented. In December 2014, FDA approved the new vaccine Gardasil-9 for girls and women as well as for boys for prevention of precancer lesions of reproductive organs the effectiveness of which is confirmed by results of international multi-center studies.

Background: Although cervical cancer is preventable, females living with HIV (FLWH) are 3-8 times more at risk compared to females who are HIV negative. Detecting cervical changes at its earliest stages when treatment is most effective is essential to reducing these cancer health disparities among FLWH. Although FLWH are more at risk for developing cervical cancer, many do not adhere to screening guidelines or recommended follow-up care for abnormal results. Therefore, there remains a critical need for increasing community access and reducing structural barriers to cervical cancer screening (including follow-up care for abnormal results) among FLWH. Objective: To describe system integration of existing ASO services and cervical cancer screening evidence-based intervention (EBI) strategies. Methods: We mapped the subsystems of a multi-level systems approach to integrating existing ASO services with cervical cancer EBI strategies to reduce disparities among FLWH. Individual, interpersonal, and organizational variables for our model were obtained from the PI’s (LTW) formative research and a literature review of cervical cancer EBIs. We used the Plectica, a visual mapping software, to build our preliminary model. Our final model will be validated by systems science exerts, healthcare professionals who provide gynecological care to FLWH, and members of the target population (i.e., ASO leaders and employees, FLWH). Results: Our preliminary model denotes the interplay between EBI strategies at the individual, interpersonal and organizational. Successful implementation will increase cervical cancer screening (including follow-up care for abnormal results), which will reduce these cancer health disparities among FLWH. The systems model that we have designed to achieve our program goal is comprised of two balancing loops and one reinforcing loop. Cervical cancer screening represents the stock, whereas adherence and mortality represent the model’s flows. The integration of two ASO subsystems (i.e., STD testing and patient navigation) with EBI strategies provided two strategically located leverage points (STD + HPV self- collected testing) and (patient navigation + follow-up care for abnormal results) for increasing community access to cervical cancer screening for FLWH at the organizational level. Peer navigation was also found to be a strategically located leverage point increasing cervical cancer screening at the interpersonal level. Conclusions: Although EBIs exist, cervical cancer screening via Pap testing alone or Pap/HPV co-testing is suboptimal, as evidence by health disparities among FLWH. An ecological approach is needed to address the complex array of healthcare and other structural barriers that FLWH may encounter when trying to access cervical cancer screening and if need be, follow-up care for abnormal results and treatment. Therefore, a multi-level approach to increasing community access is needed, including the relational dynamics with peer networks at ASOs. Citation Format: Lisa T. Wigfall, Aditi Tomar, Tiffany C. Washington. A systems model of integrating HPV self-sampling and evidence-based intervention strategies for increasing follow-up care for abnormal screening results with existing services at community-based HIV/AIDS service organizations [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-055.

Preterm delivery (PTD) can cause serious health problems and can jeopardize the life of a newborn. Diagnostic imaging of cervix is mostly limited to ultrasound (US), especially transvaginal ultrasound (TVUS) for measuring the cervical length and has shown low sensitivity and specificity for determining the risk of PTD. US viscoelasticity (VE) and photoacoustic (PA) imaging are commonly used quantitative functional imaging modalities which are used in conjunction with US imaging to provide additional information on tissue composition and functionality. Cervical ripening, or shortening and softening of the cervix, is indicative of the stage of the delivery. During the ripening process, the cervical tissue undergoes microstructural changes, such as the disorganization of the collagen network. We developed a tri-modal transvaginal US, PA, and VE imaging system and evaluated this system to monitor phantom and murine cervical changes. Specifically, in this study, we demonstrate the utility of spectroscopic PA (sPA) to monitor cervical tissue hydration and collagen disorganization. The sPA is capable of measuring tissue vascularization and oxygenation, which could serve as valuable biomarkers of cervical insufficiency and ripening. The combined probe can provide a range of clinical biomarkers characterizing the microstructural, functional and molecular changes in the cervical tissue. These biomarkers can potentially enhance the identification and prognosis of patients who are at risk of PTD.

