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The diagnosis and management of preterm labor with intact membranes
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Roberto Romero, Tinnakorn Chaiworapongsa, Francesca Gotsch, Lami Yeo, Ichchha Madan, Sonia S. Hassan
Preterm labor with intact membranes is a “syndrome” caused by multiple etiologies. The term “syndrome” refers to a combination of symptoms or signs identified as a discrete clinical entity (25). Symptoms and signs of preterm labor include increased uterine contractility, changes in cervical status (dilatation and effacement), and/or changes in membrane status (i.e., activation, which can be expressed sub-clinically as a positive fetal fibronectin, or overtly, such as rupture of membranes).
The context of birth
Published in Helen Baston, Midwifery, 2020
During the latent phase and with uterine contractions the length of the cervix shortens, which is known as ‘effacement’. The uterus and the cervix are continuous with each other. As the cervix effaces and softens its thickness becomes taken up into the body of the uterus, from the external cervical os upwards. In women who have previously given birth, effacement and dilatation can occur simultaneously.
Endocrine Regulation of Cervical Functions During Pregnancy and Labor
Published in Gabor Huszar, The Physiology and Biochemistry of the Uterus in Pregnancy and Labor, 2020
Having considered the tissue mechanics of cervical dilatation, several observations can be made regarding the manner in which the cervix effaces and dilates during human labor. The mechanism of effacement and dilatation has been described by Richardson and co-workers.19Figure 1 is a schematic representation of this process. Effacement is the process by which the cervical canal is obliterated. The upper portions of the cervical canal become incorporated into the lower segment of the uterus. The lower portions of the cervical canal, or the region of the external os, remain in its original location. Once effacement is complete or nearly complete, dilatation occurs by further incorporation of the thinned cervix into the lower uterine segment.
Serum Copeptin Levels in Threatened Preterm Labor
Published in Fetal and Pediatric Pathology, 2021
Ozlem Banu Tulmac, Cemile Dayangan Sayan, Zeynep Ozcan Dag, Yuksel Oguz, Gulenay Gencosmanoglu, Turhan Caglar, Ucler Kisa
Identification of preterm birth in later stages and the difficulty in differentiating real Labor from false Labor reduce the success of interventions to improve neonatal outcomes. Therefore, accurate and timely predictive biomarkers are needed. Currently, cervical length measurement and FFN test are used to predict preterm birth [16, 17]. Even cervical length measurement, arguably the best predictor, is only useful in high-risk patients. FFN is only recommended in selected patients [5]. When compared with the findings that are traditionally used in pregnant women with symptoms of preterm Labor, such as cervical dilatation, effacement, and presence of contractions, the use of cervical length measurement alone is insufficient to manage this condition [16]. In the current study, the change in cervical length did not reveal any difference in copeptin levels, whereas cervical dilatation more than 3 cm was associated with significant increase in copeptin levels.
The prevalence of cervical insufficiency in Chinese women with polycystic ovary syndrome undergone ART treatment accompanied with negative prognosis: a retrospective study
Published in Journal of Obstetrics and Gynaecology, 2021
Yaoqiu Wu, Meihong Cai, Xiaoyan Liang, Xing Yang
Cervical insufficiency (CI) is a major cause of late miscarriage and premature birth that affects 0.1–1.0% of all pregnancies (El-Nashar et al. 2013; Wang et al. 2016). CI is sometimes considered as a structural ‘weakness’ biochemically and biomechanically due to acquired or inherent cervical tissue defects or an outcome of asymptomatic second trimester pregnancy loss or premature birth; however, CI usually involves a combination of both types of pathological conditions (Vink and Feltovich 2016; Wang et al. 2016). The pathophysiology of CI is still poorly understood. Some authors postulated that localised cervical defects such as decreased cervical collagen concentration, elastic fibre content or increased smooth muscle cells (the ‘muscular cervix’) promoted the process of softening, effacement and dilatation during the pregnancy cause (Volozonoka et al. 2020). Premature cervical ripening (CR) is now the generally accepted cause of CI (Vink and Mourad 2017).
Reassessing the length of labour in healthy Turkish women: a retrospective and descriptive study
Published in Journal of Obstetrics and Gynaecology, 2019
İlkay Boz, Selahattin Kumru, Aysu Buldum, Mehmet Ziya Firat
Friedman first described the curve and the phases of labour in 1954. According to Friedman’s study, the active phase begins with 70% effacement and 4 cm of cervical dilation, and it ends with 100% effacement and 10 cm of cervical dilation (Friedman 1955). The diagnostic criteria for the active phase traditionally include the completion of the latent phase, greater than 4 cm of cervical dilation, and uterine contractions that are greater than or equal to 200 Montevideo units per every 10-minute period of time (Zhang et al. 2010a). In addition, the prolonged active phase was defined as a cervical dilatation of less than 1.2 cm/hour for nulliparous women and less than 1.5 cm/hour for multiparous women (ACOG/SMFM OBSTETRIC CARE CONSENSUS 2014). Until this point, births have been managed in accordance with these broadly accepted definitions.