Is Midtrimester Cervical Length Associated with Preterm Birth in Women Evaluated for Preterm Labor?
16 March 2017
11 August 2017
14 September 2017 (eFirst)
Objective This article aims to evaluate whether midtrimester cervical length (CL) is associated with improved prediction of preterm delivery in women presenting with preterm labor.
Study Design This is a retrospective cohort study of women with a singleton gestation who underwent routine CL screening between 18 and 24 weeks of gestation between 2010 and 2014 who were later evaluated for preterm labor. Women were stratified by midtrimester CL quartile. Bivariable and multivariable analyses were performed to identify factors independently associated with preterm birth <37 weeks, <34 weeks, and delivery within 7 days of evaluation. Receiver operating characteristic (ROC) curves were created for multivariable equations with and without CL quartile to determine whether addition of CL improved the predictive capacity of the model for predicting preterm birth.
Results A total of 460 women were evaluated for preterm labor and had midtrimester CL measurements available. When CL quartile was incorporated into a regression model including demographic and clinical characteristics associated with preterm birth, the area under the ROC curve was not improved (0.775 vs. 0.786, p = 0.20).
Conclusion While a shorter midtrimester CL quartile is associated with an increased incidence of preterm delivery in women evaluated for preterm labor, the addition of this variable to an existing model does not improve prediction of preterm birth.
Shorter midtrimester cervical length is associated with preterm delivery in women with preterm labor, but does not improve prediction of preterm birth.
E.S.M. is supported by NICHD K12 HD050121–09.
- 1 Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008; 371 (9606): 75-84
- 2 Nicholson WK, Frick KD, Powe NR. Economic burden of hospitalizations for preterm labor in the United States. Obstet Gynecol 2000; 96 (01) 95-101
- 3 Berghella V, Ness A, Bega G, Berghella M. Cervical sonography in women with symptoms of preterm labor. Obstet Gynecol Clin North Am 2005; 32 (03) 383-396
- 4 Crowley P, Chalmers I, Keirse MJ. The effects of corticosteroid administration before preterm delivery: an overview of the evidence from controlled trials. Br J Obstet Gynaecol 1990; 97 (01) 11-25
- 5 Sanchez-Ramos L, Delke I, Zamora J, Kaunitz AM. Fetal fibronectin as a short-term predictor of preterm birth in symptomatic patients: a meta-analysis. Obstet Gynecol 2009; 114 (03) 631-640
- 6 Creasy RK, Gummer BA, Liggins GC. System for predicting spontaneous preterm birth. Obstet Gynecol 1980; 55 (06) 692-695
- 7 Mercer BM, Goldenberg RL, Das A. , et al. The preterm prediction study: a clinical risk assessment system. Am J Obstet Gynecol 1996; 174 (06) 1885-1893 , discussion 1893–1895
- 8 Tan H, Wen SW, Chen XK, Demissie K, Walker M. Early prediction of preterm birth for singleton, twin, and triplet pregnancies. Eur J Obstet Gynecol Reprod Biol 2007; 131 (02) 132-137
- 9 Bastek JA, Sammel MD, Srinivas SK. , et al. Clinical prediction rules for preterm birth in patients presenting with preterm labor. Obstet Gynecol 2012; 119 (06) 1119-1128
- 10 van Baaren GJ, Vis JY, Grobman WA, Bossuyt PM, Opmeer BC, Mol BW. Cost-effectiveness analysis of cervical length measurement and fibronectin testing in women with threatened preterm labor. Am J Obstet Gynecol 2013; 209 (05) 436.e1-436.e8
- 11 Berghella V, Palacio M, Ness A, Alfirevic Z, Nicolaides KH, Saccone G. Cervical length screening for prevention of preterm birth in singleton pregnancy with threatened preterm labor: systematic review and meta-analysis of randomized controlled trials using individual patient-level data. Ultrasound Obstet Gynecol 2017; 49 (03) 322-329
- 12 Iams JD, Goldenberg RL, Meis PJ. , et al; National Institute of Child Health and Human Development Maternal Fetal Medicine Unit Network. The length of the cervix and the risk of spontaneous premature delivery. N Engl J Med 1996; 334 (09) 567-572
- 13 Heath VC, Southall TR, Souka AP, Elisseou A, Nicolaides KH. Cervical length at 23 weeks of gestation: prediction of spontaneous preterm delivery. Ultrasound Obstet Gynecol 1998; 12 (05) 312-317
- 14 Taipale P, Hiilesmaa V. Sonographic measurement of uterine cervix at 18-22 weeks' gestation and the risk of preterm delivery. Obstet Gynecol 1998; 92 (06) 902-907
- 15 Hassan SS, Romero R, Berry SM. , et al. Patients with an ultrasonographic cervical length < or =15 mm have nearly a 50% risk of early spontaneous preterm delivery. Am J Obstet Gynecol 2000; 182 (06) 1458-1467
- 16 Hibbard JU, Tart M, Moawad AH. Cervical length at 16-22 weeks' gestation and risk for preterm delivery. Obstet Gynecol 2000; 96 (06) 972-978
- 17 Committee on Practice Bulletins—Obstetrics, The American College of Obstetricians and Gynecologists. Practice bulletin no. 130: prediction and prevention of preterm birth. Obstet Gynecol 2012; 120 (04) 964-973