OBJECTIVE To validate the utility of fetal fibronectin (fFN) and cervical length (CL) in predicting preterm delivery among symptomatic nulliparous women. METHODS A retrospective cohort study of nulliparous women who presented with uterine contractions, abdominal pain, or cervical change at 21-34 gestational weeks at Fukushima Medical University Hospital, Japan, between 2008 and 2017. fFN (categorized as 200 ng/dL) and CL (≥15 mm or

Purpose. - Cervical cerclage treatment for cervical changes at mid trimester is a very controversial topic in twins. The aim of the study was to present our maternal and fetal outcomes of mid-trimester cervical cerclage in twin pregnancies. Basic procedures. - This study was performed using data extracted from the medical files of the twin pregnancies whom performed emergency cervical cerclage between January 2012 and March 2018 at Trakya University, Facuty of Medicine, Department of Perinatology. Main findings. - Mean (min.-max.) gestational age at delivery was [27.3 (21-34) weeks]. The median time between cervical cerclage and delivery was 6.4 weeks, while the maximum prolongation of the pregnancy was 11 weeks. The median prolongation period of pregnancy was 4.1 weeks in patients with bulging membranes, but 10 weeks in patients with cervical effacement and cervical shortening. Eight infants died at the neonatal period. Two patients (20%) developed late abortions at 21 and 22 weeks of gestation, and 2 women (20%) delivered extremely premature neonates at the 24th weeks. Overall neonatal mortality rate was 40% (8/20 neonates). Twelve out of twenty were born alive (60%). Principal conclusions. - Despite the lack of randomized controlled trials, it seems reasonable to offer emergency cervical cerclage to twin pregnancies with cervical shortening (

BACKGROUND CONTEXT Reciprocal changes in cervical alignment occur with incremental degrees of adult spinal deformity (ASD) severity, or across different sagittal morphotypes as described respectively by Schwab and Roussouly systems. The extent to which these systems relate changes in the upper cervical spine remains underexplored. PURPOSE To investigate quantitative anatomical relationships with regards to abnormal alignment in the upper cervical spine. STUDY DESIGN/SETTING Retrospective review of a prospective multicenter ASD database. PATIENT SAMPLE A total of 343 patients who met criteria for ASD. OUTCOME MEASURES Cervical alignment parameters (C2-C7 angle, C2 slope, McGregor's Slope, CBVA when available, segmental tilt), Ostrow Disability Index (ODI) METHODS Patients >18 years with ASD (scoliosis≥20°, SVA≥5cm, PT≥25°, or thoracic kyphosis ≥60°) and complete radiographic data at baseline (BL) & 1-year (1Y) were identified. Patients were grouped by BL PI and apex of LL into component types of the Roussouly classification system (Type 1: PI 65°). Patients were categorized by increasing severity of SRS-Schwab modifiers at BL (0, +, ++) and further grouped by anatomical malalignment, moving cranially (P: pelvic only; LP: lumbopelvic; TL: thoracolumbopelvic; C: subaxial & thoracolumbo-pelvic). Analysis of variance (ANOVA) tests assessed differences in BL upper cervical alignment parameters (C0-C2, C0 slope, McGregor's slope, CBVA) and ODI scores across Roussouly and Schwab modifier groups. RESULTS A total of 343 ASD patients were analyzed. Schwab modifiers at BL were as follows: SVA (0: 45.8%, +: 20.3%, ++: 33.9%), PI-LL (0: 42.3%, +: 20.7%, ++: 37.0%), PT (0: 38.6%, +: 36.2%, ++: 25.3%). By Roussouly classification, 4.2% were Type 1, 19.3% were Type 2, 43.1% were Type 3, and 33.3% were Type 4. Moving cranially up the spine, Group P (10.6%), Group LP (54.7%) and Group TL (8.5%) did not differ in C0-C2 angle, C0 slope, MGS or CBVA (all P>0.05). Group C (26.2%) had a significantly smaller C0-C2 angle, and more negative MGS, C0 slope, and CBVA than non-cervical groups. By Roussouly type, Type 1 trended slightly higher CBVA and MGS than types 2-4 without statistical significance (all P>0.05). No differences in CL, C0-C2, or C0S were found between Types 1-4 (all P>0.05). McGregor's slope (r=-0.131, P=0.015), CBVA (r=-0.473, P 34mm predicted a 1 unit(°) decrease in MGS (OR: 0.970 [0.948 – 0.993], p=0.010), while cSVA>51mm predicted a 1 unit increase in MGS (OR: 1.25[1.12-1.38], p CONCLUSIONS Our present study suggests that upper cervical alignment remains relatively stable through most broad variations of adult thoracolumbar deformity. Changes in SVA correlated most with upper cervical changes compared to other TL modifiers. Incremental trends in upper cervical alignment changes were observed as TL deformity extended cranially, with greatest variation in pts who also had subaxial malalignment. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

