Second trimester cervical length measurement for prediction spontaneous preterm birth in an unselected risk population

Peixoto, Alberto Borges; Caldas, Taciana Mara Rodrigues da Cunha; Tahan, Luisa Almeida; Petrini, Caetano Galvão; Martins, W.P.; Costa, Fabrício da Silva; Júnior, Edward Araujo

doi:10.5468/ogs.2017.60.4.329

Cited by 7 publications

(6 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Conversely, group 3 did not show an increased risk of any studied outcomes. This finding was consistent with the known high NPV and low PPV of a short CL in previous studies [29, 30].…”

Section: Discussionsupporting

confidence: 93%

Evaluation of the effectiveness of foetal fibronectin as a predictor of preterm birth in symptomatic preterm labour women

Jun

Lee

Kim

et al. 2019

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

Background The prediction of preterm birth (PTB) is important in the management of symptomatic preterm labour women. We evaluated the effectiveness of the foetal fibronectin (fFN) test for predicting PTB in symptomatic preterm labour women with consideration of physiologic changes in cervical length (CL) during pregnancy. Methods This prospective study included 85 women with symptomatic preterm labour of a singleton pregnancy. Positive fFN was defined as a fFN level of > 50 ng/mL in cervicovaginal secretion, while a short CL was defined as that below 25th percentile at the corresponding gestational age. We evaluated effectiveness of the fFN test, CL, and the combination of these two tests, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), positive likelihood ratio (LR + ), negative likelihood ratio (LR − ) to predict the PTB within 7 and 14 days of testing and PTB at < 34 and 37 weeks of gestation. We also present the odds ratios (ORs) of the test results, defining the women with both negative results as the reference group. Results Of the 85 women, 31 (36.5%) showed a positive fFN and 44 (51.8%) had a short CL. PTB occurred within 7 and 14 days of testing and before 34 and 37 weeks of gestation in 17.6, 20.0, 23.5 and 49.4% of the women, respectively. The fFN and CL results showed low predictive effectiveness for the studied outcomes with LR + (fFN, 1.5–1.9; CL, 1.0–1.5) and LR − (fFN, 0.7; CL, 0.7–0.9). The combined use of fFN and CL could not improve these results (LR + , 1.4–2.3; LR − , 0.7–0.9). However, the risk of PTB before 37 weeks was increased in women with positive fFN but not CL shortening compared to the reference group (odds ratio [OR], 3.8; 95% confidence interval [CI], 1.1–1.3). The risk of PTB before 34 weeks was increased in both positive fFN and CL compared to the reference group (OR, 8.1; 95% CI, 1.9–34.5). Conclusion Although, our approach could not improve the ability to predict PTB, it could identify women at risk for delivery before 34 or 37 weeks of gestation. Therefore, it could be used to manage women with symptomatic preterm labour.

show abstract

“…Conversely, group 3 did not show an increased risk of any studied outcomes. This finding was consistent with the known high NPV and low PPV of a short CL in previous studies [29, 30].…”

Section: Discussionsupporting

confidence: 93%

Evaluation of the effectiveness of foetal fibronectin as a predictor of preterm birth in symptomatic preterm labour women

Jun

Lee

Kim

et al. 2019

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

show abstract

“…As a screening test for PTB, TVU did not present good performance to predict PTB at < 37 weeks. This result agrees with previous studies that did not find high sensitivity or acceptable specificity to consider TVU as a screening test to predict late PTB [ 17 , 18 ]. Nevertheless, we can consider that TVU has a moderate prognostic performance to predict sPTB at < 34 weeks and, moreover, has a good performance for predicting sPTB at < 28 weeks, with a high sensitivity and acceptable specificity.…”

Section: Discussionsupporting

confidence: 93%

Association between cervical length and gestational age at birth in singleton pregnancies: a multicentric prospective cohort study in the Brazilian population

