Cervical length at 16â22 weeks' gestation and risk for preterm delivery

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

doi:10.1016/s0029-7844(00)01074-7

Cited by 96 publications

(77 citation statements)

References 12 publications

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“…The TVU report may include funneling of the sonographic internal os, so that the following parameters may be reported: functional CL, which is the closed part of the cervix; funnel length, which is the open part of the cervix and funnel width (Figure 1) [20]. Studies have established that progressive cervical effacements precede uterine contraction by several weeks in both normal and sPTB [21,22]. Overall, functional CL is the preferred method in establishing the risk of sPTB, considering that, if funneling is present, the CL is almost always short (Figure 2).…”

Section: Technical and Clinical Aspects Of Transvaginal Cervical Sonogrmentioning

confidence: 99%

Cervical length for the prediction and prevention of preterm birth

Di¹,

Berghella

2013

Expert Review of Obstetrics & Gynecology

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Section: Technical and Clinical Aspects Of Transvaginal Cervical Sonogrmentioning

confidence: 99%

Cervical length for the prediction and prevention of preterm birth

Di¹,

Berghella

2013

Expert Review of Obstetrics & Gynecology

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“…Sonographic CL measurement and its shortening in the second trimester is one of the strongest predictors for PTD in low-risk population [5,[14][15][16][17]. The "cut-off" value of 25 mm for CL is the commonest and widely used in majority of previous studies that investigated the relation of CL and incidence of PTD [5,[14][15][16].…”

Section: Discussionmentioning

confidence: 99%

“…In our earlier investigation we found positive correlation between increased electrical activity of the uterine body and shortening of the CL [3]. Additionally, several investigators have reported the relation and usefulness of second trimester sonographic assessment of the CL for prediction of PTD in asymptomatic low-risk population [5,[14][15][16][17].…”

Section: Introductionmentioning

confidence: 91%

Raised electrical uterine activity and shortened cervical length could predict preterm delivery in a low-risk population

Grgić

Matijević

Kuna

2011

Arch Gynecol Obstet

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Methods: Prospective study of 308 low-risk women. Shortened CL was defined as < 25 mm (< 5th centile), while raised EMG activity was defined as presence of > 20 action potentials in 20 minutes of assessment (> 95th centile). Outcome measures were diagnostic accuracy of both tests for prediction of PTD and early PTD (< 34 weeks).Results: The incidence of PTD was 23/308 (7.4%) while the incidence of early was 9/308 (2.9%). Shortened CL and raised EMG activity are significantly related to PTD (prevalence-weighted likelihood ratio (pwLR) 1.9 (95%CI 1.0-3.5) versus 9.5 (95%CI 2.5-35.7), but not to early PTD (pwLR 0.4 (95%CI 0.2-0.8) versus 0.6 (95%CI 0.3-1.7).Significant predictive value for early PTD was found only if shortened CL was concomitant with raised EMG activity (pwLR 4 (95% CI 1.3-14.3).Conclusion: Shortened CL and raised EMG activity in the second trimester have significant accuracy regarding the prediction of PTD in a low-risk population. However, in order to be useful as a predictor for early PTD, both tests must be positive.

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“…At 22-24 weeks gestation, the 10 th percentile is approximately 25 mm, although between 16 and 22 weeks (when women typically receive their anatomic survey and cervical length screening) the 10 th percentile is 30 mm. [1][2][3] Among nulliparous women, a short cervix is the risk factor with the highest population attributable risk for preterm birth. 4 Nevertheless, even though the presence of a short cervix increases the chance of spontaneous preterm birth, many nulliparous women with this finding will still deliver at term.…”

Section: Abstract Cervical Length; Prediction; Spontaneous Preterm Birthmentioning

confidence: 99%

732: Prediction of spontaneous preterm birth among nulliparous women with a short cervix