The cervix shortens and softens as its collagen microstructure remodels in preparation for birth. Altered cervical tissue collagen microstructure can contribute to a mechanically weak cervix and premature cervical dilation and delivery. To investigate the local microstructural changes associated with anatomic location and pregnancy, we used second harmonic generation (SHG) microscopy to quantify the orientation and spatial distribution of collagen throughout cervical tissue from 4 pregnant and 14 non-pregnant women. Across patients, the alignment and concentration of collagen within the cervix was more variable near the internal os, and less variable near the external os. Across anatomic locations, the spatial distribution of collagen within a radial zone adjacent to the inner canal of the cervix was more homogeneous than than that of a region comprising the middle and outer radial zones. Two regions with different collagen distribution characteristics were found. The anterior and posterior sections in the outer radial zone were characterized by greater spatial heterogeneity of collagen than that of the rest of the sections. Overall, collagen of cervical samples from pregnant women trended toward being 8% less aligned on the μm length scale vs. tissue from non-pregnant women; similarly, collagen alignment trended toward decreasing as parity increased. Our findings suggest that the microstructural alignment and distribution of collagen varies with anatomic location within the human cervix. These observed differences in collagen microstructural alignment may reflect local anatomic differences in cervical mechanical properties and function. Our study deepens the understanding of specific microstructural cervical changes in pregnancy and informs investigations of potential mechanisms for normal and premature cervical remodeling.

Background. Colposcopy is subjective and management of young patients with high-grade disease is challenging, as treatments may impair subsequent pregnancies and adversely affect obstetric outcomes. Conservative management of selected patients is becoming more popular amongst clinicians; however it requires accurate assessment and documentation. Novel adjunctive technologies for colposcopy could improve patient care and help individualize management decisions by introducing standardization, increasing sensitivity, and improving documentation. Case. A nulliparous 27-year-old woman planning pregnancy underwent colposcopy following high-grade cytology. The colposcopic impression was of low-grade changes, whilst the Dynamic Spectral Imaging (DSI) map of the cervix suggested potential high-grade. A DSI-directed biopsy confirmed CIN2. At follow-up, both colposcopy and DSI were suggestive of low-grade disease only, and image comparison confirmed the absence of previously present acetowhite epithelium areas. Histology of the transformation zone following excisional treatment, as per patient’s choice, showed no high-grade changes. Conclusion. Digital colposcopy with DSI mapping helps standardize colposcopic examinations, increase diagnostic accuracy, and monitor cervical changes over time, improving patient care. When used for longitudinal tracking of disease and when it confirms a negative colposcopy, it can help towards avoiding overtreatment and hence decrease morbidity related to cervical excision.

