Background Mechanical alteration of the cervical angle has been proposed to reduce spontaneous preterm birth. Performance of the uterocervical angle as measured by ultrasound for predicting ...spontaneous preterm birth is poorly understood. Objective We sought to determine whether a novel ultrasonographic marker, uterocervical angle, correlates with risk of spontaneous preterm birth in a general population. Study Design We conducted a retrospective cohort study from May 2014 through May 2015 of singleton gestations between 16 0/7-23 6/7 weeks undergoing transvaginal ultrasound for cervical length screening. Images were remeasured for uterocervical angle between the lower uterine segment and the cervical canal. Primary outcome was prediction of spontaneous preterm birth <34 weeks and <37 weeks by uterocervical angle and secondary outcome evaluated cervical length and spontaneous preterm birth. Results A total of 972 women were studied. The rate of spontaneous preterm birth in this cohort was 9.6% for delivery <37 weeks and 4.5% for <34 weeks. Uterocervical angle of ≥95 degrees was significantly associated with spontaneous preterm birth <37 weeks with sensitivity of 80% ( P < .001; confidence interval, 0.70–0.81; negative predictive value, 95%). Uterocervical angle of ≥105 degrees predicted spontaneous preterm birth <34 weeks with sensitivity of 81% ( P < .001; confidence interval, 0.72–0.86; negative predictive value, 99%). Cervical length ≤25 mm significantly predicted spontaneous preterm birth <37 weeks ( P < .001; sensitivity, 62%; negative predictive value, 95%) and <34 weeks ( P < .001; sensitivity, 63%; negative predictive value, 97%). Regression analysis revealed a significant association of maternal age, nulliparity, race, and obesity at conception with spontaneous preterm birth and uterocervical angle. There was no correlation identified between history of dilation and curettage, abnormal Pap smear results, excisional cervical procedures, smoking, or obesity at delivery on spontaneous preterm birth and uterocervical angle. Conclusion A wide uterocervical angle ≥95 and ≥105 degrees detected during the second trimester was associated with an increased risk for spontaneous preterm birth <37 and <34 weeks, respectively. Uterocervical angle performed better than cervical length in this cohort. Our data indicate that uterocervical angle is a useful, novel transvaginal ultrasonographic marker that may be used as a screening tool for spontaneous preterm birth.
Stem cells are undifferentiated cells with the capacity for differentiation. Amniotic fluid cells have emerged only recently as a possible source of stem cells for clinical purposes. There are no ...ethical or sampling constraints for the use of amniocentesis as a standard clinical procedure for obtaining an abundant supply of amniotic fluid cells. Amniotic fluid cells of human origin proliferate rapidly and are multipotent with the potential for expansion in vitro to multiple cell lines. Tissue engineering technologies that use amniotic fluid cells are being explored. Amniotic fluid cells may be of clinical benefit for fetal therapies, degenerative disease, and regenerative medicine applications. We present a comprehensive review of the evolution of human amniotic fluid cells as a possible modality for therapeutic use.
PDF