{"id":8596,"date":"2026-01-29T13:40:27","date_gmt":"2026-01-29T13:40:27","guid":{"rendered":"http:\/\/echonews.fr\/?page_id=8596"},"modified":"2026-01-29T14:05:25","modified_gmt":"2026-01-29T14:05:25","slug":"cervical-length-and-risk-of-spontaneous-preterm-delivery","status":"publish","type":"page","link":"http:\/\/echonews.fr\/?page_id=8596","title":{"rendered":"Cervical length and risk of spontaneous preterm delivery"},"content":{"rendered":"\t\t
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Bibliographic and Educational Resources in Obstetrics and Gynecology<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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This platform is designed to serve as a comprehensive educational and bibliographic resource for healthcare professionals involved in Obstetrics and Gynecology.<\/span><\/strong> Covering a wide range of up-to-date topics within the field, it offers structured access to recent scientific literature and a variety of pedagogical tools tailored to clinicians, educators, and trainees.<\/p>

Each topic is grounded in a curated selection of recent publications, accompanied by in-depth summaries that go far beyond traditional abstracts<\/strong><\/span>\u2014offering clear, clinically relevant insights without the time burden of reading full articles. These summaries act as gateways to the original literature, helping users identify which articles warrant deeper exploration.<\/p>

In addition to these detailed reviews, users will find a rich library of supplementary materials<\/span><\/strong>: topic overviews, FAQs, glossaries, synthesis sheets, thematic podcasts, fully structured course outlines adaptable for teaching, and ready-to-use PowerPoint slide decks. All resources are open access and formatted for easy integration into academic or clinical training programs.<\/p>

By providing practical, well-structured content, the platform enables members of the cytogenomics community to efficiently update their knowledge on selected topics. It also offers educational materials that are easily adaptable for instructional use.<\/span><\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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cervical length and risk of spontaneous preterm delivery<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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Dr Fran\u00e7oise Dupont<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\tHm-envelop<\/span>\n\t\t\t\t\t\t<\/i>\t\t\t\t\t<\/a>\n\t\t\t\t<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t
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Pr Pierre Durand<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\tHm-envelop<\/span>\n\t\t\t\t\t\t<\/i>\t\t\t\t\t<\/a>\n\t\t\t\t<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t
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\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\tOVERVIEW<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tIntroduction<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Spontaneous preterm birth (sPTB) remains one of the most significant challenges in modern obstetrics and is a leading cause of neonatal morbidity and mortality worldwide. Despite advances in perinatal and neonatal care, the overall incidence of preterm birth has not declined substantially over recent decades. A central feature in the pathophysiology of spontaneous preterm delivery is\u00a0premature cervical remodeling<\/strong>, which manifests clinically as cervical shortening, softening, and dilatation prior to the onset of labor. Among the various tools available to assess this process,\u00a0transvaginal ultrasonographic measurement of cervical length<\/strong>\u00a0has emerged as the most robust and reproducible predictor of spontaneous preterm delivery. The relationship between cervical length and preterm birth risk, and the therapeutic implications of identifying a short cervix, constitute the foundation of contemporary prevention strategies.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tPhysiological and Pathophysiological Role of the Cervix<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

The cervix plays a critical mechanical and biological role in maintaining pregnancy. Under normal circumstances, cervical remodeling is a gradual, tightly regulated process that occurs late in gestation, allowing for term labor. In spontaneous preterm birth, this remodeling occurs prematurely and independently of overt uterine contractions in many cases. The concept of the\u00a0preterm parturition syndrome<\/strong>\u00a0frames preterm birth as a final common pathway resulting from heterogeneous processes\u2014infectious, inflammatory, endocrine, mechanical, or vascular\u2014that converge on cervical change.<\/p>

Cervical shortening detected in the mid-trimester is therefore not merely an anatomic finding but a surrogate marker of these underlying pathological processes. Importantly, shortening may precede clinical symptoms by weeks, providing a critical window for risk stratification and intervention.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tMeasurement of Cervical Length<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Transvaginal ultrasound (TVUS) is the gold standard for cervical length assessment. Compared with digital examination, TVUS offers superior objectivity, reproducibility, and predictive accuracy. Large prospective studies have demonstrated that cervical length follows a roughly normal distribution in mid-pregnancy, with mean values around 35 mm at 24 weeks\u2019 gestation. As cervical length decreases, the risk of spontaneous preterm delivery increases in a\u00a0continuous and inverse relationship<\/strong>, rather than at a single pathological threshold.<\/p>

