Unraveling the Efficacy of Therapeutic Interventions for Short Cervix: Insights from a Retrospective Study for Improved Clinical Management
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Patient’s Data | Group 1 (n = 562 Patients) | Group 2 (n = 286 Patients) | Group 3 (n = 128 Patients) | Group 4 (n = 101 Patients) | Group 5 (n = 69 Patients) | p-Value |
---|---|---|---|---|---|---|
Maternal age, years (mean and standard deviation) | 29.46 ± 6.59 | 30.34 ± 6.54 | 29.98 ± 6.60 | 29.83 ± 6.85 | 30.67 ± 6.19 | 0.31 |
Medium (n/%) | Rural = 291 (51.9%) Urban = 270 (48.1%) | Rural = 138 (48.1%) Urban = 149 (51.9%) | Rural = 68 (53.1%) Urban = 60 (46.9%) | Rural = 52 (51.5%) Urban = 49 (48.5%) | Rural = 42 (60.9%) Urban = 39.1 (47%) | 0.41 |
Smoking (n/%) | Yes = 13 (2.3%) | Yes = 10 (3.49%) | Yes = 7 (5.5%) | Yes = 5 (5.0%) | Yes = 4 (5.8%) | 0.19 |
Personal history of preterm birth (n/%) | Yes = 34 (6.04%) | Yes = 47 (16.43%) | Yes = 50 (39.06%) | Yes = 31 (30.69%) | Yes = 18 (26.08%) | <0.001 |
Personal history of thrombosis (n/%) | Yes = 2 (0.35%) | Yes = 1 (0.34%) | Yes = 0 (0%) | Yes = 0 (0%) | Yes = 0 (0%) | 0.47 |
Diabetes (n/%) | Yes = 6 (1.1%) | Yes = 2 (0.7%) | Yes = 1 (0.8%) | Yes = 1 (1%) | Yes = 0 (0%) | 0.91 |
Thrombophilia (n/%) | Yes = 5 (0.88%) | Yes = 2 (0.69%) | Yes = 1 (0.8%) | Yes = 0 (0%) | Yes = 0 (0%) | 0.98 |
Personal history of autoimmune disorders (n/%) | Yes = 18 (3.2%) | Yes = 14 (4.89%) | Yes = 8 (6.25%) | Yes = 5 (4.95%) | Yes = 0 (0%) | 0.33 |
Personal history of ischemic placental disease (n/%) | Yes = 7 (1.24%) | Yes = 4 (1.39%) | Yes = 2 (1.56%) | Yes = 1 (1%) | Yes = 0 (0%) | 0.98 |
Cervical length, mm (mean and standard deviation) | 22.1 ± 2.16 | 20.25 ± 2.21 | 19.75 ± 1.70 | 18.75 ± 3.59 | 16.5 ± 3.87 | 0.14 |
Treatment | Late Preterm Birth | Early Preterm Birth | Extremely Preterm Birth | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
ATT | 95%CI Lower Bound | 95%CI Upper Bound | p-Value | ATT | 95%CI Lower Bound | 95%CI Upper Bound | p-Value | ATT | 95%CI Lower Bound | 95%CI Upper Bound | p-Value | |
Progesterone | −0.14 | −0.19 | −0.09 | <0.001 | −0.07 | −0.13 | 0.11 | <0.001 | −0.07 | −0.13 | 0.10 | <0.001 |
Pessary | −0.16 | −0.28 | −0.05 | <0.001 | −0.10 | −0.17 | 0.21 | 0.03 | 0.06 | −0.01 | 0.13 | 0.09 |
Cerclage | −0.14 | −0.31 | −0.01 | 0.01 | −0.08 | −0.19 | 0.23 | 0.02 | 0.06 | −0.04 | 0.17 | 0.255 |
Progesterone and pessary | −0.18 | −0.35 | −0.01 | 0.03 | −0.07 | −0.21 | 0.16 | 0.01 | 0.16 | −0.03 | 0.35 | 0.09 |
Progesterone and cerclage | −0.28 | −0.48 | −0.08 | 0.006 | −0.21 | −0.35 | 0.37 | 0.009 | 0.09 | −0.09 | 0.29 | 0.306 |
Therapeutic Intervention | Late Preterm Birth | Early Preterm Birth | Extremely Preterm Birth | |||
---|---|---|---|---|---|---|
RR and 95% CI | p-Value | RR and 95% CI | p-Value | RR and 95% CI | p-Value | |
Progesterone vs. pessary | 3.13 (2.42–4.04) | <0.001 | 3.73 (2.37–5.88) | <0.001 | 4.81 (2.49–9.26) | <0.001 |
Progesterone vs cerclage | 2.73 (1.93–3.86) | <0.001 | 3.57 (1.87–6.83) | <0.001 | 4.16 (1.71–10.12) | 0.001 |
Cerclage vs. pessary | 0.87 (0.57–1.32) | 0.52 | 1.04 (0.49–2.20) | 0.11 | 1.15 (0.40–3.28) | 0.78 |
Progesterone + pessary vs progesterone alone | 0.36 (0.24–0.54) | <0.001 | 0.44 (0.24–0.78) | 0.005 | 0.59 (0.28–1.23) | 0.15 |
