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Several studies were published about cervical pessary, with controversial results. These studies demonstrated that the patient follow-up after pessary insertion is very different between the study centers and the number of pessary insertions per center was often30 cases. This study aims to determine cervical pessary performance in singleton pregnancies with a short cervix based on a single center learning curve.Between 2011 and 2018, 128 singleton pregnancies between 18 and 24 gestational weeks with a short cervix (25 mm) were referred to our clinic. All cases were treated with progesterone, and when available in our supplies (due to low resources) cervical pessary was also offered. Three groups were created for statistical analysis: Group 1 (The learning curve was performed with all cases of pessary plus progesterone, and 30 patients were obtained as the number needed for learning, in our study with two operators. The PTB rate34 weeks was 27.3, 20, and 4.6% in groups 1, 2, and 3, respectively. There was no significant difference between Group 1 and 2 (OR 1.1; 95% CI 0.066 - 18.45;Learning curve and cumulative sum analysis determined that the application and surveillance of at least 30 patients is required to see significant improvements in the primary outcome of PTB34 weeks.

Objectives Short cervical length is a predictor of preterm birth. We evaluated if there were racial differences in variables associated with cervical length in pregnant Brazilian women. Methods Cervical length was determined by vaginal ultrasound in 414 women at 21 weeks gestation. All women were seen at the same clinic and analyzed by the same investigators. Women found to have a short cervix (≤25 mm) received vaginal progesterone throughout gestation. Composition of the vaginal microbiome was determined by analysis of the V1–V3 region of the gene coding for bacterial 16S ribosomal RNA. Demographic, clinical and outcome variables were determined by chart review. Subjects were 53.4% White, 37.2% mixed race and 9.4% Black. Results Pregnancy, medical history and education level were similar in all groups. Mean cervical length was shorter in Black women (28.4 mm) than in White (32.4 mm) or mixed race (32.8 mm) women (p≤0.016) as was the percentage of women with a short cervix (23.1, 12.2, 7.8% in Black, White, mixed race respectively) (p≤0.026). Mean cervical length increased with maternal age in White (p=0.001) and mixed race (p=0.045) women but not Black women. There were no differences in bacterial dominance in the vaginal microbiota between groups. Most women with a short cervix delivered at term. Conclusions We conclude that Black women in Brazil have a shorter cervical length than White or mixed race women independent of maternal age, pregnancy and demographic history or composition of the vaginal microbiome.

INTRODUCTION Amniotic fluid "sludge" has been associated with an increased rate of spontaneous preterm delivery before 35 weeks, a higher frequency of clinical and histologic chorioamnionitis in a high-risk population. Only one study evaluating the use of antibiotics in the presence of amniotic fluid "sludge" showed reduced rates of spontaneous preterm birth at

