Objectives: To determine the diagnostic performance of 16S rDNA nanopore sequencing method for the identification of intra-amniotic infection.Methods: We performed a prospective cohort study including 56 singleton pregnancies presenting with preterm labour.Amniotic fluid (AF) samples were obtained for the evaluation of bacteria in the amniotic cavity using cultivation and 16S rDNA Sanger sequencing methods.Participants were classified according to the results of AF culture, 16S Sanger sequencing and AF interleukin (IL)-6 concentration into four groups: 1) no intra-amniotic inflammation (AF IL-6 <2.6 ng/mL); 2) microbial invasion of the amniotic cavity (MIAC); 3) sterile intra-amniotic inflammation (AF IL-6 ≥2.6 ng/mL without MIAC); 4) intra-amniotic infection (AF IL-6 ≥2.6 ng/mL with MIAC).Nanopore sequencing was performed.Results: 1) A positive 16S nanopore sequencing had a sensitivity of 88.89%, specificity of 80.9%, positive predictive value of 47.1%, negative predictive value of 97.4%, positive likelihood ratio 4.6 (95% CI 2.5-8.7), and negative likelihood ratio 0.14 (95% CI 0.02-0.88)for the identification of intra-amniotic infection; 2) About 10 of 56 samples showed discordant results, of these 1 was false negative and 9 were false positive; 3) Among nine cases with false-positive nanopore sequencing results, two cases were classified as MIAC by positive 16S Sanger sequencing results, 3 cases were categorised in sterile intra-amniotic inflammation group.The remaining 4 cases had no intra-amniotic inflammation; and 4) Nanopore sequencing additionally detect bacteria in 21.4% of patients with sterile intra-amniotic inflammation.Conclusions: Nanopore sequencing is advantageous in detection speed with high sensitivity and negative predictive value for the identification of intra-amniotic infection.False-positive nanopore cases without intra-amniotic inflammation represent contamination.We confirmed that a subset of women with preterm/preterm PROM has sterile intra-amniotic inflammation despite deep a long read sequencing technique.
To determine whether growth rate of crown–rump length (CRL) in the first trimester is associated with abnormal birth weight. This retrospective cohort study included 680 consecutive women with singleton pregnancies who had fetal CRL measurements both at 7 + 0 - 9 + 6 weeks and subsequently at 10 + 0 - 13 + 6 weeks, which were done at least 2 weeks apart. The CRL growth rate was defined as millimeters of growth in CRL per day between the two measurements. The main outcome measures were small for gestational age (SGA) and large for gestational age (LGS) at birth. Multinominal logistic regression was used to control for confounders. SGA and LGA occurred in 6.0% and 8.5% of the population, respectively. Based on univariate analysis, the SGA group had significantly lower CRL growth rates than the AGA or LGA groups, while no significant differences in CRL growth rate were observed between the LGA and AGA groups. Maternal body mass index (BMI) differs significantly among the three groups. In the multinominal logistic regression analysis, CRL growth rate was a significant predictor of SGA neonates after adjustment for maternal BMI. However, CRL growth rate was not a significant predictor of LGA neonates in multinominal logistic regression, while only maternal BMI made a significant independent contribution. The low growth rates of CRL in the first trimester were independently associated with an increased risk of SGA. However, LGA neonates at birth do not appear to have high growth rates of CRL in the first trimester.
To identify the clinical and sonographic parameters at mid-trimester which predict the risk of Cesarean delivery in labor for nulliparas. This prospective observational study enrolled consecutive nulliparas with singleton low-risk pregnancies at 20.0–24.6 weeks gestation. All patients underwent obstetrical ultrasound for fetal biometry and cervical length measurement. The clinical parameters studied were maternal age, height, and current weight. The sonographic parameters included fetal biometric ratio (abdominal circumference [AC]/biparietal diameter [BPD] and AC/femur length [FL]) and cervical length. Regression model controlled for gestational age at delivery, weight gain in mid and late pregnancy, birth weight, induction of labor, and use of epidural analgesia. Seven hundred sixteen women who ultimately delivered a live infant in labor at term were analyzed; 73 women (10%) underwent an emergency Cesarean delivery in labor. The women who had Cesarean delivery were significantly shorter and more likely to have an excessive weight gain in mid and late pregnancy as compared to those who had a vaginal delivery. However, no significant differences existed with respect to the mean cervical length, the mean age, the mean maternal weight, the mean AC/BPD ratio, and the mean AC/FL ratio. Logistic regression analysis demonstrated that only maternal height provided a significant contribution in predicting the risk of Cesarean delivery. At mid-trimester, only maternal height appears to predict the risk of Cesarean delivery for nulliparas; sonographic measurement of the cervical length and the fetal biometric ratio considered are not predictive of Cesarean delivery.
