{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T20:43:16Z","timestamp":1790800996968,"version":"4.1.0"},"reference-count":39,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,3,26]],"date-time":"2023-03-26T00:00:00Z","timestamp":1679788800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Fundamental and Applied Research Projects grant of The Latvian Council of Science","award":["2020\/1-0042"],"award-info":[{"award-number":["2020\/1-0042"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Preterm birth is the leading cause of neonatal mortality worldwide and may be responsible for lifelong morbidities in the survivors. Cervical shortening is one of the common pathways to preterm birth associated with its own diagnostic and management challenges. The preventive modalities that have been tested include progesterone supplementation and cervical cerclage and pessaries. The study aimed to assess the management strategies and outcomes in a group of patients with a short cervix during pregnancy or cervical insufficiency. Materials and Methods: Seventy patients from the Riga Maternity Hospital in Riga, Latvia, were included in the prospective longitudinal cohort study between 2017 and 2021. Patients were treated with progesterone, cerclage, and\/or pessaries. The signs of intra-amniotic infection\/inflammation were assessed, and antibacterial therapy was given when the signs were positive. Results: The rates of PTB were 43.6% (n = 17), 45.5% (n = 5), 61.1% (n = 11), and 50.0% (n = 1) in progesterone only, cerclage, pessary, and cerclage plus pesssary groups, respectively. The progesterone therapy was associated with a reduced preterm birth risk (x2(1) = 6.937, p = 0.008)), whereas positive signs of intra-amniotic infection\/inflammation significantly predicted the risk of preterm birth (p = 0.005, OR = 3.82, 95% [CI 1.31\u201311.11]). Conclusions: A short cervix and bulging membranes, both indicators of intra-amniotic infection\/inflammation, are the key risk factors in preterm birth risk predictions. Progesterone supplementation should remain at the forefront of preterm birth prevention. Among patients with a short cervix and especially complex anamnesis, the preterm rates remain high. The successful management of patients with cervical shortening lies between the consensus-based approach for screening, follow-up, and treatment on the one side and personalising medical therapy on the other.<\/jats:p>","DOI":"10.3390\/medicina59040653","type":"journal-article","created":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T04:05:40Z","timestamp":1679889940000},"page":"653","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Management of Pregnancy with Cervical Shortening: Real-Life Clinical Challenges"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5363-8134","authenticated-orcid":false,"given":"Anna","family":"Kornete","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Riga Stradins University, LV-1007 Riga, Latvia"},{"name":"Riga Maternity Hospital, LV-1013 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0413-1481","authenticated-orcid":false,"given":"Ludmila","family":"Volozonoka","sequence":"additional","affiliation":[{"name":"Scientific Laboratory of Molecular Genetics, Riga Stradins University, LV-1007 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9120-5869","authenticated-orcid":false,"given":"Maksims","family":"Zolovs","sequence":"additional","affiliation":[{"name":"Department of Statistics, Riga Stradins University, LV-1007 Riga, Latvia"},{"name":"Institute of Life Sciences and Technologies, Daugavpils University, LV-5401 Daugavpils, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6602-3852","authenticated-orcid":false,"given":"Adele","family":"Rota","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Riga Stradins University, LV-1007 Riga, Latvia"},{"name":"Riga Maternity Hospital, LV-1013 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inga","family":"Kempa","sequence":"additional","affiliation":[{"name":"Scientific Laboratory of Molecular Genetics, Riga Stradins University, LV-1007 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7219-1294","authenticated-orcid":false,"given":"Linda","family":"Gailite","sequence":"additional","affiliation":[{"name":"Scientific Laboratory of Molecular Genetics, Riga Stradins University, LV-1007 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6287-7017","authenticated-orcid":false,"given":"Dace","family":"Rezeberga","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Riga Stradins University, LV-1007 Riga, Latvia"},{"name":"Riga Maternity Hospital, LV-1013 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1592-1852","authenticated-orcid":false,"given":"Anna","family":"Miskova","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Riga Stradins University, LV-1007 Riga, Latvia"},{"name":"Riga Maternity Hospital, LV-1013 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1002\/ijgo.13195","article-title":"Global Burden of Preterm Birth","volume":"150","author":"Walani","year":"2020","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1518","DOI":"10.1111\/1471-0528.15857","article-title":"Perinatal