Landmark multicenter studies have shown that women with a cervical length below the 10th percentile\u2014and particularly below 25 mm\u2014are at markedly increased risk of delivery before 34 or 35 weeks. This risk escalates dramatically as cervical length shortens further, reaching its highest levels in women with measurements below 15 mm. These findings apply to both low-risk women and those with prior obstetric risk factors, although absolute risk is greatest when a short cervix is combined with a history of spontaneous preterm birth.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tTiming and Population for Screening<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

The predictive value of cervical length measurement is greatest when performed in the\u00a0mid-trimester<\/strong>, typically between 16 and 24 weeks of gestation. Before 16 weeks, cervical measurements have limited predictive utility, while after 24 weeks the opportunity for preventive interventions diminishes. Current evidence supports targeted screening in women with prior spontaneous preterm birth, but there is increasing support for\u00a0universal cervical length screening<\/strong>\u00a0in singleton pregnancies, given the effectiveness and safety of available interventions.<\/p>

In multiple gestations, particularly twin pregnancies, cervical shortening is common and strongly associated with preterm birth. However, management strategies differ, as some interventions effective in singleton pregnancies\u2014such as cerclage\u2014may be ineffective or even harmful in twins.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tClinical Implications of a Short Cervix<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Identification of a short cervix has clinical value only if effective interventions exist. Historically, management strategies such as bed rest, activity restriction, prolonged tocolysis, or antibiotics were widely used despite poor evidence of benefit. High-quality trials have since clarified the roles of\u00a0progesterone therapy<\/strong>\u00a0and\u00a0cervical cerclage<\/strong>, while refuting many older practices.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tProgesterone Therapy<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Vaginal progesterone has emerged as one of the most important preventive therapies for women with a sonographically short cervix. Randomized controlled trials have demonstrated that, in asymptomatic women with singleton pregnancies and a cervical length typically \u226415\u201325 mm, vaginal progesterone significantly reduces the rate of spontaneous preterm birth before 33\u201334 weeks and improves neonatal outcomes. Importantly, this benefit appears consistent regardless of whether the woman has a prior history of preterm birth.<\/p>

Progesterone is thought to exert its effects through multiple mechanisms, including suppression of inflammatory pathways, reduction of cervical ripening, and maintenance of uterine quiescence. Its favorable safety profile and ease of administration have strengthened the argument for universal mid-trimester cervical length screening.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tCervical Cerclage<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Cervical cerclage is a surgical intervention aimed at mechanically reinforcing the cervix. Evidence indicates that cerclage is beneficial primarily in a\u00a0highly selected subgroup<\/strong>: women with a singleton pregnancy, a history of spontaneous preterm birth, and a short cervix detected in the mid-trimester. In contrast, cerclage has not demonstrated benefit in women without prior preterm birth and may increase adverse outcomes in twin pregnancies.<\/p>

These findings underscore the importance of individualized risk stratification rather than a uniform intervention strategy.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tRepeat Measurements and Dynamic Assessment<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Although cervical length is a strong predictor of outcome, studies evaluating the utility of\u00a0repeat measurements<\/strong>, particularly after interventions such as tocolysis for threatened preterm labor, have shown limited additional predictive value. Once a short cervix is identified, its prognostic significance appears to be driven more by the absolute measurement than by short-term changes.<\/p>

This has shifted focus toward earlier identification rather than intensive serial monitoring in symptomatic settings.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tBeyond Cervical Length: Emerging Technologies<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

While cervical length measurement is currently the cornerstone of prediction, it captures only the geometric aspect of cervical remodeling. Novel techniques, such as\u00a0shear wave elastography<\/strong>, aim to assess cervical stiffness and biomechanical properties, potentially detecting preclinical changes before shortening occurs. Early feasibility studies suggest that cervical softening may be independently associated with preterm birth risk, but these techniques remain investigational and are not yet integrated into routine practice.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tConclusion<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Cervical length assessment by transvaginal ultrasound represents one of the most powerful tools in obstetrics for predicting spontaneous preterm delivery. The inverse relationship between cervical length and preterm birth risk is robust, continuous, and clinically actionable. Identification of a short cervix enables targeted, evidence-based interventions\u2014most notably vaginal progesterone and, in selected cases, cervical cerclage\u2014that significantly reduce preterm birth and improve neonatal outcomes. Ongoing research into cervical biomechanics and universal screening strategies continues to refine this paradigm, positioning cervical assessment as a cornerstone of modern preventive obstetrics.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\"\"\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\tFAQ<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tWhat role does the cervix play in preventing preterm birth?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

