Cervical Length at 16–22 Weeksʼ Gestation and Risk for Preterm Delivery

Hibbard, Judith U.; Tart, Maureen; Moawad, Atef H.

doi:10.1097/00006250-200012000-00020

Cited by 15 publications

(9 citation statements)

References 11 publications

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“…Several studies reporting an association between short CL and sPTB risk were performed primarily in high-risk populations and used a CL less than 20 or 25 mm to define a short cervix. 5 12 15 18 Moreover, several data concerning the predictive values of CL in nulliparous women are derived from interventional studies in which participants (including the control group) were informed about the CL. Our study was conducted prior to the introduction of universal measurement of CL in our institution, and the participants were not informed about the CL that was measured a posteriori.…”

Section: Discussionmentioning

confidence: 99%

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Midtrimester Cervical Length in Low-Risk Nulliparous Women for the Prediction of Spontaneous Preterm Birth: Should We Consider a New Definition of Short Cervix?

et al. 2021

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Objective The study aimed to estimate the predictive value of midtrimester cervical length (CL) and the optimal cut-off of CL that should be applied with asymptomatic nulliparous women for the prediction of spontaneous preterm birth (sPTB). Study Design This is a prospective cohort study of asymptomatic nulliparous women with a singleton gestation. Participants underwent CL measurement by transvaginal ultrasound between 20 and 24 weeks of gestation. The participants and their health care providers remained blinded to the results of CL measurement. The primary outcomes were sPTB before 35 weeks and sPTB before 37 weeks. Receiver operating characteristics (ROC) curve analyses were performed. Analyses were repeated by using multiples of median (MoM) of CL adjusted for gestational age. Results Of 796 participants, the mean midtrimester CL was 40 ± 6 mm with a 1st, 5th, and 10th percentile of 25, 29, and 32 mm, respectively. ROC curve analyses suggest that a cut-off of 30 mm was the optimal CL to predict sPTB before 35 weeks (area under the ROC curve [AUC]: 0.70, 95% confidence interval [CI]: 0.56–0.85) and before 37 weeks (AUC: 0.70, 95% CI: 0.59–0.80). Midtrimester CL <30 mm could detect 35% of all sPTB before 35 weeks at a false-positive rate of 5% (relative risk: 9.1, 95% CI: 3.5–23.5, p < 0.001). We observed similar results using a cut-off of CL <0.75 MoM adjusted for gestational age. Conclusion A midtrimester CL cut-off of 30 mm (instead of 25 mm), or CL less than 0.75 MoM, should be used to identify nulliparous women at high risk of sPTB. Key Points

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Section: Discussionmentioning

confidence: 99%

“…By convention, the 10th percentile of CL for the population has been used to indicate women at “high risk” of sPTB, but the 25 mm cut-off has been established in populations at higher risk of PTB, including parous women with prior history of sPTB. 12 18…”

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confidence: 99%

Midtrimester Cervical Length in Low-Risk Nulliparous Women for the Prediction of Spontaneous Preterm Birth: Should We Consider a New Definition of Short Cervix?

et al. 2021

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“…Preterm birth is the leading cause of neonatal morbidity and mortality worldwide (1), and babies born prematurely are at higher risk for long-term health issues, such as intellectual, developmental, and physical disabilities (1,2). A single mid-trimester cervical length measurement by transvaginal ultrasound is the best available technique for predicting (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) and preventing preterm birth, when paired with the administration of vaginal progesterone or cerclage in patients with a short cervix . Despite promise as a diagnostic tool this measure is characterized by relatively low sensitivity (9,42).…”

Section: Introductionmentioning

confidence: 99%

“…Estimates for the mean length of the cervix in the mid-trimester vary between 35 and 45 mm, depending on the population (52)(53)(54), with cervical lengths shorter than 25 mm before 24 weeks meeting the clinical definition of a short cervix (28). A short cervix in the mid-trimester is associated with a six-fold increase in the risk of preterm delivery (4), and the earlier in pregnancy that the shortening occurs, the higher the risk for spontaneous preterm birth (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

