Changes in cervical length and the risk of preterm labor

Naim, Arjang; Haberman, Shoshana; Burgess, Traci; Navizedeh, Navid; Minkoff, Howard

doi:10.1067/mob.2002.123058

Cited by 48 publications

(31 citation statements)

References 3 publications

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“…These findings are consistent with a report by another investigator (Fox et al, 2010), who demonstrated that the change in CL over time is a significant predictor of SPTD, even in the absence of a short cervix. These observations were novel, but not unexpected because a previous study revealed that independent of the baseline CL, more rapid shortening of the cervix increases the risk of preterm birth (Naim et al, 2002). However, the current results are different from the findings of Gibson et al (Gibson et al, 2004) who showed that the change in CL from 18-24 weeks or 24-28 weeks has poor predictive value for SPTD prior to 35 weeks' gestation.…”

Section: Discussioncontrasting

confidence: 83%

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The Change in Cervical Length Over Time as a Predictor of Preterm Delivery in Asymptomatic Women With Twin Pregnancies Who Have a Normal Mid-Trimester Cervical Length

Park

Jeong

et al. 2012

Twin Res Hum Genet

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Aim: To determine whether or not the change in cervical length (CL) over time is valuable in predicting spontaneous preterm delivery (SPTD) in asymptomatic twin pregnancies with a normal mid-trimester CL (>25 mm). Methods: This was a prospective study including 190 consecutive asymptomatic twin gestations with a CL > 25 mm at 20-24 weeks. The women underwent an initial CL measurement at the time of routine ultrasound examination between 20 and 24 weeks' gestation, followed 4-5 weeks later by a repeat CL measurement. The primary outcome measure was SPTD at <32 completed weeks' gestation. Multicollinearity was a concern in the multivariable model since change in CL and follow-up CL were highly correlated. Results: The rate of SPTD at <32 weeks was 4.2%. Multiple logistic regression analyses demonstrated that the change in CL and the follow-up CL were significantly associated with SPTD before 32 weeks after adjusting for baseline covariate such as in vitro fertilization. The best cut-off values for the prediction of SPTD at <32 weeks' gestation were 13% for the change in CL with a sensitivity of 87.5% and a specificity of 63.2%. There was no significant difference in the area under the receiver operating characteristic curves between the change in CL and the follow-up CL. Conclusions: A greater change in CL is a good predictor of SPTD in asymptomatic twin pregnancies with a normal mid-trimester CL. However, the change in CL cannot provide data beyond the follow-up CL. In the setting of a normal mid-trimester CL, a follow-up CL measurement should be considered in asymptomatic twin pregnancies.

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Section: Discussioncontrasting

confidence: 83%

“…Recent studies involving singleton pregnancies have shown that a reduction in CL over time is associated with SPTD (Fox et al, 2007;Naim et al, 2002). However, with respect to twin pregnancies, there is limited data on the relationship between the change in CL and SPTD, and the RECEIVED 25 May 2011; ACCEPTED 1 February 2012.…”

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confidence: 99%

The Change in Cervical Length Over Time as a Predictor of Preterm Delivery in Asymptomatic Women With Twin Pregnancies Who Have a Normal Mid-Trimester Cervical Length

Park

Jeong

et al. 2012

Twin Res Hum Genet

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“…6 In Arjang Naim et al (2002) study, incidence of preterm delivery was 23% for cut off cervical length <30mm. 7 Variation in results of present study and other studies might be due to racial and ethnic factors. In other studies cut off values of cervical lengths are different and incidence of preterm deliveries considered for ≤ 32 weeks, ≤35 weeks and ≤ 36 weeks.…”

Section: Discussioncontrasting

confidence: 46%

Prediction of Preterm Delivery by Assessment of Cervical Length Using Transvaginal Ultrasound