To determine whether sonographic short cervix at mid-trimester is associated with an increased risk of the development of histologic chorioamnionitis and funisitis in asymptomatic women who subsequently had spontaneous preterm delivery (<37.0 weeks). This is a retrospective cohort study of 135 consecutive women with spontaneous preterm delivery before 37 weeks who underwent routine cervical length assessment between 19 and 25 weeks of gestation. Two groups of women were identified and compared: those with a mid-trimester sonographically short cervix and those without evidence of cervical shortening. Women with multiple gestation, cerclage, and indicated preterm delivery without labour were excluded. The placentas were examined histologically after delivery. The data were analyzed at cutoff cervical lengths of 25, 20, and 15 mm to define a short cervix. A short mid-trimester cervical length (<2.5 cm) was found in 9.6% (13/135) of women with spontaneous preterm delivery. Maternal demographic characteristics were not significantly different between the two groups. Women with mid-trimester cervical shortening had significantly higher rates of both histologic chorioamnionits and funisitis, as compared to women without mid-trimester cervical shortening. In multivariable linear regression, both a short cervix and histologic chorioamnionitis were significantly associated with gestational age at birth. In asymptomatic women at mid-trimester who subsequently delivered prematurely, a short cervix is associated with an increased risk of subsequent histologic chorioamnionitis and funisitis. Both a short cervix and histologic chorioamnionitis were independently associated with gestational age at birth. These data suggest that earlier gestational age at birth associated with a short mid-trimester cervix is not merely due to intra-uterine infection.
To evaluate the predictive value of maternal weight, Bishop score, and sonographically measured cervical length at 37 weeks' gestation for predicting the risk of intrapartum Cesarean delivery in parous women with prior vaginal delivery. This prospective observational study recruited parous women with singleton pregnancies with previous vaginal delivery at 37 weeks' gestation. Transvaginal ultrasound for measurement of the cervical length was performed and the Bishop score was determined by digital examination. The data collected at enrollment included maternal weight, height and age. A regression model was constructed with control for known intra- and post-partum confounders. Five hundred twenty women were analyzed; 6 women (1.2%) underwent Cesarean delivery in labor. Based on univariate analysis, the maternal weight at 37 weeks was significantly associated with the risk for intrapartum cesarean delivery in parous women, whereas cervical length, Bishop score, maternal age and height at 37 weeks, epidural anesthesia, labor induction, and birth weight were not associated. Multiple logistic regression demonstrated that only maternal weight at 37 weeks provided a significant contribution in predicting intrapartum cesarean delivery. To predict cesarean delivery in labor, the best cut-off value of maternal weight was 72.4 kg, with a sensitivity of 83.3% and a specificity of 79.8%. Maternal weight at 37 weeks' gestation independently predicted the risk of intrapartum Cesarean delivery in parous women with prior vaginal delivery. However, the sonographic measurement of the cervical length and Bishop score were not predictive of Cesarean delivery.
To evaluate whether an increased sonographic cervical length at mid-trimester is associated with an increased risk of failed labour induction and to compare cervical length measurements at mid-trimester and at the time of induction of labour. This is a retrospective cohort study including 518 singleton pregnant women who underwent cervical length screening between 19 and 24 weeks of gestations and underwent induction of labour at 33 completed weeks of gestations or later. Ultrasound measurements of the cervical length were performed both at mid-trimester and at the time of induction. Primary outcome was induction failed. A multivariate analysis was conducted, with control for known confounding factors associated with the failed induction of labour. Labor induction failed in 23.9 %. Women failed to induce labour had significantly longer cervical lengths at mid-trimester and at labour induction, a higher proportion of nulliparity and a higher body mass index, and earlier gestational age at induction than those who induced labour successfully. Multivariate analysis demonstrated that cervical length at mid-trimester was significantly associated with failed induction of labour after adjustment for body mass index, gestational age at induction and parity. The area under curve for the cervical length at labour induction was a significantly larger than that for the cervical length at mid-trimester. However, neither cervical length at mid-trimester nor cervical length at the time of induction was associated with the risk of Caesarean delivery in univariate and multivariate analysis. Increased cervical length at mid-trimester is independently associated with an increased risk of failed labour induction. However, cervical length at mid-trimester appeared to have a less predictive value for the risk of failed induction than that at the time of induction.