The cervix maintains pregnancy by remaining long, firm, and closed until late gestation. Premature cervical remodeling compromises this function and increases the risk of early delivery.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tWhat is meant by \u201ccervical remodeling\u201d?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Cervical remodeling refers to biochemical and structural changes\u2014shortening, softening, and dilatation\u2014that normally occur near term but may occur prematurely in sPTB.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tHow is cervical length best measured?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Cervical length is best measured by\u00a0transvaginal ultrasound<\/strong>, which provides superior accuracy and reproducibility compared with digital examination or transabdominal approaches.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tAt what gestational age is cervical length most predictive of sPTB?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Measurement between\u00a016 and 24 weeks of gestation<\/strong>\u00a0provides the highest predictive value for spontaneous preterm birth.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tWhat is considered a \u201cshort cervix\u201d?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

A cervical length of\u00a0\u226425 mm<\/strong>\u00a0in the mid-trimester is commonly used as the threshold for increased risk, although risk rises continuously as length decreases.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tIs there a linear relationship between cervical length and preterm birth risk?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Yes. The risk of sPTB increases progressively as cervical length shortens, rather than abruptly at a single cutoff value.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tDoes cervical length predict preterm birth in low-risk women?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Yes. Even in women without prior obstetric risk factors, a short cervix is a strong independent predictor of spontaneous preterm birth.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tHow does prior preterm birth interact with cervical length?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Women with both a prior spontaneous preterm birth and a short cervix have the highest absolute risk of recurrence.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tIs digital cervical examination reliable for predicting sPTB?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

No. Digital examination is subjective and poorly predictive compared with transvaginal ultrasound measurement.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tWhat is the role of vaginal progesterone in women with a short cervix?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Vaginal progesterone significantly reduces the risk of spontaneous preterm birth and neonatal morbidity in women with a singleton pregnancy and a short cervix.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tDoes progesterone benefit women without a history of preterm birth?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Yes. Evidence shows that vaginal progesterone is effective in asymptomatic women with a short cervix regardless of prior obstetric history.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tWhat is the proposed mechanism of action of progesterone?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Progesterone helps maintain uterine quiescence, reduces cervical inflammation, and delays cervical remodeling.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tWhen is cervical cerclage beneficial?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Cerclage is beneficial mainly in women with a singleton pregnancy, a history of spontaneous preterm birth, and a short cervix detected in the mid-trimester.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tIs cerclage effective in women without prior preterm birth?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

No. In women without prior sPTB, cerclage has not been shown to reduce preterm birth and may increase complications.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tWhat about cerclage in twin pregnancies?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Cerclage is generally ineffective and may be harmful in twin pregnancies, even when cervical shortening is present.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tShould cervical length be remeasured after treatment for threatened preterm labor?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Repeat measurement after successful tocolysis does not improve prediction of preterm birth and has limited clinical utility.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tIs universal cervical length screening justified?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Evidence suggests that universal screening combined with vaginal progesterone is effective, safe, and cost-saving in singleton pregnancies.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

\n\t\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tAre there emerging tools beyond cervical length measurement?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Yes. Techniques such as shear wave elastography aim to assess cervical stiffness, but they remain investigational and are not yet part of routine care.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\tDO'S AND DONTS<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tDo use transvaginal ultrasound as the standard method for cervical length measurement<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

TVUS provides objective, reproducible, and validated measurements and is superior to digital, transabdominal, or transperineal approaches for predicting spontaneous preterm birth.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tDo perform cervical length screening in the mid-trimester (16\u201324 weeks)<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

This gestational window offers the highest predictive accuracy and aligns with the timing used in intervention trials for progesterone and cerclage.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

\n\t\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tDo interpret cervical length as a continuous risk factor<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Preterm birth risk increases progressively as cervical length shortens; clinical thresholds (e.g. 25 mm) are pragmatic, not biological absolutes.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tDo prescribe vaginal progesterone for asymptomatic singleton pregnancies with a short cervix<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

High-quality randomized trials demonstrate significant reductions in early preterm birth and neonatal morbidity with excellent safety profiles.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tDo individualize the use of cervical cerclage<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Cerclage should be reserved for women with a singleton pregnancy, prior spontaneous preterm birth, and a short cervix\u2014where evidence supports benefit.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