Health Monitoring through a European Lens: Eight Lessons from the Euro-Peristat Report on 2015 Births","volume":"126","author":"Zeitlin","year":"2019","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1126\/science.1251816","article-title":"Preterm Labor: One Syndrome, Many Causes","volume":"345","author":"Romero","year":"2014","journal-title":"Science"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.3109\/14767058.2014.954243","article-title":"Sterile Intra-Amniotic Inflammation in Asymptomatic Patients with a Sonographic Short Cervix: Prevalence and Clinical Significance","volume":"28","author":"Romero","year":"2015","journal-title":"J. Matern. Neonatal Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.bpobgyn.2018.01.022","article-title":"The Biological Basis and Prevention of Preterm Birth","volume":"52","author":"Tosto","year":"2018","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_6","first-page":"CD007235","article-title":"Cervical Assessment by Ultrasound for Preventing Preterm Delivery","volume":"9","author":"Berghella","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_7","first-page":"185","article-title":"Cervical Length at 28-32 Weeks of Gestation Predicts Preterm Birth","volume":"3","author":"Zhang","year":"2021","journal-title":"Matern. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"100097","DOI":"10.1016\/j.ajogmf.2020.100097","article-title":"Cervical Length Screening after 24 Weeks for Prediction and Prevention of Preterm Birth: Not Evidence Based Yet\u2026","volume":"2","author":"Berghella","year":"2020","journal-title":"Am. J. Obstet. Gynecol. MFM"},{"key":"ref_9","first-page":"S311","article-title":"466: The Risk of Anticipated Delivery in Asymptomatic Women Presenting with Short Cervix in Early Viability","volume":"220","author":"Gulersen","year":"2019","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_10","unstructured":"Levine, D. (2022). Short Cervix before 24 Weeks: Screening and Management in Singleton Pregnancies. UpToDate, 1\u201337."},{"key":"ref_11","unstructured":"Nazir, M.A. (2008). Operative Obstetrics, Cambridge University Press."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"ACOG (2014). PB142_Cerclage for the Management of Cervical Insufficiency. Obstet. Gynecol., 123, 372\u2013379.","DOI":"10.1097\/01.AOG.0000443276.68274.cc"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.jogc.2018.08.009","article-title":"No. 373-Cervical Insufficiency and Cervical Cerclage","volume":"41","author":"Brown","year":"2019","journal-title":"J. Obstet. Gynaecol. Can."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Volozonoka, L., Rots, D., Kempa, I., Kornete, A., Rezeberga, D., Gailite, L., and Miskova, A. (2020). Genetic Landscape of Preterm Birth Due to Cervical Insufficiency: Comprehensive Gene Analysis and Patient next-Generation Sequencing Data Interpretation. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0230771"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.ajog.2017.11.576","article-title":"Vaginal Progesterone for Preventing Preterm Birth and Adverse Perinatal Outcomes in Singleton Gestations with a Short Cervix: A Meta-Analysis of Individual Patient Data","volume":"218","author":"Romero","year":"2018","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1111\/1471-0528.15173","article-title":"Clinical Guidelines for Prevention and Management of Preterm Birth: A Systematic Review","volume":"125","author":"Medley","year":"2018","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1002\/uog.26020","article-title":"ISUOG Practice Guidelines: Role of Ultrasound in the Prediction of Spontaneous Preterm Birth","volume":"60","author":"Coutinho","year":"2022","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1002\/ijgo.13835","article-title":"FIGO Good Practice Recommendations on Cervical Cerclage for Prevention of Preterm Birth","volume":"155","author":"Shennan","year":"2021","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_19","unstructured":"Norwitz, E.R. (2013). Transvaginal Cervical Cerclage. Uptodate 21.6, 1\u20134."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1002\/ijgo.13837","article-title":"FIGO Good Practice Recommendations on the Use of Pessary for Reducing the Frequency and Improving Outcomes of Preterm Birth","volume":"155","author":"Grobman","year":"2021","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1800","DOI":"10.1016\/S0140-6736(12)60030-0","article-title":"Cervical Pessary in Pregnant Women with a Short Cervix (PECEP): An Open-Label Randomised Controlled Trial","volume":"379","author":"Goya","year":"2012","journal-title":"Lancet"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1515\/JPM.2006.002","article-title":"A Sonographic Short Cervix as the Only Clinical Manifestation of Intra-Amniotic Infection","volume":"34","author":"Hassan","year":"2006","journal-title":"J. Perinat. