Cervical length and obstetric history predict spontaneous preterm birth: development and validation of a model to provide individualized risk assessment

Çelik, Ebru; To, Meekai; Gajewska, Katarzyna; Smith, Gordon Cs; Nicolaides, Kypros H.

doi:10.1002/uog.5333

Cited by 191 publications

(169 citation statements)

References 23 publications

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“…15 Even models derived from large samples have failed to provide high predictive performance. 13,14,17,18 More recent efforts have focused on biomarkers such as pregnancy-associated plasma protein A, fetal fibronectin, and placental growth factor to augment the predictive capacity of demographic and clinical risk factors; however, this body of research has not yet yielded a clear approach for implementation in clinical practice. [19][20][21][22] As with prior studies, important risk factors in our model included race and obstetric history.…”

Section: Figmentioning

confidence: 99%

“…[13][14][15] More recently, risk models including cervical length as well as various biomarkers have shown promise in increasing prognostic performance. [16][17][18][19][20][21][22] However, this research has not yet yielded a risk assessment tool for use in clinical practice; moreover, the majority of these prediction models have been derived using a general population, which may overinflate their ability to discriminate risk within an a priori at-risk population of Medicaid recipients.…”

Section: Introductionmentioning

confidence: 99%

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Risk Prediction for Adverse Pregnancy Outcomes in a Medicaid Population

Goyal

Hall

Greenberg

et al. 2015

Journal of Women's Health

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Background: Despite prior efforts to develop pregnancy risk prediction models, there remains a lack of evidence to guide implementation in clinical practice. The current aim was to develop and validate a risk tool grounded in social determinants theory for use among at-risk Medicaid patients. Methods: This was a retrospective cohort study of 409 women across 17 Cincinnati health centers between September 2013 and April 2014. The primary outcomes included preterm birth, low birth weight, intrauterine fetal demise, and neonatal death. After random allocation into derivation and validation samples, a multivariable model was developed, and a risk scoring system was assessed and validated using area under the receiver operating characteristic curve (AUROC) values. Results: The derived multivariable model (n = 263) included: prior preterm birth, interpregnancy interval, late prenatal care, comorbid conditions, history of childhood abuse, substance use, tobacco use, body mass index, race, twin gestation, and short cervical length. Using a weighted risk score, each additional point was associated with an odds ratio of 1.57 for adverse outcomes, p < 0.001, AUROC = 0.79. In the validation sample (n = 146), each additional point conferred an odds ratio of 1.20, p = 0.03, AUROC = 0.63. Using a cutoff of 20% probability for the outcome, sensitivity was 29%, with specificity 82%. Positive and negative predictive values were 22% and 85%, respectively. Conclusions: Risk scoring based on social determinants can discriminate pregnancy risk within a Medicaid population; however, performance is modest and consistent with prior prediction models. Future research is needed to evaluate whether implementation of risk scoring in Medicaid prenatal care programs improves clinical outcomes.

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Section: Figmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk Prediction for Adverse Pregnancy Outcomes in a Medicaid Population

Goyal

Hall

Greenberg

et al. 2015

Journal of Women's Health

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“…Patients with a CL <15 mm have an approximate 50% likelihood of preterm delivery <32 weeks, regardless of risk factors [28][29][30]. It is also possible to calculate the individual risk for sPTB based on CL and other risk factors [30].…”

Section: Reviewmentioning

confidence: 99%

Cervical length for the prediction and prevention of preterm birth

Di¹,

Berghella

2013

Expert Review of Obstetrics & Gynecology

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“…The cervix is dynamic and protocols that standardise measurement recommend making multiple measurements over a five minute period of assessment 6 . Algorithms that describe individualised levels of risk of preterm delivery have been proposed 9 . The accuracy of these algorithms is dependent on the quality of measurement of cervical length and may be affected by the mode of ultrasound assessment 10 …”

Section: Introductionmentioning

confidence: 99%

Cervical length measurement: Comparison of transabdominal and transvaginal approach

Westerway

Pedersen

Hyett

2015

Australas J Ultrason Med

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Objective: To compare transabdominal (TA) and transvaginal (TV) ultrasound assessment of cervical length at 16–41 weeks gestation. Methods: TA and TV ultrasound measurements of cervical length were made on 491 pregnancies of 16–41 weeks gestation. Cervical length was measured from internal to external cervical os. Bland‐Altman plots and Wilcoxon signed rank test were used to evaluate differences between TA and TV measurements. Results: The validity of the TA method depended on cervical length. Although the TA method underestimated cervical length by 2.0 mm on average (P < 0.001), Bland Altman plots showed an inverse trend with shorter cervixes. In women with a cervix < 25 mm (n = 30) based on TV scan measurement, TA overestimated cervical length by 12 mm (P < 0.001). The sensitivity and specificity of TA as a test to detect cervical length < 25 mm were 10% (95% CI: 2.1–26%) and 94% (95% CI: 92–96%) respectively; the negative LR was 0.96 (95% CI: 0.84–1.08). The maximum area under the ROC curve would be obtained at a TA cut‐off = 32 mm (to detect a cervix < 25 mm), corresponding to a sensitivity of 77% and a specificity of 58%. Conclusion: TA measurements do not reflect TV assessment accurately, particularly if the cervix is short. At 24–34 weeks, a policy of proceeding to TV scan if TA measurement is < 25 mm will only detect 10% of affected pregnancies and has a poor positive predictive value so is of limited value as a predictive tool for women attending with symptoms and signs of preterm labour > 24 weeks gestation. There is no value in TA assessment of the cervix > 36 weeks.

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Cervical length and obstetric history predict spontaneous preterm birth: development and validation of a model to provide individualized risk assessment

Abstract: Objectives

Cited by 191 publications

References 23 publications

Risk Prediction for Adverse Pregnancy Outcomes in a Medicaid Population

Risk Prediction for Adverse Pregnancy Outcomes in a Medicaid Population

Cervical length for the prediction and prevention of preterm birth

Cervical length measurement: Comparison of transabdominal and transvaginal approach

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