Mid‐trimester sonographic cervical consistency index to predict spontaneous preterm birth in a low‐risk population

Baños, Núria; Murillo, Carla Victoria Jara; Julià, Carla; Perez‐Moreno, Alvaro; Ríos, José; Gratacós, E.; Valentin, Lil; Palacio, Montse

doi:10.1002/uog.17482

Cited by 26 publications

(48 citation statements)

References 35 publications

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“…These findings support the idea that despite use in clinical practice, CL measurement in high-risk singleton pregnancies is not adequate as a stand-alone predictor of sPTB. 10 It is important to highlight that when compared with a cohort of singleton low sPTB risk pregnancies published in a previous study, 24 both CCI and CL measurements were significantly reduced in the high-risk compared with the low-risk pregnancies. However, the diagnostic accuracy of both measurements was better in the low-risk population than in the high-risk population.…”

Section: Discussionmentioning

confidence: 88%

“…However, the diagnostic accuracy of both measurements was better in the low-risk population than in the high-risk population. 24 This may be due to the fact that up to 32.9% (27/82) of high sPTB risk women in our study received some kind of intervention which could have interfered with the natural course of the condition. To avoid unnecessary interventions, in our center, we treat the patients only when there is an evidence-based indication.…”

Section: Discussionmentioning

confidence: 91%

“… 19 20 21 22 23 Therefore, assessment of the early stage in cervical remodeling such as softening using the CCI would potentially allow early identification of the women at increased risk. In fact, in a previous publication, CCI was found to be a better predictor of sPTB <37 +0 and <34 +0 weeks than sonographic CL 24 during the second-trimester scan in a low-risk population.…”

mentioning

confidence: 80%

“…An image acquisition guide and quality criterion were defined to ensure the optimal acquisition parameters and explained in depth in a previous publication. 24 Briefly, to acquire the basal image, a sagittal view of the cervix was obtained without exerting any pressure with the transducer, identifying the internal and external os as well as the cervical canal ( Fig. 1a ).…”

Section: Methodsmentioning

confidence: 99%

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Mid-Trimester Cervical Consistency Index and Cervical Length to Predict Spontaneous Preterm Birth in a High-Risk Population

Baños

Julià

Lorente

et al. 2018

AJP Rep

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Background Short cervical length (CL) has not been shown to be adequate as a single predictor of spontaneous preterm birth (sPTB) in high-risk pregnancies. Objective The objective of this study was to evaluate the performance of the mid-trimester cervical consistency index (CCI) to predict sPTB in a cohort of high-risk pregnancies and to compare the results with those obtained with the CL. Study Design Prospective cohort study including high-risk singleton pregnancies between 19 +0 and 24 +6 weeks. The ratio between the anteroposterior diameter of the uterine cervix at maximum compression and at rest was calculated offline to obtain the CCI. Results Eighty-two high sPTB risk women were included. CCI (%) was significantly reduced in women who delivered <37 +0 weeks compared with those who delivered at term, while CL was not. The area under the curve (AUC) of the CCI to predict sPTB <37 +0 weeks was 0.73 (95% confidence interval [CI], 0.61–0.85), being 0.51 (95% CI, 0.35–0.67), p = 0.03 for CL. The AUC of the CCI to predict sPTB <34 +0 weeks was 0.68 (95% CI, 0.54–0.82), being 0.49 (95% CI, 0.29–0.69), p = 0.06 for CL. Conclusion CCI performed better than sonographic CL to predict sPTB. Due to the limited predictive capacity of these two measurements, other tools are still needed to better identify women at increased risk.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 91%

mentioning

confidence: 80%

Section: Methodsmentioning

confidence: 99%

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Mid-Trimester Cervical Consistency Index and Cervical Length to Predict Spontaneous Preterm Birth in a High-Risk Population

Baños

Julià

Lorente

et al. 2018

AJP Rep

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“…Cervical consistency index (CCI), formulated as (AP 1 /AP) x 100, measuring anteroposterior cervical diameter before (AP) and after (AP 1 ) is reported as being more effective than cervical length in prediction of PB [ 39 , 40 ].…”

Section: Ultrasound Markersmentioning

confidence: 99%

Prediction of Preterm Birth: Maternal Characteristics, Ultrasound Markers, and Biomarkers: An Updated Overview

Kaplan

Özgü-Erdinç

2018

Journal of Pregnancy

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There is not a single or combined screening method for preterm birth with high sensitivity which will truly identify the women at risk for preterm birth while also with high specificity to prevent unnecessary interventions and high treatment costs. Measurement of cervical length is the most cost-effective method that is used in clinical practice. Bedside tests have also been developed for detecting markers like fetal fibronectin, insulin-like growth factor binding protein-1 (IGFBP-1), interleukin-6, and placental alpha-macroglobulin-1. Taking the maternal history, health condition, and sociodemographical factors into consideration is recommended. Ultrasound markers apart from cervical length measurements as uterocervical angle and placental strain ratio are studied. Investigations on metabolomics, proteomics, and microRNA profiling have brought a new aspect on this subject. Maybe in the future, with clear identification of women at true risk for preterm birth, development of more effective preventive strategies will not be unfeasible.

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Cervical consistency index and risk of Cesarean delivery after induction of labor at term

Rueda

Ángeles

Baños

et al. 2019

Ultrasound in Obstet & Gyne

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Objective To evaluate the association between the cervical consistency index (CCI) and the risk of Cesarean delivery after planned induction of labor (IOL) at term. MethodsThis was a prospective observational study of women with a term singleton pregnancy admitted for IOL due to maternal or fetal indication. Ultrasonographic images were obtained before IOL and CCI was calculated offline once recruitment was completed. The main outcome was defined as Cesarean delivery due to failed IOL or arrest of labor. Cesarean deliveries indicated due to maternal or fetal compromise (Van Dillen's grade 1 or 2) were excluded from analysis. Univariate statistical analysis was performed using Fisher's exact test and Student's t-test for categorical and continuous variables, respectively. Multivariate analysis was performed using logistic regression, including CCI and other variables related to the main outcome. Intraclass correlation coefficients were used to estimate intra-and interobserver agreement. ResultsOf 510 women admitted for IOL during the study period and for whom image quality was adequate, 46 were excluded due to emergency Cesarean delivery leaving 464 pregnancies for analysis. Cesarean section due to failed IOL or arrest of labor was performed in 100/464 (21.6%) pregnancies. The mean CCI of women who underwent Cesarean delivery was not significantly different from that in those who had vaginal delivery after IOL (70.1 ± 12.3% vs 70.0 ± 13.1%; P = 0.94). Multivariate analysis also showed absence of statistical association between CCI and Cesarean delivery for failed IOL or arrest of labor. Intraclass correlation coefficients for intra-and interobserver agreement were 0.81 (95% CI, 0.66-0.89) and 0.86 (95% CI, 0.75-0.92), respectively.Conclusion CCI does not seem to be associated with the risk of Cesarean delivery after IOL.

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Mid‐trimester sonographic cervical consistency index to predict spontaneous preterm birth in a low‐risk population

Cited by 26 publications

References 35 publications

Mid-Trimester Cervical Consistency Index and Cervical Length to Predict Spontaneous Preterm Birth in a High-Risk Population

Mid-Trimester Cervical Consistency Index and Cervical Length to Predict Spontaneous Preterm Birth in a High-Risk Population

Prediction of Preterm Birth: Maternal Characteristics, Ultrasound Markers, and Biomarkers: An Updated Overview

Cervical consistency index and risk of Cesarean delivery after induction of labor at term

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