Alexandros Sotiriadis

Aristotle University of Thessaloniki, Saloníki, Central Macedonia, Greece

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Publications (64)186.1 Total impact

  • Alexandros Sotiriadis, Elisavet Diamanti, Fotios Chatzinikolaou
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    ABSTRACT: A cranial gap was detected in the left frontal area of a 24-week fetus. Reconstruction of the frontal bones and metopic suture using 3D ultrasound revealed the presence of an additional xiphoid bone extending from the anterior fontanelle to the nasal region between the frontal bones, without other major findings. Postnatal examination confirmed the cranial findings and additionally revealed a coloboma in the left eyelid and bilateral preauricular tags. This is an atypical case of Goldenhar syndrome, highlighting the importance of not adhering to the typical clefting and hemifacial microsomia pattern looking for minor detectable signs (colobomas, tags) when a cranial deformity, however atypical for Goldenhar, is detected.
    Ultrasound in Obstetrics and Gynecology 07/2014; · 3.56 Impact Factor
  • George Makrydimas, Alexandros Sotiriadis
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    ABSTRACT: About 13% of twins are born before 34 weeks and 7% before 32 weeks. The prediction of preterm birth in twins is based on the same tests as in singleton pregnancies. In twin pregnancies, the cut-off for short cervix at the second trimester scan is less than 25 mm (compared with 15 mm in singletons); length less than 20 mm is associated with 42% risk for birth before 32 weeks and cervical length less than 25 mm is associated with 28% risk for birth before 28 weeks. The measurement of cervical length in pregnancies with symptoms of preterm labour may have limited accuracy in predicting preterm birth. In asymptomatic women, a positive fetal fibronectin test seems to be associated with 35% risk for birth before 32 weeks and 40% risk for birth less than 34 weeks, whereas a negative test decreases the risk to 6% and 17%, respectively. The differences in the predictive value of tests between twins and singletons reflect the diverse pathophysiology of preterm birth between the two groups.
    Best practice & research. Clinical obstetrics & gynaecology 12/2013; · 1.87 Impact Factor
  • Archives of Gynecology and Obstetrics 12/2013; · 1.33 Impact Factor
  • Kimon Chatzistamatiou, Alexandros Sotiriadis, Theodoros Agorastos
    Archives of Gynecology 08/2013; · 0.91 Impact Factor
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    ABSTRACT: OBJECTIVES: To pool published data regarding the sensitivity and specificity of nuchal translucency (NT) in the diagnosis of major congenital heart defects (CHD) in fetuses with normal karyotype. METHODS: MEDLINE and SCOPUS searches using combinations of the terms 'nuchal' AND 'cardiac*' were complemented by perusal of the references of the retrieved articles and an additional automated search using the 'search for related articles' PubMed function. Only children with a normal karyotype and major CHDs were analyzed. Weighted estimates and summary receiver operating characteristic curves were calculated RESULTS: The analysis included 20 studies (205232 fetuses, 537 cases with major CHDs. The pooled sensitivity and specificity of NT>95(th) centile was 44.4% (95% CI 39.5-49.5) and 94.5% (95% CI 94.4-94.6), respectively. The pooled sensitivity and specificity of NT>99(th) centile was 19.5% (95% CI 15.9-23.5) and 99.1% (95% CI 99.1-99.2), respectively. For the subgroup of studies in which the NT was measured by Fetal Medicine Foundation-certified operators, the pooled sensitivity and specificity of NT>95(th) centile was 45.6% (95% CI 39.6-51.7) and 94.7% (95% CI 94.6-94.9), respectively. The corresponding estimates for NT>99(th) centile were 21.0% (95%CI 16.5-26.1) and 99.2% (95% CI 99.2-99.3). The pooled positive likelihood ratio for NT>99(th) centile was 30.5 (95% CI 24.3-38.6). There was high across-studies heterogeneity for most estimates. CONCLUSION: Approximately 44% of CHDs in chromosomally normal fetuses have NT>95(th) centile and 20% have NT>99(th) centile. However, there is increased heterogeneity across studies, which largely remains even in subgroup analyses of studies of apparently similar design, potentially indicating the presence of some residual unidentified bias.