Made available in DSpace on 2021-06-25T12:36:01Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-27 Bill and Melinda Gates Foundation Brazilian Ministry of Health (DECIT) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) NIH COBRE grant Background: Predictors of spontaneous preterm birth in primigravid women remain undetermined. Aim: We evaluated whether biomarkers in vaginal secretions and/or differences in the dominant bacterium in the vaginal microbiome predicted the risk for spontaneous preterm birth in primigravid women with a cervical length >25mm. Study design: In a prospective study, 146 second trimester pregnant women with their first conception and a cervix >25mm were enrolled. The vaginal microbiome composition was characterized by analysis of 16S ribosomal RNA gene sequences. The concentrations of d- and l-lactic acid, matrix metalloproteinase (MMP) 2, 8 and 9 and tissue inhibitor of metalloproteinase (TIMP) 1 and 2 in vaginal secretions were measured by ELISA. Cervical length was determined by vaginal ultrasonography. Pregnancy outcome data were subsequently collected. There was a spontaneous preterm birth (SPTB) in 13 women (8.9%) while in an additional 8 women (5.5%) preterm delivery was medically indicated. Lactobacillus iners was the dominant vaginal bacterium in 61.5% of women with a SPTB but only in 31.2% of those who delivered at term (p = .0354). The vaginal concentration of TIMP-1 (p = .0419) and L-lactic acid (p = .0495) was higher in women with a SPTB as compared to those who delivered at term. Lactobacillus iners dominance was associated with elevated levels of TIMP-1 (p = .0434) and TIMP-2 (p = .0161) and lower levels of D-lactic acid (p < .0001) compared to when L. crispatus was dominant. Conclusion: In this exploratory study of primigravid women, elevations in vaginal TIMP-1 and L- lactic acid and L. iners dominance in the vaginal microbiome are associated with an increased occurrence of SPTB. Fed Univ Jundiai, Dept Obstet & Gynecol, Sao Paulo, Brazil Univ Fed Sao Paulo, Dept Obstet, Sao Paulo, Brazil Univ Sao Paulo, Inst Trop Med, Sao Paulo, Brazil Univ Idaho, Dept Biol Sci, Moscow, ID 83843 USA Univ Idaho, Inst Bioinformat & Evolutionary Studies, Moscow, ID 83843 USA Univ Fed Ceara, Dept Obstet & Gynecol, Fortaleza, Ceara, Brazil Univ Sao Paulo, Dept Obstet & Gynecol, Sch Med, Sao Paulo, Brazil Weill Cornell Med, Dept Obstet & Gynecol, New York, NY USA Univ Fed Sao Paulo, Dept Prevent Med, Sao Paulo, Brazil Sao Paulo State Univ, Dept Obstet & Gynecol, Sch Med, Botucatu, SP, Brazil Univ Sao Paulo, Inst Trop Med, Virol Lab LIM 52, Sao Paulo, Brazil Sao Paulo State Univ, Dept Obstet & Gynecol, Sch Med, Botucatu, SP, Brazil CNPq: 401626/2013-0 NIH COBRE grant: P30GM103324

Objective The present study aims to determine if the use of cervical pessary plus progesterone in short-cervix (≤ 25 mm) dichorionic-diamniotic (DC-DA) twin pregnancies is equivalent to the rate of preterm births (PBs) with no intervention in unselected DC-DA twin pregnancies. Methods A historical cohort study was performed between 2010 and 2018, including a total of 57 pregnant women with DC-DA twin pregnancies. The women admitted from 2010 to 2012 (n = 32) received no treatment, and were not selected by cervical length (Non-Treated group, NTG), whereas those admitted from 2013 to 2018 (n = 25), were routinely submitted to cervical pessary plus progesterone after the diagnosis of short cervix from the 18th to the 27th weeks of gestation (Pessary-Progesterone group, PPG). The primary outcome analyzed was the rate of PBs before 34 weeks. Results There were no statistical differences between the NTG and the PPG regarding PB Conclusion In DC-DA twin pregnancies with a short cervix, (which means a higher risk of PB), the treatment with cervical pessary plus progesterone could be considered equivalent in several aspects related to PB in the NTG, despite the big difference between these groups.

Objective This study aims to determine the performance of cervical pessary in singleton pregnancies with a short cervix based on the learning curve. Design, Settings, Population, and Methods Between 2011 and 2018, 128 singleton gestation between 18th to 24th weeks with a short cervix (

Objective Does the combined analysis of compounds in vaginal secretions plus vaginal microbiota composition improve the ability to predict risk for spontaneous preterm birth (SPTB) in women with a short cervix. Design Prospective observational study Setting Three hospitals in Brazil Samples Vaginal secretions from 568 women at 21-24 weeks gestation with cervical length measurement. Method Vaginal microbiome composition was determined by analysis of the V1-V3 region of the bacterial 16S ribosomal RNA gene. D- lactic acid and tissue inhibitor of matrix metalloproteinase (TIMP)-1 in vaginal secretions were measured by ELISA. Main outcome measures SPTB in relation to cervical length and dominant vaginal bacteria. Results When Lactobacillus crispatus was the dominant bacterium the concentration of TIMP-1 was lower, and D-lactic acid was higher, than when either L. iners or Gardnerella vaginalis predominated (p 1.5 ng/ml best predicted the absence of L. crispatus dominance. Vaginal levels of TIMP-1 were highest (p = 0.024) and D-lactic acid levels were lowest (p=0.032) in women with the shortest cervical length. The absence of L. crispatus dominance increased the sensitivity for predicting a SPTB from 22.4% to 81.8% or 78.3% in women with a cervical length

