Prediction of preterm birth: the role cervical assessment by ultrasound and cervico-vaginal biomarkers

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Abstract


Preterm delivery (PTB) is one of the most common and serious complications of pregnancy. PTB accounts for approximately 70% of neonatal deaths and is a major cause of neonatal morbidity including respiratory distress syndrome, necrotising enterocolitis and long-term neurological disabilities. Prevention of PTB and its complications include identification among symptomatic women those at high risk of immediate delivery requiring prenatal corticosteroids administration. Transvaginal ultrasonographic evaluation of the cervical length (CL) is predictive of PTB and a value < 15 mm identifies among symptomatic women approximately 70% of women who will deliver within one week. In the range of CL within 15 and 30 mm biomarkers in cervical-vaginal fluids (fetal fibronectin, phosphorylated insulin-like growth factor protein-1, placental alpha-microglobulin-1, cytokines) and other ultrasonographic cervical variables (posterior cervical angle, elastography) improve the identification of women at risk. In asymptomatic women CL can be applied as screening and has been proposed as a universal screening during the second trimester in singleton gestations. The finding of a CL ≤ 25 mm is associated with an increased risk of subsequent PTB with a sensitivity between 30 and 60% that is improved with the combination of biomarkers. Asymptomatic women with a CL ≤ 25 mm should be offered vaginal progesterone treatment for the prevention of preterm birth and neonatal morbidity. The role of cerclage and pessary is still controversial. In this review we discuss the evidence-based role of ultrasonographic cervical assessment and cervicovaginal biomarkers in the prediction of PTB in symptomatic and asymptomatic women.


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About the authors

Giuseppe Rizzo

University of Roma Tor Vergata; The First I.M. Sechenov Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: giuseppe.rizzo@uniroma2.it
ORCID iD: 0000-0002-5525-4353
Scopus Author ID: 7102724281
Mendeley Profile: https://www.mendeley.com/impact/giuseppe-rizzo3/

Italy, Rome; Moscow

MD, PhD, Professor

Ilenia Mappa

Unive rsity of Roma Tor Vergata

Email: mappa.ile@gmail.com

Italy, Rome

Assistant

Victoria O. Bitsadze

The First I.M. Sechenov Moscow State Medical University (Sechenov University)

Email: vikabits@mail.ru
ORCID iD: 0000-0001-8404-1042
SPIN-code: 5930-0859
Scopus Author ID: 6506003478
Mendeley Profile: https://www.mendeley.com/profiles/victoria-bitsadze/

Russian Federation, Trubetskaya str. 8-2, 119991 Moscow

MD, PhD, Professor

Jamilya Kh. Khizroeva

The First I.M. Sechenov Moscow State Medical University (Sechenov University)

Email: jamatotu@gmail.com
ORCID iD: 0000-0002-0725-9686
SPIN-code: 8225-4976
Scopus Author ID: 57194547147
ResearcherId: F-8384-2017
Mendeley Profile: https://www.mendeley.com/impact/jamilya-khizroeva2/

Russian Federation, Trubetskaya str. 8-2, 119991 Moscow

MD, PhD, Professor

Alexander D. Makatsariya

The First I.M. Sechenov Moscow State Medical University (Sechenov University)

Email: gemostasis@mail.ru
ORCID iD: 0000-0001-7415-4633
SPIN-code: 7538-2966
Scopus Author ID: 6602363216
Mendeley Profile: https://www.mendeley.com/profiles/alexander-makatsariya1/
https://internist.ru/lectors/detail/makatsariya-/

Russian Federation, Trubetskaya str. 8-2, 119991 Moscow

MD, PhD, Professor

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Supplementary files

Supplementary Files Action
1.
Figure: 1. An example of a normal cervix - the internal and external pharynx is visualized and a measurement is made along the cervical canal, resulting in a cervical length of 31 mm

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2.
Figure: 2. An example of a short cervix, its length - 18 mm

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3.
Figure: 3. An example of a funnel-shaped cervix (indicated by an arrow)

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4.
Figure: 4. An example of a normal posterior angle of the cervix

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5.
Figure: 5. An example of an abnormal posterior cervical angle

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6.
Figure: 6. Elastography of the cervix - a color map of elastography deformation, elastogram with hard (blue) and soft (red) tissue1

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7.
Figure: 7. Distribution of the length of the cervix in women with suspected threatening premature birth

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8.
Figure: 8. Scheme of symptomatic management of women with preterm labor, depending on the length of the cervix

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