Posts Tagged ‘short cervix’

Study shows progesterone shots do not reduce preterm delivery in twin pregnancies

Friday, February 22nd, 2013

While 17P, a form of progesterone, has been shown to prevent premature delivery among about one-third of women who are pregnant with a single baby and who have experienced a prior preterm delivery, the latest research shows that 17P prescriptions can’t do the same for moms having twins.

“Twins are very high risk for preterm delivery, in fact, 60 percent of twins are born too soon. We can’t assume that what works for singleton pregnancies will work with multiples such as twins or triplets,” says Edward R. B. McCabe, MD, PhD, March of Dimes senior vice president and medical director. “This research finding is valuable because it will guide the care of women with a multi-fetal pregnancy, and highlights the need to better understand how to prevent preterm births for multiples.”

“We found that 17P was not effective in women with twin pregnancies and a short cervix (defined as less than 25 mm between 24 and 32 weeks),” says Philippe Deruelle, MD, with the Department of Obstetrics and Gynecology at Hôpital Jeanne de Flandre, Université Lille 2, France, and one of the study’s authors. “We actually seemed to have found an increase in the rate of preterm delivery before 32 weeks in the treatment group when compared to the non-treatment group.”

For the study, Dr. Deruelle and his colleagues conducted their trial on 165 women over the age of 18 at 10 university hospitals between June 2006 and January 2010. Outcome data was available for 161 of the 165 (97.6%) women. (The study’s title is Prevention of preterm delivery by 17 alpha-hydroxyprogesterone caproate in asymptomatic twin pregnancies with a short cervix: a randomized controlled trial, and was presented at the Society for Maternal-Fetal Medicine’s 33rd annual meeting last week.)

Dr. Deruelle recommends that women who know they are pregnant with twins get an ultrasound to measure their cervical length, as this factor has shown to predict which women with twins are at higher risk for premature pregnancy.

Hopefully, future research will help to shed light on ways to prevent pretem births for women who are pregnant with multiples.

Chat on short cervix and pregnancy concerns

Tuesday, November 29th, 2011

dr-jason-baxterDr. Jason Baxter will be our guest for our next #pregnancychat on short cervix and progesterone treatment. He is a Maternal-Fetal Medicine specialist practicing at Thomas Jefferson University.  Dr. Baxter cares for women at high risk for premature birth as well as with other pregnancy complications. He is an author of ground-breaking research on progesterone and prematurity prevention. Dr. Baxter has dedicated much of his research career to helping solve the mysteries of prematurity and to finding ways to prevent early deliveries that all too often have tragic consequences for babies and families. 

Perhaps you heard him on NPR as he discussed the latest research.

Dr. Baxter will be talking with us and answering questions.  Join us on Twitter at 1:00PM EST on Wednesday, November 30th.  Don’t forget to use #pregnancychat.

What is cervical insufficiency?

Monday, August 16th, 2010

Cervical insufficiency (sometimes called incompetent cervix) refers to a cervix that opens too early during pregnancy, usually without pain and contractions. This most often occurs in the second or early third trimester of pregnancy, resulting in late miscarriage or premature birth. A woman may be diagnosed with cervical insufficiency based largely on this history. There is no specific diagnostic test.

Medical experts don’t always know why cervical insufficiency occurs. Factors that may contribute include:
• Uterine defects: Women with certain uterine defects, such as bicornuate uterus (two cavities), are more likely to have cervical insufficiency than women without these defects.
• History of surgical procedures involving the cervix: These include LEEP (loop electrosurgical excision procedure), which is used to diagnose and treat abnormal cells found during a Pap test.
• Injuries during a previous birth.
• Short cervix: The shorter the cervix, the more likely the woman is to have cervical insufficiency. In some cases, a short cervix can be congenital.

Miscarriage and premature birth due to cervical insufficiency frequently happen again in another pregnancy. These problems can sometimes be prevented with a procedure called cerclage, in which the provider places a stitch in the cervix to keep it from opening too early. The provider removes the stitch when the woman is ready to give birth.

It is not always clear which women will benefit from cerclage. This is because there is no specific test for cervical insufficiency, and many women who have had a late miscarriage or early premature birth go on to have normal pregnancies without treatment. Some studies suggest that cerclage is most likely to be beneficial in women who have had three or more late miscarriages or premature births. In some cases, providers may monitor a woman suspected of having cervical insufficiency with repeated vaginal ultrasounds to see if her cervix is shortening or showing other signs that she may give birth soon. The provider may recommend cerclage if these changes occur.

Some women learn that they have a short cervix during a routine ultrasound. Most of these women do not end up having a premature birth. However, short cervix, especially a very short cervix (less than 15 millimeters), does increase her risk of premature birth. Studies suggest that treatment with the hormone progesterone (17P) may help reduce the risk of premature birth in women with a very short cervix. According to the American College of Obstetricians and Gynecologists (ACOG), progesterone treatment may be considered for these women. However, ACOG does not recommend routine cervical-length screening for low-risk women.