Premature birth and its complications are the largest contributors to infant death in the United States and globally. A short cervical length and the depletion of Lactobacillus species are known risk factors for preterm birth. However, in many resource-poor areas of the world, the technology to test for their occurrence is unavailable, and pregnant women with these risk factors are neither identified nor treated. In this study, we used path analysis to gain an unprecedented understanding of interactions between vaginal microbiome composition, the concentrations of various compounds in vaginal secretions, and cervical length. We identified low-cost point-of-care measures that might be used to identify pregnant women at risk for preterm birth. The use of these measures coupled with appropriate preventative or treatment strategies could reduce the incidence of preterm births in poor areas of the world that lack access to more sophisticated diagnostic methods., In many impoverished regions of the world, it may not be possible to assess two major risk factors for preterm birth: a short cervical length and the depletion of vaginal lactobacilli. We determined whether measuring specific compounds in vaginal fluid might be a simple, noninvasive, and cost-effective way to predict the bacteria that dominate the vaginal microbiome and indicate the presence of a shortened cervix (

Objective: To establish reference ranges of the fetal adrenal gland (AG) and fetal zone (FZ) volumes using three-dimensional ultrasound (3DUS).Methods: We performed a prospective cross-sectional study with 204 normal singleton pregnancies between 24 and 37 + 6 weeks of gestation. The fetal AG and FZ volumes were obtained using the virtual organ computer-aided analysis method with a 30° rotation. To establish reference ranges as the function of gestational age (GA), quantile regression was performed with the adjusted coefficient of determination (R2). Intra- and inter-observer repeatability was performed using the intraclass correlation coefficient (ICC).Results: The mean results of fetal AG and FZ values were 0.42 cm3 (0.04–1.22) and 0.10 cm3 (0.02–0.47), respectively. The best-fit quantile regression models for fetal AG and FZ volumes as the function of GA were in first-degree models: AG = −0.937 + 0.041 × GA (R2 = 0.124) and FZ = −0.201 + 0.009 × GA (R2 = 0.127), respectively. We observed good i...

Objective:To investigate whether fetal blood circulation is influenced by the maternal supine position.Methods:The inclusion criteria were good health, a singleton pregnancy, maternal age between 18 and 40 years, gestational age between 36 and 40 weeks, and an agreement to participate in the study. Each participant (n=20) was initially asked to adopt the left lateral position for 5 min, while fetal Doppler measurements were taken of the fetal middle cerebral artery (MCA), umbilical artery (UA), and umbilical vein (UV). Subsequently, they were asked to change to the supine position for Doppler measurements at 5 and at 10 min.Results:When a woman remained in the supine position for 5 min, there was a significant reduction in fetal MCA-pulsatility index (PI) (median 1.70 vs. 1.42, P=0.003). This reduction did not persist after 10 min (median 1.70 vs. 1.65 P=1.0). There was no significant difference between the left lateral and the supine position at 5 and at 10 min in terms of UA-PI (0.853 vs. 0.870 vs. 0.858, P=0.850), UV flow (217 vs. 242 vs. 236 mL/min, P=0.263), and normalized UV flow (72.2 vs. 80.8 vs. 78.8 mL/min/kg, P=0.271).Conclusions:Changing maternal position from the left lateral to the supine position caused a reduction in resistance in fetal MCA and no changes in UA or UV indices. However, despite the changes in cerebral circulation which occurred at 5 min by shifting position, they did not remain for 10 min. The changes may be related to reduction in maternal oxygen saturation as there was no decrease in UV blood flow.