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International Journal of Gynaecology... Oct 2021Cervical cerclage is an intervention which when given to the right women can prevent preterm birth and second-trimester fetal losses. A history-indicated cerclage should...
Cervical cerclage is an intervention which when given to the right women can prevent preterm birth and second-trimester fetal losses. A history-indicated cerclage should be offered to women who have had three or more preterm deliveries and/or mid-trimester losses. An ultrasound-indicated cerclage should be offered to women with a cervical length <25 mm if they have had one or more spontaneous preterm birth and/or mid-trimester loss. In high-risk women who have not had a previous mid-trimester loss or preterm birth, an ultrasound-indicated cerclage does not have a clear benefit in women with a short cervix. However, for twins, the advantage seems more likely at shorter cervical lengths (<15 mm). In women who present with exposed membranes prolapsing through the cervical os, a rescue cerclage can be considered on an individual case basis, taking into account the high risk of infective morbidity to mother and baby. An abdominal cerclage can be offered in women who have had a failed cerclage (delivery before 28 weeks after a history or ultrasound-indicated [but not rescue] cerclage). If preterm birth has not occurred, removal is considered at 36-37 weeks in women anticipating a vaginal delivery.
Topics: Cerclage, Cervical; Cervix Uteri; Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Trimester, Second; Premature Birth
PubMed: 34520055
DOI: 10.1002/ijgo.13835 -
Best Practice & Research. Clinical... Oct 2018Spontaneous preterm birth (SPTB), defined as delivery before 37 weeks' gestation, remains a significant obstetric dilemma even after decades of research in this field.... (Review)
Review
Spontaneous preterm birth (SPTB), defined as delivery before 37 weeks' gestation, remains a significant obstetric dilemma even after decades of research in this field. Although trends from 2007 to 2014 showed the rate of preterm birth slightly decreased, the CDC recently reported the rate of preterm birth has increased for two consecutive years since 2014. Currently, 1 in 10 pregnancies in the US still end prematurely. In this chapter, we focus on the "compartment" of the cervix. The goal is to outline the current knowledge of normal cervical structure and function in pregnancy and the current knowledge of how the cervix malfunctions lead to SPTB. We review the mechanisms by which our current interventions are hypothesized to work. Finally, we outline gaps in knowledge and future research directions that may lead to novel and effective interventions to prevent premature cervical failure and SPTB.
Topics: Animals; Cerclage, Cervical; Cervix Uteri; Female; Humans; Pessaries; Pregnancy; Premature Birth; Progesterone; Progestins; Risk Factors
PubMed: 30314740
DOI: 10.1016/j.bpobgyn.2018.03.007 -
Seminars in Fetal & Neonatal Medicine Apr 2016The cervix functions as a barrier between the uterus and vagina and keeps the uterus closed until term so that the fetus can develop. For delivery the cervix must soften... (Review)
Review
The cervix functions as a barrier between the uterus and vagina and keeps the uterus closed until term so that the fetus can develop. For delivery the cervix must soften and dilate, and finally reconstitute to close the uterus. This complex process involves precisely timed activation of molecular and microstructural events. Spontaneous preterm birth (sPTB) can result from aberrant timing of these events in the cervix. Unfortunately, the pathophysiology of sPTB due to cervical causes remains unclear and thus our treatment options remain limited - even if all appropriate candidates were identified and correctly treated with currently available interventions, the rate of sPTB would only be reduced by 5%. Very recent molecular and microstructural investigation is challenging prevailing concepts about cervical remodeling in pregnancy. We believe that progress toward novel, targeted solutions for the diverse pathways to sPTB entails a paradigm shift in which the overlapping and complex interactions between the cervix, uterus, membranes, fetus, placenta, and surrounding (structural and molecular) environment are suitably honored.
Topics: Cervical Ripening; Cervix Uteri; Early Diagnosis; Female; Humans; Pregnancy; Premature Birth; Prenatal Diagnosis; Uterine Cervical Incompetence
PubMed: 26776146
DOI: 10.1016/j.siny.2015.12.009 -
BMJ Case Reports Jul 2020Cellular angiofibroma is a rare type of benign mesenchymal tumour that arises mostly in middle-aged women. It needs to be distinguished from other neoplasms and has a...