    Ultrasound in Obstetrics and Gynecology 04/2013; · 3.56 Impact Factor
  • Article: Reply.
    A Sotiriadis, S Papatheodorou, G Makrydimas
    Ultrasound in Obstetrics and Gynecology 10/2012; 40(4):488. · 3.56 Impact Factor
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    ABSTRACT: Objective: To evaluate prospectively the efficacy to screen for congenital heart defects (CHD) during the first trimester nuchal translucency (NT) ultrasound examination by assessing the four chambers' view of fetal heart. Methods: Pregnancies that were examined prospectively by ultrasound in the first trimester (11th-14th week), the second (19th-24th week) and third trimester were included in the study. 3774 fetuses were examined and fetal heart was assessed during the NT scan by examining the four chambers view. Detailed echocardiography was performed during the anomaly and growth scans. Diagnosis of congenital heart defects (CHD) was further confirmed by a fetal cardiologist. Results: The four chambers view was obtained in 99.52% of the cases. CHD were diagnosed in 29 fetuses (0.77%). Thirteen cases (44.8%) were detected during the 11-13 weeks' scan, 14 cases (48.3%) during the anomaly scan, 1 CHD (3.5%) during the third trimester scan and 1 case (3.5%) postpartum. Conclusion: Assessment of the four chambers of fetal heart early in pregnancy was feasible and allowed the detection of 45% of CHD. Additional parameters of fetal cardiac anatomy during the NT scan may further improve the detection rate providing pregnancy management information early in the first trimester.
    The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 06/2012; · 1.36 Impact Factor
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    A Sotiriadis, S Papatheodorou, G Makrydimas
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    ABSTRACT: To quantify the effect on perinatal outcome in women treated with progesterone for the prevention of preterm birth. MEDLINE and SCOPUS searches, including references of the retrieved articles and additional automated search using the 'search for related articles' PubMed function, were used. Randomized controlled trials assigning women at risk for preterm birth to progesterone or placebo were included (both singleton and multiple pregnancies). Outcomes were neonatal and perinatal death, respiratory distress syndrome (RDS), retinopathy, necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH) Grade 3-4, sepsis, admission to the neonatal intensive care unit (NICU) and composite adverse outcome. Sixteen studies (singletons, n = 7; twins, n = 7; triplets, n = 2) were included in the meta-analysis. For singleton pregnancies, progesterone reduced the rates of neonatal death (risk ratio (RR) 0.487 (95% CI, 0.290-0.818)), RDS (RR 0.677 (95% CI, 0.490-0.935)), NICU admission (RR 0.410 (95% CI, 0.204-0.823)) and composite adverse outcome (RR 0.576 (95% CI, 0.373-0.891)). No favorable effect was observed in twins; in fact, progesterone was associated with increased rates of perinatal death (RR 1.551 (95% CI, 1.014-2.372)), RDS (RR 1.218 (95% CI, 1.038-1.428)) and composite adverse outcome (RR 1.211 (95% CI, 1.029-1.425)). No significant effect was observed in triplet pregnancies. Progesterone administration in singleton pregnancies at risk for preterm birth improves perinatal outcomes, but may actually have adverse effects in multiple pregnancies.
    Ultrasound in Obstetrics and Gynecology 05/2012; 40(3):257-66. · 3.56 Impact Factor
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    ABSTRACT: Evaluate the results obtained from Quantitative Fluorescent (QF)-PCR and conventional karyotype analysis to determine the advantages and disadvantages of dual testing in prenatal diagnosis. From 1 June 2006 to 1 June 2010, dual testing by QF-PCR and karyotype analysis was performed in 13,500 prenatal samples. The rates of concordant results between the two methods were evaluated and the rates of clinically significant chromosomal abnormalities undetected by QF-PCR were assessed. Abnormal karyotype was found in 320 out of 13,500 cases (2.37%, 95% confidence interval (CI) 2.11-2.63%). From these, QF-PCR did not detect the abnormality in 70 cases (0.52%, 95% CI 0.4-0.64%), whereas 34 had a high/unknown risk of adverse outcome (0.25%, 95% CI 0.17-0.33%). By selectively applying dual testing only at cases with ultrasound findings and/or genetic history, 13 cases of high/unknown risk would have been missed (0.1%, 95% CI 0.05-0.15%). Selective dual testing is expected to achieve a serious beneficial economical outcome and reduce parental anxiety produced by ambiguous cytogenetic findings. However, the percentage of 0.1% undetected clinically significant abnormalities cannot be ignored. A suggestion would include the offering of a choice to the pregnant women, undergoing prenatal screening, by informing them about different approaches and various complications.