To develop a model based on clinical and ultrasound parameters to predict the risk of Cesarean delivery after induction of labor in twin gestations. The study population consisted of 141 consecutive women with twin gestations at > 36.0 weeks of gestation who were scheduled for induction of labor. Seventy-four patients were prospectively recruited from October 2008 to October 2011 and 67 patients entered into a previous prospective investigation of induction success (defined as the achievement of the active phase of labor) were retrospectively collected from March 2004 to September 2008. Ultrasound measurement of the cervical length and determination of the Bishop score were performed. The data collected at enrolment included maternal age, height, weight, parity, length of pregnancy, Bishop score and cervical length. Receiver-operating characteristics curve and logistic regression analysis were used for statistical analysis. Thirty-nine (27.6%) of these 141 women had Cesarean delivery. Logistic regression analysis identified maternal height, parity, and cervical length, but not maternal age, weight or Bishop score, as the best predictors of cesarean delivery. A risk score based on a model including these 3 parameters was calculated for each patient. The model was shown to have an adequate goodness of fit (P = 0.253), and the area under the curve was 0.744, indicating reasonably good discrimination. Maternal height, parity, and cervical length are the most important parameters in predicting the risk of Cesarean delivery after labor induction in twin gestations. A predictive model using these parameters at the initiation of labor induction provides useful information in the decision-making process regarding the mode of delivery.
Granulocytic sarcoma (GS) is a rare manifestation of leukemia and has been reported in 3–5% of acute myelogenous leukemia (AML) patients. GS in the uterine cervix is very rare and is also called chloroma because of its greenish appearance. We present the case of a patient whose disease relapsed as chloroma of the uterine cervix after bone marrow transplantation (BMT). She remained in continuous complete remission for 2 years after allogeneic BMT. However, she visited the hospital because of painless vaginal bleeding. She was diagnosed as having chloroma by cervical smear and colposcopically directed biopsy of the cervix. Systemic chemotherapy was administered on the presumption that myelogenous leukemia had recurred as chloroma, and a good clinical response was achieved. We describe the first case of AML that relapsed as chloroma of the uterine cervix after complete remission of the AML, which had complete response to only systemic chemotherapy.
The purpose of this study is to evaluate the correlation between middle cerebral artery peak systolic velocity and hemoglobin concentration and the probability of elevated middle cerebral artery peak systolic velocity (MCA-PSV) in the monochorionic twins. Doppler examination of the middle cerebral artery peak systolic velocity was performed in 50 monochorionic twin pregnancies between 18 and 38 weeks of gestation. Both hemoglobin concentration and middle cerebral artery peak systolic velocity were expressed in multiples of the median (MoM) on the gestational age. We correlated values of MCA-PSV just before delivery and fetal hemoglobin levels of the umbilical vein at delivery. Fetal anemia was confirmed 6 cases of 89 twins. The proportion of elevated MCA-PSV (more than 1.5 MoM) prior to delivery was 10% and cases of twin-to-twin transfusion without laser therapy were 11 pairs. Gestational age at delivery was 34.6 (26.9-38.4) weeks. The relation between peak systolic velocity and hemoglobin concentration was plotted by polynomial function (y = 2.497-MCA-PSV MoM×0.9245+3.1611.2885xMCA-PSV2 −3.537 × MCA-PSV3). The sensitivity and specificity of middle cerebral artery peak systolic velocity in the prediction of moderate-to-severe fetal anemia were of 50% and 93%. The measurement of middle cerebral artery peak systolic velocity in monochorionic twins can be screened for fetuses at risk of anemia. However, the occurrence of an elevated MCA-PSV in the third trimester correlates weakly with severity of fetal anemia.
To determine whether vitamin D binding protein (VDBP), interleukin (IL)-6 and IL-8 levels in the cervicovaginal fluid (CVF), alone or in combination with clinical risk factors, can predict spontaneous preterm delivery (SPTD) in women with cervical insufficiency or a short cervix (≤25 mm). This retrospective cohort study included 62 asymptomatic women with cervical insufficiency (n = 27) or an asymptomatic short cervix (n = 35) at 18–27 weeks. Cervicovaginal swab samples were taken for assays of VDBP, IL-6, and IL-8 before cervical examination, and maternal blood was collected for determination of the C-reactive protein (CRP) level and white blood cell (WBC) count. The primary outcome measurement was SPTD at <32 weeks of gestation. Logistic regression analysis and receiver-operating characteristic curves were used for statistical analyses. The rate of SPTD at <32 weeks was 40.3% (25/62). The CVF levels of VDBP and IL-6, but not IL-8, were significantly higher in women who had SPTD at <32 weeks. The women who had SPTD at <32 weeks had significantly more advanced cervical dilatation at presentation and a higher level of serum CRP. By using stepwise regression analysis, a combined prediction model was developed that included CVF VDBP and cervical dilatation at presentation (AUC 0.882), and was shown to have an adequate goodness of fit (P = 0.976). The median levels of CVF VDBP and IL-6 in cervical insufficiency group were significantly higher as compared to short cervix group. In women with cervical insufficiency or a short cervix, VDBP and IL-6 in the CVF may be useful as non-invasive predictors of SPTD. A combination of CVF VDBP and cervical dilatation appeared to be the best for non-invasive method of predicting SPTD.
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