“…In most uncomplicated full-term pregnancies, the length of the cervix remains constant or gradually decreases beginning around 30 weeks (66,67). However, in some pregnancies rapid and progressive cervical shortening can occur earlier (46,66,68,69), which is associated with an increased risk for many adverse pregnancy outcomes, including preterm premature rupture of membranes (pPROM) (70,71), ascending infection (72)(73)(74), preterm labor (75)(76)(77), and premature delivery (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)18). Maternal characteristics, such as advanced maternal age (53), BMI > 25 (78,79), higher parity (48), Black race/ethnicity (80), tobacco use (81), and history of cervical trauma (82) have all been associated with an increased risk of a short cervix in the mid-trimester.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Spontaneous Preterm Birth are Mediated through Changes in Cervical Length

Wolf

Latendresse

Strauss

et al. 2023

Preprint

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Although short cervical length in the mid-trimester of pregnancy is a one of the strongest predictors of preterm birth (i.e., parturition before 37 completed weeks), there is limited understanding of how the dynamics of cervical remodeling (i.e., changes in cervical length) leading up to labor and delivery can inform obstetrical risk. In this study, latent growth curve analysis was applied to serial cervical length measurements across pregnancy (median of 6; IQR = 3-8) to quantify characteristics of cervical change in a cohort of 5,111 singleton pregnancies consisting predominantly of Black women from Detroit, Michigan. A conditional mediation model including nine common maternal risk factors for spontaneous preterm birth as exogenous predictors accounted for 26.5% of the variability in gestational age at delivery (P < 0.001). This model provides insight into distinct mechanisms by which specific maternal risk factors influence preterm birth. For instance, effects of maternal parity and smoking status were fully mediated through cervical change parameters, whereas the influence of previous preterm birth was only partially explained, suggesting alternative pathways could be involved. This study provides the first account of the intermediary role of cervical dynamics in associations between known maternal risk factors and gestational age at delivery.

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Uterine contraction may not be an independent risk factor for spontaneous preterm birth before 35 weeks in women with cervical shortening

Horie

Takahashi

Mieno

et al. 2022

Intl J Gynecology & Obste

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Objective To compare the risk of spontaneous preterm birth (SPTB) before 35 weeks in symptomatic and asymptomatic women with cervical shortening at 16–34 weeks under mid‐trimester universal screening of cervical length (CL). Method Multicenter retrospective cohort study involving six secondary/tertiary perinatal centers was planned in 2016. Primary outcomes were SPTB before 35 weeks. In all, 407 women were analyzed using multivariable logistic regression analysis for predicting SPTB before 35 weeks while adjusting for presence/absence of uterine contraction, gestational weeks, vaginal bleeding, and CL classification (1–9, 10–14, 15–19, and 20–24 mm) at admission, the execution of cervical cerclage, and the presence/absence of past history of preterm delivery. Results SPTB before 35 weeks of pregnancy occurred in 14.5%. Presence of uterine contraction was not an independent risk factor for SPTB before 35 weeks (adjusted odds ratio [aOR] 1.22, 95% confidence interval [CI] 0.67–2.20). CL of 1–9 mm, CL of 10–14 mm, and vaginal bleeding at admission were independent risk factors for SPTB before 35 weeks (aOR 5.35, 95% CI 2.11–13.6; aOR 2.79, 95% CI 1.12–6.98; and aOR 2.37, 95% CI 1.12–5.10, respectively). Conclusion In women with a cervical shortening at 16–34 weeks, presence of uterine contractions at admission may not be an independent risk factor for the occurrence of SPTB before 35 weeks.

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Cervical Length at 16–22 Weeksʼ Gestation and Risk for Preterm Delivery

Cited by 15 publications

References 11 publications

Midtrimester Cervical Length in Low-Risk Nulliparous Women for the Prediction of Spontaneous Preterm Birth: Should We Consider a New Definition of Short Cervix?

Midtrimester Cervical Length in Low-Risk Nulliparous Women for the Prediction of Spontaneous Preterm Birth: Should We Consider a New Definition of Short Cervix?

Risk Factors for Spontaneous Preterm Birth are Mediated through Changes in Cervical Length

Uterine contraction may not be an independent risk factor for spontaneous preterm birth before 35 weeks in women with cervical shortening

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