    Prenatal Diagnosis 04/2012; 32(7):680-5. · 2.68 Impact Factor
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    ABSTRACT: Brain thalami are important for a wide range of sensorimotor and neuropsychiatric functions. This study was carried out to calculate normative values for thalami volume during fetal life. Fetal thalami volumes were measured using 3D ultrasound in 122 normal, singleton fetuses at 20(+0) -34(+6) weeks' gestation. Virtual Organ Computer-aided AnaLysis (VOCAL) was used to obtain a sequence of six sections of each thalamus, starting from the transthalamic view of the brain at an axial plane. Thalamic contour was drawn manually. Volume contrast imaging was used to enhance image quality when needed. The volume of the thalamus distal to the transducer was also measured by a second operator in 30 randomly selected cases, blind to the measurements of the first, to calculate interobserver agreement. Thalamic volume increased with gestational age, following a quadratic equation (R(2) = 0.83). There was no significant difference in volume between the right and left thalamus. The mean volume of each thalamus increased from 0.45 ml at 20(+0) weeks, to 1.39 ml at 28(+0) weeks, to 2.17 ml at 34(+0) weeks. The 95% limits of interobserver agreement for thalamic volume were -14.3% to +17.2%. The increase in thalamic volume with gestation can be described adequately by a quadratic equation. The moderate interobserver repeatability is attributed to the similar echogenicity between the thalamus and its surrounding structures.
    Journal of Clinical Ultrasound 01/2012; 40(4):207-13. · 0.70 Impact Factor
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    ABSTRACT: The purpose of this study was (1) to explore for socio-demographic factors that could potentially affect the intention of women to vaccinate themselves, their 13-year-old daughter and their 13-year-old son against HPV, and (2) to investigate the main reasons for declining vaccination. A structured questionnaire was used in participants of the project (N = 5,249). Logistic regression analysis was applied in order to examine the correlation between vaccine acceptability and a list of potential predictors. In women declining vaccination, the reported reasons for decline were analyzed. Residence in rural areas and low to medium tiers of family income were the most constant factors in favor of intention to vaccinate. Receiving information from a healthcare professional was found to positively affect vaccine acceptability for the woman herself, but it did not affect her intention to vaccinate her daughter or her son. The acceptance rates decreased significantly after the vaccine became available, both for the women themselves and for their daughters or sons. During the same year, a shift was noted in the reason for declining vaccination; the self-perception of insufficient knowledge significantly decreased and the fear of adverse effects significantly increased in all three cases. Apart from demographic factors which may favor or disfavor vaccine acceptability, the intention to vaccinate decreased significantly and the proportion of women rejecting vaccination for safety concerns increased significantly after the introduction of the vaccine, coinciding with isolated cases of negative publicity and highlighting the potential of misinformation by the media.
    Archives of Gynecology 01/2012; 285(6):1719-24. · 0.91 Impact Factor
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    Alexandros Sotiriadis, George Makrydimas
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    ABSTRACT: To systematically review published data on the neurodevelopment of children that were diagnosed prenatally with isolated agenesis of the corpus callosum. Medline and Scopus searches (1960-July 2011); cross-referencing of retrieved articles. Sixteen reports (132 cases of apparently isolated agenesis of the corpus callosum) were included in the analysis. The rates of normal outcome, borderline or moderate disability and severe disability were 94/132 (71.2%; 95% confidence interval [CI], 63.0-78.3), 18/132 (13.6%; 95% CI, 8.8-20.5), and 22/132 (15.2%; 95% CI, 10.0-22.2), respectively. Magnetic resonance imaging detected additional cerebral abnormalities in 22.5% (95% CI, 12.3-37.5) of apparently isolated agenesis of the corpus callosum cases. In truly isolated agenesis of the corpus callosum (confirmed by magnetic resonance imaging), the rates of normal neurodevelopment and severe disability were 52/69 (75.4%; 95% CI, 64.0-84.0) and 8/69 (11.6%; 95% CI, 6.0-21.2), respectively. Prenatally diagnosed, isolated agenesis of the corpus callosum is usually associated with a favorable outcome. Larger, prospective series are required, as current data are limited, inconsistent, and prevent subgroup analyses (eg, complete vs partial agenesis of the corpus callosum).