Grobman

2014

American Journal of Obstetrics and Gynecology

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Objective-To evaluate whether demographic and sonographic factors associated with spontaneous preterm birth (sPTB) among nulliparous women with a cervical length (CL) < 30 mm could be combined into an accurate prediction model for sPTB.Methods-Secondary analysis of a trial of nulliparous women with a singleton gestation, a CL <30 mm on transvaginal ultrasound between 16 and 22 weeks, and who lacked other risk factors for spontaneous (e.g., prior cervical excisional procedure) or medically-indicated preterm birth (e.g., chronic hypertension), who were randomized to either 17 hydroxyprogesterone caproate or placebo. Risk factors associated with sPTB within the entire cohort were identified using univariable analysis. Factors significantly associated (P < 0.05) with sPTB were included in multivariable logistic regression analyses to determine whether an accurate prediction model could be developed.Results-Of the 657 randomized patients, 109 (16.6%) had sPTB less than 37 weeks of gestation. Logistic regression analysis revealed only cervical length (OR 1.06 per 1 mm decrease, 95% CI 1.02-1.10) to be associated with sPTB. The area under the ROC curve based on this regression was low (AUC: 0.63, 95% CI 0.58-0.69). Results were similar for the outcome of sPTB < 34 weeks.Conclusions-An accurate prediction model for sPTB among nulliparous women with a short cervix could not be developed. Keywords cervical length; prediction; spontaneous preterm birthIt is well established that the midtrimester sonographic length of the cervix is associated with the chance of preterm birth. 1 By convention, the 10 th percentile of cervical length for the population has been used to indicate women at "high risk" of preterm birth. At 22-24 weeks gestation, the 10 th percentile is approximately 25 mm, although between 16 and 22 weeks (when women typically receive their anatomic survey and cervical length screening) the 10 th percentile is 30 mm. 1-3 Among nulliparous women, a short cervix is the risk factor with the highest population attributable risk for preterm birth. 4 Nevertheless, even though the presence of a short cervix increases the chance of spontaneous preterm birth, many nulliparous women with this finding will still deliver at term. For example, among nulliparous women in the United States, a cervical length less than the 10 th percentile in the second trimester conveys a risk of preterm birth of approximately 25%. 1,3 That is, the majority of nulliparous women classified as "high risk" will actually deliver at term. These nulliparous women, whose short cervix has been a false positive finding with respect to spontaneous preterm birth, may receive medical treatments (e.g. progesterone), unproven interventions (e.g., bed rest), and experience anxiety because of their high-risk classification. [6][7][8] Some investigators previously have attempted, without success, to elucidate other factors in addition to cervical length that could assist in prediction of preterm birth. 9 However, the Author ManuscriptAuthor Manuscript ...

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Cervical length at 16â22 weeks' gestation and risk for preterm delivery

Abstract: Transvaginal measurement of cervical length during routine ultrasound at 16-22 weeks' gestation in asymptomatic gravidas might help identify women at risk for spontaneous preterm delivery.

Cited by 96 publications

References 12 publications

Cervical length for the prediction and prevention of preterm birth

Cervical length for the prediction and prevention of preterm birth

Raised electrical uterine activity and shortened cervical length could predict preterm delivery in a low-risk population

732: Prediction of spontaneous preterm birth among nulliparous women with a short cervix

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Cervical length at 16â22 weeks' gestation and risk for preterm delivery

Abstract: Transvaginal measurement of cervical length during routine ultrasound at 16-22 weeks' gestation in asymptomatic gravidas might help identify women at risk for spontaneous preterm delivery.

Cited by 96 publications

References 12 publications

Cervical length for the prediction and prevention of preterm birth

Cervical length for the prediction and prevention of preterm birth

Raised electrical uterine activity and shortened cervical length could predict preterm delivery in a low-risk population

732: Prediction of spontaneous preterm birth among nulliparous women with a short cervix

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Cervical length at 16â22 weeks' gestation and risk for preterm delivery