Shinde¹,

Kshirsagar²,

Laddad³

et al. 2015

jemds

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AIMS AND OBJECTIVES:To identify patients at risk of preterm deliveries before the onset of symptoms. Purpose of this study is to assess the diagnostic performance of transvaginal ultrasonographic evaluation of cervix in the prediction of preterm delivery. MATERIAL AND METHODS: Sonographic cervical length assessment in 200 antenatal women between 20 -28 weeks gestation attending OPD was done. Study group was divided in group A (Those with cervical length more than 25mm) and group B (those with cervical length ≤25mm, again these women with short cervix divided in Group B1-Women with cervical length 21-25mm, Group B2-Women with cervical length ≤20mm). Cervical length was measured for all enrolled women using 6.5 MHz transvaginal probe. Cervical length on transvaginal sonography ≤25mm were considered as short cervix and remaining (>25 mm) were considered as normal cervical lengths. In present study, women with short cervix ≤25 mm and history of previous preterm delivery or second trimester abortions and evidence of cervical defect were treated with elective cervical cerclage by McDonald method. Women in group A and remaining women in group B (who had short cervix but os was closed and women without history of previous preterm delivery or second trimester abortions) were conservatively followed up. RESULTS: Out of 200 women 5(2.5%) women had cervical lengths ≤20 mm measured with TVS (Group B2); 11(5.5%) had cervical lengths ranging from 21-25mm (group B1). Out of 16 women (group B); 9(4.6%) women underwent elective cerclage and remaining 7(3.6%) women were managed conservatively. Incidence of preterm delivery in group A was 5.6% while in group B it was 75%. Relative risk of preterm delivery in group B was 13.35 (P=0.0000000 ←). Odds Ratio =50.4. Sensitivity of TVS 54.5%, Specificity of TVS 97.6% Positive predictive value 75%, Negative predictive value 94.3%. Incidence of preterm delivery was more in women with visible membranes at time of cerclage compared to women without visible membranes at time of cerclage (100% vs. 33.3%). Relative risk of preterm delivery in women who had previous history of 2 nd trimester abortions and had cervical length ≤25mm on TVS was 4. Odds ratio =11.33 Chi-square value =3.91, P=0.047 and hence significant. In women with history of previous preterm deliveries; 6(75%) women had cervical length ≤25mm on TVS; out of which 3 (50%) women delivered preterm (<37weeks). Mean gestational age at birth in group A was 38.94±2.3 weeks while in group B; it was 35.3±3.2 weeks. Relative risk of preterm delivery (≤32 weeks) in women with cervical length ≤25mm on TVS was 5.56. Relative risk of preterm delivery (≤32 weeks) in women with ≤20 mm cervical length on TVS was 8.90. In group A; out of 10 preterm babies 50% required NICU care. Term babies were 168 and 2.4% required NICU care. In group B; 11(68.8%) babies were preterm out of which 36.4% babies required NICU care. Mean birth weight was lower in group B (2.3kg) compared to group A (2.8 kg). There were no neonatal deaths in group A. There wa...

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“…[16][17][18][19] Cervical length measured by transvaginal ultrasonography has been shown to predict preterm birth in these asymptomatic high-risk women. 13,[20][21][22][23][24][25][26][27][28] Some studies have suggested that cervical length shortening by transvaginal ultrasonography may further increase the risk of preterm birth, 26,[29][30][31][32][33][34] whereas other studies have not noted this association. [35][36][37] There is a limited information regarding the benefit of follow-up cervical length ultrasound in high-risk asymptomatic women found to have a short cervical length.…”

Section: Introductionmentioning

confidence: 85%

“…26,[29][30][31][32][33][34][35][36][37] Many of these studies, however, evaluated low-risk women 29,30,32,34 or those with symptoms of preterm labor. 37 Several studies have evaluated cervical shortening in high-risk women finding conflicting results, with some suggesting it added additional predictive value, 26,31,33 whereas others found it did not.…”

Section: Discussionmentioning

confidence: 99%

Follow-up cervical length in asymptomatic high-risk women and the risk of spontaneous preterm birth

Crane

Hutchens

2010

J Perinatol

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Objective: To determine whether further cervical length shortening by transvaginal ultrasonography in asymptomatic high-risk women with a short cervical length adds additional predictive value for spontaneous preterm birth and perinatal morbidity.Study Design: Women with a history of spontaneous preterm birth, loop electrosurgical excision procedure, cone biopsy or uterine anomaly, who were pregnant with singleton gestations and were found by transvaginal ultrasonography to have a cervical length <3.0 cm at 20 to 28 weeks' gestation, and who underwent a follow-up cervical length within 3 weeks were evaluated, comparing those with further cervical length shortening (>10%) to those without further shortening. Primary outcomes were spontaneous preterm birth <35 weeks' gestation and perinatal morbidity. Secondary outcomes included spontaneous preterm birth <37 weeks, <34 weeks, <32 weeks, birth weight <2500 g, maternal and other neonatal outcomes.Result: Compared with women without further cervical shortening, those with further shortening were found by univariate analyses to have higher rates of spontaneous preterm birth <35 weeks (34.8 versus 8.5%, P ¼ 0.014), <37 weeks (56.5 versus 21.3%, P ¼ 0.003), <34 weeks (30.4 versus 2.1%, P ¼ 0.001), <32 weeks (21.7 versus 0%, P ¼ 0.003), birth weight <2500 g (60.9 versus 17.0%, P<0.0001), neonatal intensive care unit admission (47.8 versus 17.0%, P ¼ 0.006) and composite perinatal morbidity (43.5 versus 14.9%, P ¼ 0.009). Logistic regression revealed the only independent predictors of spontaneous preterm birth <35 weeks were further cervical length shortening (adjusted odds ratio (aOR) 5.73; 95% confidence interval (CI) 1.31 to 24.43) and gestational age at short cervical length (aOR 0.95; 95% CI 0.91 to 0.99). Conclusion:Further cervical length shortening in asymptomatic high-risk women with a short cervical length is an important independent predictor of spontaneous preterm birth <35 weeks and perinatal morbidity.

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Changes in cervical length and the risk of preterm labor

Cited by 48 publications

References 3 publications

The Change in Cervical Length Over Time as a Predictor of Preterm Delivery in Asymptomatic Women With Twin Pregnancies Who Have a Normal Mid-Trimester Cervical Length

The Change in Cervical Length Over Time as a Predictor of Preterm Delivery in Asymptomatic Women With Twin Pregnancies Who Have a Normal Mid-Trimester Cervical Length

Prediction of Preterm Delivery by Assessment of Cervical Length Using Transvaginal Ultrasound

Follow-up cervical length in asymptomatic high-risk women and the risk of spontaneous preterm birth

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