    American journal of obstetrics and gynecology 12/2011; 206(4):337.e1-5. · 3.28 Impact Factor
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    A Sotiriadis, S Papatheodorou, G Makrydimas
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    ABSTRACT: To systematically review and, when feasible, pool, published data regarding the prevalence of childhood neurodevelopmental delay in fetuses with increased first-trimester nuchal translucency (NT), normal karyotype and absence of structural defects or identifiable syndromes. MEDLINE and SCOPUS searches using combinations of the terms 'nuchal translucency' AND 'outcome*' were complemented by perusal of the references of the retrieved articles and an additional automated search using the 'search for related articles' PubMed function. Only children with a normal karyotype and no structural defects or syndromic abnormalities were included in the analysis. Between-studies heterogeneity was assessed using the I(2) statistic. The total prevalence of developmental delay in all 17 studies was 28/2458 (1.14%; 95% CI, 0.79-1.64; I(2) = 57.6%). Eight studies (n = 1567) used NT > 99(th) centile as the cut-off; 15 children (0.96%; 95% CI, 0.58-1.58%) were reported as having developmental delay (I(2) = 72.2%). Four studies (n = 669) used the 95(th) centile as the cut-off for increased NT; seven children (1.05%; 95% CI, 0.51-4.88%) were reported as having developmental delay (I(2) = 29.2%). Five studies used 3.0 mm as the cut-off for increased NT; the pooled rate of developmental delay was six of 222 children (2.70%; 95% CI, 1.24-5.77%; I(2) = 0.0%). The rate of neurodevelopmental delay in children with increased fetal NT, a normal karyotype, normal anatomy and no identifiable genetic syndromes does not appear to be higher than that reported for the general population. More large-scale, prospective case-control studies would be needed to enhance the robustness of the results.
    Ultrasound in Obstetrics and Gynecology 11/2011; 39(1):10-9. · 3.56 Impact Factor
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    Ultrasound in Obstetrics and Gynecology 10/2010; 36(S1):59. · 3.56 Impact Factor
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    ABSTRACT: The most compelling question in evaluating the possible replacement of the conventional Papanicolaou smear from a high-risk HPV testing method is the balance between specificity and sensitivity for detection of cervical intraepithelial neoplasia grade ≥CIN 2 (CIN 2+). Multiple studies have shown that HPV testing has higher sensitivity than cytology for the detection of high-grade CIN. Positivity increases the test cut-off for HPV and may reduce false positive results without significantly compromising the sensitivity, potentially alleviating the concern of low specificity. Overall, available evidence convincingly shows that HPV testing is superior to traditional screening for the detection of high-grade cervical lesions, and efforts are focused on improving its sensitivity, either by increasing its cut-off for positivity or by selecting those subgroups where HPV testing is expected to have higher positive predictive value for cervical disease, or by seeking to optimize triage tests after a positive HPV result.
