Spontaneous preterm birth and cervical length in a pregnant Asian population

Thain, Serene; Yeo, G. S. H.; Kwek, Kenneth; Chern, Bernard; Tan, Kok Hian

doi:10.1371/journal.pone.0230125

Cited by 26 publications

(23 citation statements)

References 28 publications

(32 reference statements)

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“… 26 A study by Thain et al found a significantly shorter median CL at 28 to 22 weeks and at 28 to 32 weeks in the Indian population compared with the other ethnicities. 27 To the best of our knowledge, no study has been undertaken to evaluate the relation of ethnicity and UCA.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Uterocervical Angle and Cervical Length as Predictors of Spontaneous Preterm Birth

Singh

Srivastava

Kumar

et al. 2022

Indian J Radiol Imaging

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Aim The aim of this article was to evaluate uterocervical angle (UCA) and cervical length (CL) measured at 16 to 24 weeks of gestation using transvaginal sonography (TVS) as predictors of spontaneous preterm birth. Methods In this prospective study, TVS was performed in 159 primigravidas with a singleton, uncomplicated pregnancy at 16 to 24 weeks of gestation to measure the anterior UCA and CL. All the cases were followed until labor to document gestational age at delivery. Results The risk of spontaneous preterm birth was higher in women with obtuse UCA (>95 degrees) with sensitivity of 86.7%, specificity of 93.0%, positive predictive value of 83.0%, negative predictive value of 94.6%, and p-value of <0.001. The difference between the means was statistically significant (p-value < 0.001). UCAs ≥105degrees and 95 to 105 degrees were found to be significantly associated with spontaneous preterm births at <34 weeks and 34 to 37 weeks, respectively. CL <2.5 cm was found to predict spontaneous preterm births at <37 weeks with sensitivity of 31.1%, specificity of 95.6%, and p-value of <0.001. UCA was found to be a better predictor of spontaneous preterm birth with a higher coefficient of variation (56.4%) when compared with CL (16.9%). Conclusions UCA proved to be a novel ultrasound parameter that can serve as a better predictor of spontaneous preterm births in comparison to CL. A strong correlation exists between obtuse UCA and a risk of spontaneous preterm birth.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Uterocervical Angle and Cervical Length as Predictors of Spontaneous Preterm Birth

Singh

Srivastava

Kumar

et al. 2022

Indian J Radiol Imaging

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“…Cervical length is a key determinant of PTB [ 26 ]. In our meta-analysis, the subgroup analysis revealed that the rates of PTB <37 weeks and PTB <35 weeks were significantly lower in patients who had non-selected cervical length at the time of study inclusion and randomization.…”

Section: Discussionmentioning

confidence: 99%

17-alpha hydroxyprogesterone caproate for the prevention of recurrent preterm birth among singleton pregnant women with a prior history of preterm birth: a systematic review and meta-analysis of six randomized controlled trials

et al. 2021

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To perform a systematic review and meta-analysis of all randomized controlled trials (RCTs) that investigated the clinical benefits of 17-alpha hydroxyprogesterone caproate (17OHPC) in the prevention of recurrent preterm birth (PTB) among singleton pregnant women with a previous history of PTB. We searched four major databases up till April 2021 and assessed the risk of bias in the included studies. We meta-analyzed various maternal-neonatal endpoints (n=18) and pooled them as mean difference or risk ratio (RR) with 95% confidence interval (CI) using the random-effects model. Six RCTs met the inclusion criteria, comprising 2,573 patients (17OHPC=1,617, control=956). RCTs revealed an overall low risk of bias. The rates of PTB <35 weeks (n=5 RCTs; RR, 0.77; 95% CI, 0.63-0.93; P=0.008), PTB <32 weeks (n=3 RCTs; RR, 0.68; 95% CI, 0.51-0.91; P=0.009), neonates with low birth weight (<2.5 kg) at delivery (n=3 RCTs; RR, 0.63; 95% CI, 0.5-0.79; P<0.001), and neonatal death (n=4 RCTs; RR, 0.41; 95% CI, 0.20-0.84; P=0.02) were significantly reduced in the 17OHPC group compared with the control group. Moreover, 17OHPC treatment correlated with a significantly decreased rate of retinopathy (n=2 RCTs; RR, 0.42; 95% CI, 0.18-0.97; P=0.004). However, there were no significant differences in the rates of neonatal intensive care unit admission, cesarean delivery, and other pretermrelated complications between both the groups. Among singleton pregnant women with a prior history of PTB, 17OHPC may favorably decrease the risks of recurrent PTB and reduce the rate of neonatal death.