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.ajog.2019.03.017","article-title":"Evidence That Antibiotic Administration Is Effective in the Treatment of a Subset of Patients with Intra-Amniotic Infection\/Inflammation Presenting with Cervical Insufficiency","volume":"221","author":"Oh","year":"2019","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.ajog.2019.03.018","article-title":"Antibiotic Administration Can Eradicate Intra-Amniotic Infection or Intra-Amniotic Inflammation in a Subset of Patients with Preterm Labor and Intact Membranes","volume":"221","author":"Yoon","year":"2019","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_25","first-page":"223","article-title":"Diagnosis and Management of Intraamniotic Infection","volume":"2","author":"Fan","year":"2020","journal-title":"Matern. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1002\/ijgo.13425","article-title":"Antibiotic Treatment of Amniotic Fluid \u201cSludge\u201d in Patients during the Second or Third Trimester with Uterine Contraction","volume":"153","author":"Jin","year":"2021","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"4775","DOI":"10.1080\/14767058.2020.1863369","article-title":"Cervical Insufficiency, Amniotic Fluid Sludge, Intra-Amniotic Infection, and Maternal Bacteremia: The Need for a Point-of-Care Test to Assess Inflammation and Bacteria in Amniotic Fluid","volume":"35","author":"Jung","year":"2020","journal-title":"J. Matern. Neonatal Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1080\/14767058.2019.1588245","article-title":"Cervical Cerclage, Pessary, or Vaginal Progesterone in High-Risk Pregnant Women with Short Cervix: A Randomized Feasibility Study","volume":"34","author":"Care","year":"2021","journal-title":"J. Matern. Neonatal Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1002\/uog.17357","article-title":"Interventions for Women with Mid-Trimester Short Cervix: Which Ones Work?","volume":"49","author":"Vintzileos","year":"2017","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.ajog.2019.09.040","article-title":"MAVRIC: A Multicenter Randomized Controlled Trial of Transabdominal vs Transvaginal Cervical Cerclage","volume":"222","author":"Shennan","year":"2020","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Conde-Agudelo, A., Romero, R., and Nicolaides, K.H. (2020). Cervical Pessary to Prevent Preterm Birth in Asymptomatic High-Risk Women: A Systematic Review and Meta-Analysis, Elsevier Inc.","DOI":"10.1097\/01.ogx.0000723864.06879.b5"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1002\/uog.18908","article-title":"Prevention of Preterm Birth with Pessary in Singletons (PoPPS): Randomized Controlled Trial","volume":"51","author":"Dugoff","year":"2018","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.7863\/ultra.16.08054","article-title":"Cervical Pessary for Preventing Preterm Birth in Singleton Pregnancies With Short Cervical Length: A Systematic Review and Meta-Analysis","volume":"36","author":"Saccone","year":"2017","journal-title":"J. Ultrasound Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1002\/uog.24839","article-title":"Vaginal Progesterone for the Prevention of Preterm Birth and Adverse Perinatal Outcomes in Twin Gestations with a Short Cervix: An Updated Individual Patient Data Meta-Analysis","volume":"59","author":"Romero","year":"2022","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_35","unstructured":"Romero, R., Sci, D.M., Yeo, L., Miranda, J., Sonia, S., Conde-agudelo, A., and Bronshtein, E. (2018). Universal Cervical Screening and Vaginal Progesterone to Prevent Preterm Birth, Elsevier. No. 313."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1002\/ijgo.13852","article-title":"FIGO Good Practice Recommendations on Progestogens for Prevention of Preterm Delivery","volume":"155","author":"Shennan","year":"2021","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1055\/s-0040-1710008","article-title":"Predictors of Early Preterm Birth despite Vaginal Progesterone Therapy in Singletons with Short Cervix","volume":"37","author":"Boelig","year":"2020","journal-title":"Am. J. Perinatol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1002\/uog.5159","article-title":"Vaginal Progesterone Is Associated with a Decrease in Risk for Early Preterm Birth and Improved Neonatal Outcome in Women with a Short Cervix: A Secondary Analysis from a Randomized, Double-Blind, Placebo-Controlled Trial","volume":"30","author":"DeFranco","year":"2007","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1002\/uog.15953","article-title":"Vaginal Progesterone Decreases Preterm Birth \u2009\u2264\u2009 34\u2009Weeks of Gestation in Women with a Singleton Pregnancy and a Short Cervix: An Updated Meta-Analysis Including Data from the OPPTIMUM Study","volume":"48","author":"Romero","year":"2016","journal-title":"Ultrasound Obstet. Gynecol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/4\/653\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:03:18Z","timestamp":1760122998000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/4\/653"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,26]]},"references-count":39,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["medicina59040653"],"URL":"https:\/\/doi.org\/10.3390\/medicina59040653","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,26]]}}}