    Annals of the New York Academy of Sciences 09/2010; 1205:51-6. · 4.38 Impact Factor
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    ABSTRACT: A large (165 × 235 × 250 mm) solitary, unilocular cyst with a thin, smooth wall and homogeneous anechoic content was detected during a routine ultrasound scan at 24 weeks of gestation in an asymptomatic 39-year-old woman with a singleton pregnancy. The cyst was aseptate, lacked mural blood flow and was not associated with ascites. It was located in the central abdominal area above and anterior to the uterus. Gradually increasing abdominal discomfort developed, and a laparotomy was performed at 27 weeks; the cyst was removed after aspiration of 6.3 L of serous fluid and the ipsilateral ovary was preserved. Pathological examination indicated a large luteinized follicular cyst of pregnancy. A healthy male infant was delivered vaginally at term. A rapidly enlarging ovarian mass in pregnancy poses significant diagnostic problems. Large luteinized cysts of pregnancy are uncommon and thought to involve stimulation by human chorionic gonadotropin (hCG), or increased tissue sensitivity to hCG. A literature search identified four previous cases that had been detected prenatally. With one exception, the cysts appeared to enlarge during pregnancy, eventually becoming symptomatic, and two previous cases also required removal of the cyst before birth. Adverse pregnancy outcome was only reported in one of the previous cases. In summary, large luteinized cysts of pregnancy are an uncommon type of cystic mass particular to pregnancy, characterized by the combination of a benign appearance and a tendency to enlarge rapidly, eventually becoming symptomatic and most often necessitating surgery.
    Ultrasound in Obstetrics and Gynecology 05/2010; 36(4):517-20. · 3.56 Impact Factor
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    ABSTRACT: Implementation of human papillomavirus (HPV) vaccination is expected to change the epidemiology of HPV infection. Using age-dependent (inhomogeneous) Markov chains, we tested the effect of type-specific (ie, HPV-16/HPV-18 and other high-risk HPV types) HPV incidence on 3 screening strategies in a cohort of 100,000 women, starting screening at the age of 25 years and continuing until the age of 34 years. All the strategies started with an HPV test; if the result was positive, the next step was triage with cytology (strategy 1), cytology and colposcopy together (strategy 2), or colposcopy only (strategy 3). Published background data were used for the models. Strategy 2 had the highest sensitivity; the absolute number of missed cervical intraepithelial neoplasia (CIN)3+ cases was associated with HPV incidence in all the strategies, but their relative sensitivity remained unaffected. Strategy 2 was cheaper per diagnosed CIN3+ for very low HPV incidence rates, but this changed for higher incidence rates. For any given pair of HPV-16/HPV-18 and other high-risk-type incidence, the cost of the triage and the total cost of screening was highest in screening 2 and lowest in screening 1. For each screening strategy, the cost per diagnosed CIN3+ was mainly determined by the incidence of HPV-16/HPV-18, and the cost of the triage and the total screening cost by the incidence of other high-risk types. Type-specific HPV incidence affects the absolute number of missed CIN3+ cases and the cost of screening in a mathematically describable way and can be used for prediction of changes in these outcomes with changing HPV epidemiology.
    International Journal of Gynecological Cancer 02/2010; 20(2):276-82. · 1.94 Impact Factor
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    ABSTRACT: To integrate data on the performance of cervical length measurement for the prediction of preterm birth in symptomatic women. MEDLINE, SCOPUS and manual searches for studies with transvaginal ultrasound measurement of the cervical length in symptomatic women were carried out. Random effects models were used for data integration, and pooled test estimates of sensitivity, specificity, and positive and negative likelihood ratios (LR+ and LR-) were calculated along with their 95% CIs. Twenty-eight studies fulfilled the selection criteria. For birth within 1 week from presentation, the pooled sensitivity, specificity, LR+ and LR- of cervical length < 15 mm were 59.9% (95% CI, 52.7-66.8%), 90.5% (95% CI, 89.0-91.9%), 5.71 (95% CI, 3.77-8.65) and 0.51 (95% CI, 0.33-0.80), respectively. The same estimates for studies with presentation at or before 34 + 0 weeks were 71.0% (95% CI, 60.6-79.9%), 89.8% (95% CI, 87.4-91.9%), 5.19 (95% CI, 2.29-11.74) and 0.38 (95% CI, 0.11-1.34), respectively. For prediction of birth before 34 weeks, the pooled sensitivity, specificity, LR+ and LR- of cervical length < 15 mm were 46.2% (95% CI, 34.8-57.8%), 93.7% (95% CI, 90.7-96.0%), 4.31 (95% CI, 2.73-6.82) and 0.63 (95% CI, 0.38-1.04), respectively. There was considerable heterogeneity across studies in most estimates. Measurement of cervical length in symptomatic women can detect a significant proportion of those who will deliver within 1 week and help to rationalize their management. The considerable heterogeneity across studies may be indicative of methodological flaws, which either were not reported at all or were under-reported.