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“…Ultrasound cervical shortening can be detected weeks before delivery, at about 32 weeks for term births and as early as 16–24 weeks for preterm births [ 2 ]. A study conducted on 934 asymptomatic patients who had serial cervical length measurements performed at 4 antenatal visits showed that there is a significantly shorter cervical length in the 2nd and 3rd trimester in patients who eventually had a preterm birth [ 5 ]. However, the role for cervical length measurements in women with symptoms of PTL remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Prediction of labour onset in women who present with symptoms of preterm labour using cervical length

Wong

Yong

Tung

et al. 2021

BMC Pregnancy Childbirth

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Background Diagnosis of preterm labour is difficult because initial symptoms and signs are often mild and may occur in continuing pregnancies. This study aims to investigate the utility of measuring cervical length, using transvaginal ultrasound, in women presenting to the delivery suite with symptoms of preterm labour. Methods This was a prospective cohort study performed in KK Women’s and Children’s Hospital, Singapore from September 2017 to July 2018. Women with singleton pregnancies, presenting with symptoms of contraction pain, between 24+ 0 to 36+ 6 weeks gestation, were included. Transvaginal ultrasound cervical length measurements were done at presentation to the labour ward, after four hours and in the following morning. The primary outcome of the study was delivery within 1 week. All statistical analyses were conducted with Microsoft Excel and Statistical Package for the Social Sciences. Results A total of 95 subjects were included. A one-millimeter increase in the 1st cervical length increases scan-to-delivery time by 0.802 days (p-value 0.003, CI 0.280–1.323). Receiver Operator Characteristic (ROC) curve analysis for prediction of delivery within 1 week showed an Area Under Curve (AUC) of 0.667, optimal cut-off value of 27.5mm (sensitivity 77.8 %, specificity 61.6 %). A one-millimetre increase in the 3rd cervical length increases scan-to-delivery time by 0.770 days (p-value 0.023, CI 0.108–1.432). ROC curve analysis for prediction of delivery within 1 week showed an AUC of 0.915, optimal cut-off value of 25.5mm (sensitivity 100 %, specificity 73.6 %). However, the change in cervical length over a period of 1 day was not significant in predicting delivery within 1 week. Conclusions Our results indicate that by using a cervical length cut off of 27.5mm at presentation, we would have predicted 77.8 % of deliveries within 1 week. If we were to repeat the cervical length scan the next day, with the same cut-off of 27.5mm, we would have predicted 100 % of deliveries within 1 week. In our study, measuring the transvaginal ultrasound cervical length is a reliable diagnostic test for delivery within 1 week. However, the results are limited by the small sample size. Further studies should be conducted with a larger sample size.

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Spontaneous preterm birth and cervical length in a pregnant Asian population

Cited by 26 publications

References 28 publications

Evaluation of Uterocervical Angle and Cervical Length as Predictors of Spontaneous Preterm Birth

Evaluation of Uterocervical Angle and Cervical Length as Predictors of Spontaneous Preterm Birth

17-alpha hydroxyprogesterone caproate for the prevention of recurrent preterm birth among singleton pregnant women with a prior history of preterm birth: a systematic review and meta-analysis of six randomized controlled trials

Prediction of labour onset in women who present with symptoms of preterm labour using cervical length

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