Introduction The aim of this study was to analyze how the progression of cervical dilatation in active labor can be predicted by digital assessment in low-risk pregnant women, in spontaneous labor at term. Material and methods This prospective observational study was performed on 328 women with singleton term gestations experiencing midwife-led labor according to local protocols, progressing to full dilatation and spontaneous delivery without any medical intervention. Mixed nonlinear models were adopted to (i) model individual cervical data into centile curves and (ii) calculate the time needed to gain 1 cm in cervical dilatation (TNG1cm) modeled as a function of current dilatation. We correlated the first and the last TNG1cm on parturients with at least four cervical data points. Results TNG1cm showed large variations, both before and after 6 cm. This variability of natural progression of cervical curves described by the 10th and 90th centiles exceeded the differences observed in published curves from cohorts homogeneous for parity, weight and ethnicity. There was no significant correlation between the first and the last TNG1cm. Neonatal base excess was not significantly different in women with TNG1cm 90th centile. Conclusions The rate of cervical dilatation, traced by parsimonious nonlinear mixed models, is largely unpredictable in the case of spontaneous naturally progressing labor, even when possible larger individual variability is excluded by prudent clinical rules. Future research in labor and delivery should be focused on the diagnosis of the causes that lie behind apparently erratic cervical changes.

Aim of the study Aim of the study was to estimate the incidence of unexpected premalignant gynecological lesions in women undergoing vaginal hysterectomy for utero-vaginal prolapse. Material and methods Eighty women with asymptomatic utero-vaginal prolapse were included in this prospective study for vaginal hysterectomy after preoperative preparation and after written informed consent. Women included in this study were screened preoperatively by high vaginal swab, Pap smear, endometrial biopsy and trans-vaginal ultrasound. Surgically removed uteri and ovaries were sent for histopathological examination. Results of histopathological examination as gold standard were compared with conventional gynecological screening methods. Results Histopathological examination of surgically removed uteri and ovaries after vaginal hysterectomy for uterovaginal prolapse showed abnormal findings in 61.25% (49/80) of studied cases (10 chronic cervicitis; 20 cervical intra-epithelial neoplasia-1 [CIN-1]; 5 CIN-2; 2 CIN-3; 10 simple endometrial hyperplasia without atypia and 2 simple serous ovarian cyst). Also, histopathological examination showed premalignant changes in 33.75% (27/80) of studied cases (20 CIN-1; 5 CIN-2 and 2 CIN-3), which mean 50% sensitivity of pre-operative Pap smear to detect premalignant cervical changes. Conclusions Asymptomatic women with utero-vaginal prolapse may have associated premalignant lesions which may not be detected by conventional screening methods, and this should be explained preoperatively for women undergoing surgery, especially if conservative management was considered.

OBJECT Alignment changes in the cervical spine that occur following surgical correction for thoracic deformity remain poorly understood. The purpose of this study was to evaluate such changes in a cohort of adults with thoracic deformity treated surgically. METHODS The authors conducted a multicenter retrospective analysis of consecutive patients with thoracic deformity. Inclusion criteria for this study were as follows: corrective osteotomy for thoracic deformity, upper-most instrumented vertebra (UIV) between T-1 and T-4, lower-most instrumented vertebra (LIV) at or above L-5 (LIV ≥ L-5) or at the ilium (LIV-ilium), and a minimum radiographic follow-up of 2 years. Sagittal radiographic parameters were assessed preoperatively as well as at 3 months and 2 years postoperatively, including the C-7 sagittal vertical axis (SVA), C2–7 cervical lordosis (CL), C2–7 SVA, T-1 slope (T1S), T1S minus CL (T1S-CL), T2–12 thoracic kyphosis (TK), apical TK, lumbar lordosis (LL), pelvic incidence (PI), PI-LL, pelvic tilt (PT), and sacral slope (SS). RESULTS Fifty-seven patients with a mean age of 49.1 ± 14.6 years met the study inclusion criteria. The preoperative prevalence of increased CL (CL > 15°) was 48.9%. Both 3-month and 2-year apical TK improved from baseline (p < 0.05, statistically significant). At the 2-year follow-up, only the C2–7 SVA increased significantly from baseline (p = 0.01), whereas LL decreased from baseline (p < 0.01). The prevalence of increased CL was 35.3% at 3 months and 47.8% at 2 years, which did not represent a significant change. Postoperative cervical alignment changes were not significantly different from preoperative values regardless of the LIV (LIV ≥ L-5 or LIV-ilium, p > 0.05 for both). In a subset of patients with a maximum TK ≥ 60° (35 patients) and 3-column osteotomy (38 patients), no significant postoperative cervical changes were seen. CONCLUSION Increased CL is common in adult spinal deformity patients with thoracic deformities and, unlike after lumbar corrective surgery, does not appear to normalize after thoracic corrective surgery. Cervical sagittal malalignment (C2–7 SVA) also increases postoperatively. Surgeons should be aware that spontaneous cervical alignment normalization might not occur following thoracic deformity correction.