et al. 2023

View full text Add to dashboard Cite

Background Short cervical length measured during the second trimester of pregnancy is an important risk factor for spontaneous preterm birth (sPTB). The aim of this study is to identify the association between mid-pregnancy cervical length (CL) and gestational age at birth in asymptomatic singleton pregnant women. Methods This is a prospective cohort study involving singleton pregnant women who participated in the screening phase of a Brazilian multicenter randomized controlled trial (P5 trial) between July 2015 and March 2019. Transvaginal ultrasound 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. For this analysis we considered all women with CL ≤ 30 mm receiving progesterone and a random selection of women with CL > 30 mm, keeping the populational distribution of CL. We obtained prognostic effectiveness data (area under receive operating characteristic curve (AUC), sensitivity and specificity and estimated Kaplan–Meier curves for preterm birth using different CL cutoff points. Results We report on 3139 women and identified a negative association between cervical length and sPTB. CL ≤ 25 mm was associated with sPTB < 28, sPTB < 34 and sPTB < 37 weeks, whereas a CL 25–30 mm was directly associated with late sPTB. CL by transvaginal ultrasound presented an AUC of 0.82 to predict sPTB < 28 weeks and 0.67 for sPTB < 34 weeks. Almost half of the sPTB occurred in nulliparous women and CL ≤ 30 mm was associated with sPTB at < 37 weeks (OR = 7.84; 95%CI = 5.5–11.1). The number needed to screen to detect one sPTB < 34 weeks in women with CL ≤ 25 mm is 121 and we estimated that 248 screening tests are necessary to prevent one sPTB < 34 weeks using progesterone prophylaxis. Conclusions CL measured by transvaginal ultrasound should be used to predict sPTB < 34 weeks. Women with CL ≤ 30 mm are at increased risk for late sPTB.

show abstract

“…However, regardless of the threshold, the same CL defines a short cervix throughout 18 +0 to 23 +6 weeks of gestation [9, 11, 12], based on the concept that CL does not change during this period in pregnancy [13]. Nevertheless, there is a physiologic shortening of the cervix, and a different CL distribution as gestation advances [14] that, in turn, may affect the prevalence of a short cervix if the scan is performed either at 18 weeks or at 24 weeks of gestation [4, 15-17].…”

Section: Introductionmentioning

confidence: 99%

“…Universal cervical length (CL) screening is usually performed between 18 +0 and 23 +6 weeks of gestation to identify women with a short cervix who can be treated with vaginal progesterone to reduce the rate of preterm delivery (PTD) [1][2][3][4]. Different thresholds have been proposed to define a short cervix, either 15 mm [5,6], 20 mm [7], 25 mm [8,9], or even 30 mm [10,11], dependent upon the characteristics of the population.…”

Section: Introductionmentioning

confidence: 99%

Weekly Differences in the Prevalence of a Short Cervix at 18+0 to 23+6 Weeks of Gestation in Pregnant Women with and without a History of Preterm Delivery

Soto¹,

Huntley²,

Hernández‐Andrade³

2022

Gynecol Obstet Invest

View full text Add to dashboard Cite

Objective: To estimate weekly differences in the prevalence of a short cervix during the period of 18+0 to 23+6 weeks of gestation in pregnant women with and without a history of previous preterm delivery (PTD). Design: Observational study Methods: Setting and participants: 20,002 pregnant women, 18,591 without a history of previous PTD (low risk) and 1,411 with at least one previous PTD (high risk) were evaluated at 18+0 to 23+6 weeks + days of gestation. Weekly differences in the prevalence of a short cervix (≤25 mm, ≤20 mm, and ≤15mm) between women with and without previous PTD were estimated. Results: High-risk women had a significantly higher prevalence of a short cervix, defined either as ≤25 mm (4.4% vs. 2.2%; p<0.0001), or ≤20 mm (2.4% vs. 1.2%; p<0.0001) but not for ≤15 mm (1.2% vs. 0.9%; p<0.2) as compared to low risk pregnant women. The odds ratio for a short cervix ≤25 mm in high-risk as compared to low-risk women was 2.0 (95% CI 1.54-2.61; p<0.0001). Among low-risk women, those evaluated at 22 or 23 weeks of gestation had a significantly higher prevalence of a short cervix ≤25mm (3.8% vs. 1.9%; p<0.0001), ≤20mm (2.4% vs. 0.98%; p<0.0001), and ≤15 mm (1.6% vs. 0.7%; p<0.0001) than low-risk women scanned between 18 and 21 weeks of gestation. Similar results were observed for high-risk women. Limitations: No gestational age at delivery was evaluated Conclusion: There is higher prevalence of short cervix when pregnant women are evaluated at 22+0 to 23+6 than at 18+0 to 21+6 weeks of gestation.

show abstract

Second trimester cervical length measurement for prediction spontaneous preterm birth in an unselected risk population

Cited by 7 publications

References 19 publications

Evaluation of the effectiveness of foetal fibronectin as a predictor of preterm birth in symptomatic preterm labour women

Evaluation of the effectiveness of foetal fibronectin as a predictor of preterm birth in symptomatic preterm labour women

Association between cervical length and gestational age at birth in singleton pregnancies: a multicentric prospective cohort study in the Brazilian population

Weekly Differences in the Prevalence of a Short Cervix at 18+0 to 23+6 Weeks of Gestation in Pregnant Women with and without a History of Preterm Delivery

Contact Info

Product

Resources

About