    Ultrasound in Obstetrics and Gynecology 12/2009; 35(1):54-64. · 3.56 Impact Factor
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    ABSTRACT: As knowledge of regional human papillomavirus (HPV) type distribution is essential for the optimization of prevention strategies, this study was carried out to explore the prevalence and type distribution of high-risk HPV in a screening population across Greece. Cervical samples were collected by local physicians and nurses in hospitals and health centers across the country from 4139 women attending for cervical cancer screening. High-risk HPV-DNA was detected by using Hybrid Capture-2 (HC2) and positive samples with adequate cellular content were further typed by restriction fragment length polymorphism-polymerase chain reaction. Almost six percent (5.9%) of women tested positive in HC2. The most common type was HPV16 (1.4% in the whole sample and 32.4% of the typed samples), followed by HPV53 (0.6 and 14.0%, respectively), HPV31 (0.6 and 12.9%, respectively), HPV35 (0.5 and 12.3%, respectively), HPV51 (0.4 and 7.8%, respectively), HPV18 (0.3 and 7.3%, respectively) and 22 more types. Almost 15% of the typed samples showed a coinfection with two HPV types and 2.1% with three types. There was a bimodal distribution by age, with the highest peak in women 20-29 years old and a lower peak in women 50-59 years old. Apart from the types originally included in HC2 cocktail, PCR analysis identified 15 more types (HPV6, HPV11, HPV34, HPV37, HPV38, HPV42, HPV53, HPV54, HPV55, HPV61, HPV62, HPV66, HPV73, HPV82, HPV83). Eleven percent of HC2-positive results arose from single-type infections with HPV53 (10%) and HPV66 (1%), which are potentially high-risk types. In conclusion, HPV16 is the most common type in the largest Greek screening sample used to date and, together with its related types, accounts for more than half of high-risk HPV infections. Approximately 10% of positive HC2 results arise from HPV53, which is not normally detected by the test, but may be clinically significant.
    European Journal of Cancer Prevention 10/2009; 18(6):504-9. · 2.97 Impact Factor
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    ABSTRACT: To assess the predictive performance of cervical length measurement at presentation and 24h later in women with symptoms of preterm labour. Cervical length was measured transvaginally at presentation and 24 hours later in 122 women presenting with threatened preterm labour between 23 and 33+6 gestational weeks. Six women delivered within 1 week of presentation. The sensitivity and specificity of a cervical length <15 mm at admission for delivery within one week was 83.3 and 95.8%, respectively. A reduction of >20% in cervical length 24h after admission predicted 50% of preterm deliveries within 1 week, with a specificity of 92.7%; in combination with cervical length at presentation it did not improve the prediction. The same was observed for birth before 32 weeks (N=9) and birth before 35 weeks (N=15). Women with threatened preterm labour and a cervical length of <15 mm at presentation are at high risk of delivering preterm. Cervical change in the following 24 hours does not seem to improve the prediction.
    European journal of obstetrics, gynecology, and reproductive biology 09/2009; 148(1):17-20. · 1.97 Impact Factor

Publication Stats

800 Citations
186.10 Total Impact Points

Institutions

  • 2011–2014
    • Aristotle University of Thessaloniki
      • Department of Obstetrics and Gynecology IV
      Saloníki, Central Macedonia, Greece
  • 2012–2013
    • General Hospital Thessaloniki
      Saloníki, Central Macedonia, Greece
  • 1999–2009
    • University Hospital of Ioannina
      Yannina, Epirus, Greece
  • 2007
    • King's College Hospital NHS Foundation Trust
      Londinium, England, United Kingdom
  • 2005
    • King's College London
      Londinium, England, United Kingdom
  • 2004
    • Kettering General Hospital NHS Foundation Trust
      Кеттеринг, England, United Kingdom
  • 1998–2004
    • University of Ioannina
      • Division of Obstetrics-Gynaecology
      Yannina, Epirus, Greece