Introduction. Systemic lupus erythematosus (SLE) is a complex disease with variable presentations, course, and prognosis. The female genital tract may be a potential target organ in SLE since cervical inflammation may be associated with disease activity. An increase in cervical dysplasia, a precursor of cervical cancer, has been reported in females with SLE.Aim of the Work. This work aimed to study the prevalence of abnormal cervicovaginal smears in patients with systemic lupus erythematosus (SLE) and to correlate abnormal smear findings with exposure to infection with human papilloma virus (HPV) in SLE patients.Patients and Methods. Thirty-two patients with SLE, fulfilling the 1997 revised criteria for the classification of SLE, were included in this study. They were subjected to full history taking, clinical examination, laboratory investigations, and cervicovaginal smearing. Twenty healthy subjects not known to suffer from any rheumatological disease were used as controls, and they were subjected to cervicovaginal smearing.Results. Four out of 32 SLE patients showed abnormal Pap smears (12.5%) compared to none showing any cervical changes in the control group (0%). Among these 4 patients, 3 were having ASCU and one was having LSIL (HPV).Conclusion. Cervicovaginal smearing is an easy, economic, safe, repeatable, and noninvasive technique for screening and early detection of cervical neoplastic lesions in SLE.

Background: Although cervical dilatation curves are crucial for appropriate management of labor progression, abnormal labor progression and obstetric interventions were included in previous and widely-used cervical dilatation curves. We aimed to describe the cervical dilatation curves of normal labor progression in pregnant Japanese females without abnormal labor progression and obstetric interventions. Methods: We completed retrospective obstetric record reviews on 3172 pregnant Japanese females (parity = 0, n = 1047; parity = 1, n = 1083; parity ≥ 2, n = 1042), aged 20 to 39 years old at delivery, with pregravid body mass indices of less than 30. All patients underwent spontaneous deliveries with term, singleton, cephalic and live newborns of appropriate-for-gestational age birthweight, without adverse neonatal outcomes. We characterized labor progression patterns by examining the relationship between elapsed times from the full dilatation and cervical dilatation stages, and labor durations by examining the distribution of time intervals from one cervical dilatation stage, to the next, and ultimately to the full dilatation. Results: Fastest cervical changes occurred at 6 cm (primiparas) and 5 cm (multiparas) of dilatation. The 95%tile of labor progression took over 3 hours to progress from 6 cm to 7 cm (primiparas), and over 2 hours to progress from 5 cm to 6 cm (multiparas). The 5%tile of traverse time to the full dilatation, during the active phase, was less than 1 hour (primiparas) and 0.5 hours (multiparas). At the end of the active phase, no deceleration phase was observed. Conclusions: Active labor may not start until 5 cm of dilatation. At the beginning of the active phase, cervical dilatation was slower than previously described. These results may reduce opportunities for obstetric interventions during labor progression.