Progesterone + pessary vs. cerclage | 0.79 (0.47–1.32) | 0.37 | 1.58 (0.69–3.61) | 0.27 | 2.45 (0.82–7.35) | 0.10 |
Progesterone + pessary vs. pessary | 1.14 (0.72–1.82) | 0.55 | 1.65 (0.82–3.28) | 0.15 | 2.83 (1.13–7.11) | 0.05 |
Progesterone + cerclage vs. progesterone alone | 0.30 (0.18–0.52) | <0.001 | 0.49 (0.26–0.91) | 0.02 | 0.27 (0.08–0.84) | 0.02 |
Progesterone + cerclage vs. pessary | 0.96 (0.53–1.73) | 0.91 | 1.84 (0.88–3.81) | 0.10 | 1.31 (0.37–4.60) | 0.66 |
Progesterone + cerclage vs. cerclage | 0.84 (0.45–1.58) | 0.60 | 1.76 (0.74–4.17) | 0.19 | 1.13 (0.28–4.56) | 0.85 |
Progesterone + pessary vs. progesterone +cerclage | 1.18 (0.61–2.29) | 0.61 | 0.89 (0.39–2.01) | 0.79 | 1.61 (0.43–5.92) | 0.47 |
Outcome | Late Preterm Birth | Early Preterm Birth | Extremely Preterm Birth | |||
---|---|---|---|---|---|---|
aOR and 95% CI | p-Value | aOR and 95% CI | p-Value | aOR and 95% CI | p-Value | |
Cesarean delivery | 2.11 (0.35–5.41) | <0.001 | 0.95 (0.70–1.29) | 0.78 | 0.88 (0.49–1.57) | 0.68 |
Apgar score at 1 min < 7 | 1.82 (1.42–2.31) | <0.001 | 1.79 (0.68–4.41) | 0.007 | 1.83 (0.19–4.51) | 0.008 |
Apgar score at 5 min < 7 | 1. 21 (0.45–3.58) | <0.001 | 2.65 (1.55–4.55) | <0.001 | 1.28 (0.45–3.44) | 0.03 |
NICU admission | 0.96 (0.67–1.38) | 0.84 | 1.26 (0.17–4.21) | <0.001 | 0.72 (0.18–2.87) | <0.001 |
Necrotizing enterocolitis | 0.44 (0.16–1.85) | 0.79 | 1.04 (0.55–2.65) | <0.001 | 1.97 (0.49–3.35) | <0.001 |
Invasive ventilation | 1.39 (0.54–3.09) | <0.001 | 1.42 (0.73–2.10) | <0.001 | 1.47 (0.25–2.75) | <0.001 |
ARDS | 1.56 (0.37–3.32) | <0.001 | 1.38 (0.38–2.44) | <0.001 | 2.32 (0.92–3.37) | <0.001 |
Cerebral palsy | 0.96 (0.08–4.83) | 0.67 | 0.20 (−0.30–0.72) | 0.42 | 1.99 (0.26–4.04) | 0.035 |
Visual or hearing impairment | 0.48 (0.02–2.52) | 0.43 | 0.90 (−0.86–2.68) | 0.31 | 1.67 (0.08–4.68) | 0.003 |
Intraventricular hemorrhage | 0.56 (0.37–1.32) | 0.06 | 0.38 (−0.38–1.14) | 0.32 | 2.32 (0.92–3.37) | <0.001 |
Neonatal death | 0.68 (0.36–1.82) | 0.79 | 1.04 (−0.55–2.65) | <0.001 | 1.97 (0.49–3.35) | <0.001 |
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Luca, A.-M.; Bernad, E.; Nemescu, D.; Vaduva, C.; Harabor, A.; Adam, A.-M.; Harabor, V.; Nechita, A.; Strobescu, C.; Mogos, R.; et al. Unraveling the Efficacy of Therapeutic Interventions for Short Cervix: Insights from a Retrospective Study for Improved Clinical Management. Medicina 2023, 59, 1018. https://doi.org/10.3390/medicina59061018
Luca A-M, Bernad E, Nemescu D, Vaduva C, Harabor A, Adam A-M, Harabor V, Nechita A, Strobescu C, Mogos R, et al. Unraveling the Efficacy of Therapeutic Interventions for Short Cervix: Insights from a Retrospective Study for Improved Clinical Management. Medicina. 2023; 59(6):1018. https://doi.org/10.3390/medicina59061018
Chicago/Turabian StyleLuca, Alina-Madalina, Elena Bernad, Dragos Nemescu, Cristian Vaduva, Anamaria Harabor, Ana-Maria Adam, Valeriu Harabor, Aurel Nechita, Cristina Strobescu, Raluca Mogos, and et al. 2023. "Unraveling the Efficacy of Therapeutic Interventions for Short Cervix: Insights from a Retrospective Study for Improved Clinical Management" Medicina 59, no. 6: 1018. https://doi.org/10.3390/medicina59061018