Cellular angiofibroma is a rare type of benign mesenchymal tumour that arises mostly in middle-aged women. It needs to be distinguished from other neoplasms and has a predilection for the vulvovaginal region. To our knowledge, this is the first case of a cervical cellular angiofibroma. A 34-year-old nulligravid woman was referred with a large mass bulging in the fornix posterior. Ultrasound scanning and MRI showed a large solid mass projecting in the pouch of Douglas. Laparoscopic surgical excision was performed. Histopathological examination showed a well-demarcated, unencapsulated tumour, consisting of short fascicles of spindle cells in-between thick-walled medium-sized vessels. On immunohistochemistry, there was strong reactivity with antibodies against CD34 and oestrogen receptor. Angiofibromas are benign mesenchymal tumours mostly occurring in middle-aged women. They can cause abnormal swelling and uterine bleeding and need to be distinguished from other (malignant) neoplasms.
Topics: Adult; Angiofibroma; Cervix Uteri; Female; Humans; Uterine Cervical Neoplasms; Vagina
PubMed: 32675122
DOI: 10.1136/bcr-2020-235241 -
Seminars in Perinatology Dec 2017The process of parturition is poorly understood, but the cervix clearly plays a key role. Because of this, recent research efforts have been directed at objective... (Review)
Review
The process of parturition is poorly understood, but the cervix clearly plays a key role. Because of this, recent research efforts have been directed at objective quantification of cervical remodeling. Investigation has focused on two basic areas: (1) quantification of tissue deformability and (2) presence, orientation, and/or concentration of microstructural components (e.g. collagen). Methods to quantify tissue deformability include strain elastography and shear wave elasticity imaging (SWEI). Methods to describe tissue microstructure include attenuation and backscatter. A single parameter is unlikely to describe the complexities of cervical remodeling, but combining related parameters should improve accuracy of cervical evaluation. This chapter reviews options for cervical tissue characterization.
Topics: Biomechanical Phenomena; Cervix Uteri; Elasticity Imaging Techniques; Female; Gestational Age; Humans; Parturition; Pregnancy; Reproducibility of Results
PubMed: 29191290
DOI: 10.1053/j.semperi.2017.08.006 -
American Journal of Obstetrics &... May 2024In recent years, there has been a significant rise in cases of placenta accreta spectrum, a group of life-threatening placental disorders that can arise during... (Review)
Review
In recent years, there has been a significant rise in cases of placenta accreta spectrum, a group of life-threatening placental disorders that can arise during childbirth. Early detection plays a crucial role in facilitating meticulous delivery planning, ultimately leading to a reduction in mortality and morbidity rates and improved overall outcomes. Although third-trimester ultrasound has traditionally been the primary method for prenatal screening for placenta accreta spectrum, it often falls short in identifying cases or diagnosis is too late for optimal delivery planning. Emerging evidence has highlighted the option of early detection of placenta accreta spectrum indicators during the first trimester of pregnancy. This comprehensive review delves into our current knowledge of sonographic assessment of the uterine cervicoisthmic complex in the first trimester, examining the location and appearance of cesarean scars and exploring first-trimester screening strategies, ultimately paving the way for improved maternal and neonatal outcomes.
Topics: Humans; Placenta Accreta; Pregnancy; Female; Pregnancy Trimester, First; Ultrasonography, Prenatal; Cesarean Section; Cicatrix; Early Diagnosis; Cervix Uteri
PubMed: 38447672
DOI: 10.1016/j.ajogmf.2024.101329 -
Trends in Endocrinology and Metabolism:... Jun 2010Appropriate and timely cervical remodeling is key for successful birth. Premature cervical opening can result in preterm birth which occurs in 12.5% of pregnancies.... (Review)
Review
Appropriate and timely cervical remodeling is key for successful birth. Premature cervical opening can result in preterm birth which occurs in 12.5% of pregnancies. Research focused on the mechanisms of term and preterm cervical remodeling is essential to prevent prematurity. This review highlights recent findings that better define molecular processes driving progressive disorganization of the cervical extracellular matrix. This includes studies that redefine the role of immune cells and identify diverse functions of the cervical epithelia and hyaluronan in remodeling. New investigations proposing that infection-induced premature cervical remodeling is distinct from the normal process are presented. Recent advances in our understanding of term and preterm cervical remodeling provide new directions for investigation and compel investigators to reevaluate currently accepted models.