\n\t\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tDo recognize that most early preterm births occur in women without prior history<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Relying solely on obstetric history misses many at-risk women; current-pregnancy cervical assessment is essential.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

\n\t\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tDo ensure proper technique and training for cervical length measurement<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Probe pressure, bladder filling, and landmark identification significantly affect measurements; standardized protocols are critical.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

\n\t\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tDo counsel patients that screening identifies risk, not certainty<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

A short cervix increases risk but does not guarantee preterm birth; progesterone reduces risk but does not eliminate it.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

\n\t\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tDo distinguish between singleton and twin pregnancies in counseling and management<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Predictive value and treatment efficacy differ substantially; evidence-based interventions for singletons cannot be extrapolated to twins.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

\n\t\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tDo view emerging tools (e.g. elastography) as investigational<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Biomechanical assessment of the cervix is promising but currently complements research, not routine clinical decision-making.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tDon\u2019t rely on digital cervical examination to predict preterm birth<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Digital exams are subjective and consistently inferior to TVUS cervical length for risk stratification.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tDon\u2019t perform cervical length screening without a clear management pathway<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Screening is only justified when effective interventions (e.g. progesterone) are available and implemented appropriately.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tDon\u2019t assume that all short cervixes reflect the same pathology<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Cervical shortening may result from diverse mechanisms (inflammatory, mechanical, endocrine) with different therapeutic implications.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tDon\u2019t use cerclage indiscriminately in women with a short cervix<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Randomized trials show no benefit\u2014and potential harm\u2014when cerclage is applied broadly without appropriate selection.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

\n\t\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tDon\u2019t extrapolate singleton pregnancy data to twins<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Progesterone and cerclage have not shown consistent benefit in twin pregnancies with cervical shortening.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

\n\t\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tDon\u2019t overinterpret short-term changes in cervical length after tocolysis<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Repeat measurements over short intervals add little prognostic value once baseline cervical length is known.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tDon\u2019t recommend bed rest as a preventive strategy<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Bed rest has no proven benefit and may increase maternal morbidity and psychosocial harm.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tDon\u2019t delay intervention while waiting for symptoms<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Cervical shortening often precedes contractions; prevention is most effective when applied before clinical preterm labor.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tDon\u2019t equate statistical association with clinical utility<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

Predictive markers must be linked to interventions that improve outcomes, not merely identify risk.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

\n\t\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tDon\u2019t present cervical length screening as optional when evidence supports benefit<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

In singleton pregnancies, failure to screen denies access to proven, low-risk preventive therapy.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\"\"\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\tBIBLIOGRAPHY<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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    Progesterone and the risk of preterm birth among women with a short cervix.\u00a0New England Journal of Medicine<\/em>. 2007;357:462\u2013469.<\/li>
  4. Hassan SS, Romero R, Vidyadhari D, Fusey S, Baxter JK, Khandelwal M, et al.<\/strong>
    Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter randomized double-blind placebo-controlled trial.\u00a0Ultrasound in Obstetrics & Gynecology<\/em>. 2011;38(1):18\u201331.<\/li>
  5. Combs CA.<\/strong>
    Vaginal progesterone for asymptomatic cervical shortening and the case for universal screening of cervical length.\u00a0American Journal of Obstetrics and Gynecology<\/em>. 2012;206:124\u2013130.\u00a0(Editorial)<\/em><\/li>
  6. Campbell S.<\/strong>
    Universal cervical-length screening and vaginal progesterone prevents early preterm births, reduces neonatal morbidity and is cost saving: doing nothing is no longer an option.\u00a0Ultrasound in Obstetrics & Gynecology<\/em>. 2011;38:1\u20139.\u00a0(Editorial)<\/em><\/li>
  7. Berghella V, Odibo AO, Tolosa JE.<\/strong>
    Cerclage for prevention of preterm birth in women with a short cervix found on transvaginal ultrasound examination: a randomized trial.\u00a0American Journal of Obstetrics and Gynecology<\/em>. 2004;191:1311\u20131317.<\/li>
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    Cervical assessment at 22 and 27 weeks for the prediction of spontaneous birth before 34 weeks in twin pregnancies: is transvaginal sonography more accurate than digital examination?\u00a0Ultrasound in Obstetrics & Gynecology<\/em>. 2005;26:707\u2013712.<\/li>
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    Assessment of the cervix in pregnant women using shear wave elastography: a feasibility study.\u00a0Ultrasound in Medicine & Biology<\/em>. 2015;41(11):2789\u20132797.<\/li><\/ol>