Reviewing short cervix in singleton pregnancies: a multicentric prospective cohort study in the Brazilian population

Abstract

Objective: To identify the association between cervical length (CL) and gestational age at birth. Design: Prospective cohort study. Setting: Seventeen Brazilian reference hospitals. Population: A cohort of 3139 asymptomatic singleton pregnant women who participated in the screening phase of a Brazilian multicenter randomized controlled trial (P5 trial). Methods: Transvaginal ultrasound (TVU) to measure CL was performed from 18 to 22+6 weeks. Women with CL ≤ 30 mm received vaginal progesterone (200 mg/day) until 36 weeks’ gestation. Main Outcome Measures: Area under receive operating characteristic curve (AUC), sensitivity, specificity, Kaplan-Meier curves for preterm birth (PTB), number needed to screen (NNS). Results: CL ≤25mm was associated with extremely severe, severe, moderate and late PTB, whereas a CL 25–30mm was directly associated with late sPTB. The AUC to predict sPTB<28 weeks was 0.82 and for sPTB<34 weeks was 0.67. Almost half of the sPTB occurred in nulliparous women and CL ≤30mm was associated with sPTB <37 weeks (OR = 7.84; 95%CI = 5.5–11.1). The NNS to detect one sPTB <34 weeks in women with CL ≤25mm is 121 and 248 screening tests are necessary to prevent one sPTB <34 weeks using vaginal progesterone prophylaxis. Conclusions: CL measured by TVU is associated with sPTB <34 weeks. Women with CL ≤30mm are at increased risk for late sPTB. Funding: Bill & Melinda Gates Foundation [OPP1107597], the Brazilian Ministry of Health, and the Brazilian National Council for Scientific and Technological Development (CNPq) [401615/20138]. Keywords: cervical length; number needed to screen; preterm birth; short cervix.

Hypertensive disorders during pregnancy as a major cause of preterm birth and adverse perinatal outcomes: findings from a Brazilian National Survey

“…Clinical phenotypes related to PTB have already been explored using the EMIP database; (16) our results suggest that women with hypertension who had PTB were older, had a better educational level, and had a partner, suggesting that they had a higher economic status when compared to those with no hypertension. They also attended more prenatal care, possibly because this group included women with chronic hypertension and were more aware of their condition, with increased surveillance of maternal conditions and pregnancy outcomes.…”

“…These four easily identified characteristics (age, educational level, marital status, and obesity) in women with hypertension are likely to be associated with medically indicated PTB, and healthcare providers should be aware of this association. (16) Most PTB cases in the hypertensive group occurred before 34 weeks of gestation. These characteristics may explain the increased use of antenatal corticosteroids einstein (São Paulo).…”