Topics: Animals; Cervical Ripening; Cervix Uteri; Female; Humans; Labor Stage, First; Parturition; Pregnancy
PubMed: 20172738
DOI: 10.1016/j.tem.2010.01.011 -
The British Journal of Radiology May 2021Currently, ultrasound (US) is a valuable imaging tool for the initial assessment and evaluation of the female genital organs, uterus, and adnexa. However, it is easy to...
Currently, ultrasound (US) is a valuable imaging tool for the initial assessment and evaluation of the female genital organs, uterus, and adnexa. However, it is easy to overlook the uterine cervix while conducting a pelvic US. Uterine cervical lesions may range from benign to malignant in nature. Therefore, meticulous examination with US may play a key role in assessing uterine cervical lesions. Although there is substantial overlap in the US findings across various uterine cervical lesions, some US features, in tandem with clinical characteristics, may suggest a specific diagnosis. Familiarity with the clinical settings and US characteristics of different uterine cervical lesions can support prompt and accurate diagnosis of suspicious lesions. This review article aims to describe the features of US and possible values for distinction of these lesions in the uterine cervix.
Topics: Abortion, Spontaneous; Adolescent; Adult; Carcinoma; Cervix Uteri; Child; Endometriosis; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Polyps; Pregnancy; Pregnancy, Ectopic; Ultrasonography; Uterine Artery; Uterine Cervical Diseases; Uterine Cervical Incompetence; Uterine Neoplasms
PubMed: 33560888
DOI: 10.1259/bjr.20201242 -
Fetal Diagnosis and Therapy 2010Ultrasound may play an important role in the management of labor and delivery. Induction of labor is a common obstetric intervention, performed in about 20% of... (Review)
Review
Ultrasound may play an important role in the management of labor and delivery. Induction of labor is a common obstetric intervention, performed in about 20% of pregnancies. Pre-induction cervical length, measured by transvaginal sonography, has been shown to have a significant association with the induction-to-delivery interval and the risk for cesarean section. In the management of labor there is extensive evidence that digital pelvic examination does not provide accurate assessment of the position and descend of the fetal head both during the first but also in the second stage of labor. Several recent studies using both two- and three-dimensional ultrasound have now described objective measures of progression of the fetal head during labor. In instrumental deliveries an important determinant of a successful and safe use of vacuum and forceps is the correct determination of the fetal head position and appropriate application of the instrument. However, ultrasound studies have shown that digital examination before instrumental delivery fails to identify the correct fetal position in a high proportion of cases. The use of ultrasound is of crucial importance in performing a safe operative delivery and can help in the prediction of whether a vaginal delivery would be successful.
Topics: Cervix Uteri; Delivery, Obstetric; Female; Humans; Labor Presentation; Labor, Induced; Labor, Obstetric; Obstetrical Forceps; Pregnancy; Pregnancy, Prolonged; Ultrasonography; Vacuum Extraction, Obstetrical
PubMed: 20173318
DOI: 10.1159/000287588 -
Journal of Biomechanics Jun 2015Appropriate mechanical function of the uterine cervix is critical for maintaining a pregnancy to term so that the fetus can develop fully. At the end of pregnancy,... (Review)
Review
Appropriate mechanical function of the uterine cervix is critical for maintaining a pregnancy to term so that the fetus can develop fully. At the end of pregnancy, however, the cervix must allow delivery, which requires it to markedly soften, shorten and dilate. There are multiple pathways to spontaneous preterm birth, the leading global cause of death in children less than 5 years old, but all culminate in premature cervical change, because that is the last step in the final common pathway to delivery. The mechanisms underlying premature cervical change in pregnancy are poorly understood, and therefore current clinical protocols to assess preterm birth risk are limited to surrogate markers of mechanical function, such as sonographically measured cervical length. This is what motivates us to study the cervix, for which we propose investigating clinical cervical function in parallel with a quantitative engineering evaluation of its structural function. We aspire to develop a common translational language, as well as generate a rigorous integrated clinical-engineering framework for assessing cervical mechanical function at the cellular to organ level. In this review, we embark on that challenge by describing the current landscape of clinical, biochemical, and engineering concepts associated with the mechanical function of the cervix during pregnancy. Our goal is to use this common platform to inspire novel approaches to delineate normal and abnormal cervical function in pregnancy.
Topics: Animals; Biomechanical Phenomena; Cervix Uteri; Collagen; Female; Humans; Models, Biological; Pregnancy; Premature Birth
PubMed: 25841293
DOI: 10.1016/j.jbiomech.2015.02.065