Serial Cervical Length Evaluation in Low-Risk Women with Shortened Cervical Lengths in the Midtrimester: How Many Will Dilate Prior to 24 Weeks?
28 May 2019
25 June 2019
09 August 2019 (online)
Objective To determine what proportion of women with a short cervical length (CL) without a history of spontaneous preterm birth (SPTB) will ultimately be dilated at <24 weeks.
Study Design This is a retrospective cohort study of women with singleton pregnancies with a short CL (≤25 mm) between 16 and 22 weeks' gestational age (GA). We excluded women with a history of SPTB. We examined the progression of women with short CL based on the CL measurement and GA at diagnosis. The primary outcome was cervical dilation or spontaneous delivery <24 weeks.
Results A total of 163 women were included, of whom 27 (16.6%) were ultimately dilated and 4 (2.5%) had pregnancy loss by 24 weeks. The median GA at diagnosis of short CL was 195/7 (range: 15–22) weeks. Women with a CL <15 mm were more likely to have cervical dilation or loss prior to 24 weeks than women whose CL was 15 to 25 mm (42.5 vs. 11.9%, <0.001, adjusted odds ratio: 3.72, 95% confidence interval: 1.52–9.09). GA at diagnosis was not associated with risk of progression.
Conclusion In women with a short CL without a history of SPTB, the risk of dilation or pregnancy loss <24 weeks is significant, approaching 50% for women with a CL <15 mm.
This study was presented as a poster at the Annual Scientific Meeting of the Society for Maternal-Fetal Medicine, February 15–17, 2019, Las Vegas, NV.
- 1 Martin JA, Hamilton BE, Osterman MJK. Births in the United States, 2017. NCHS Data Brief 2018; (318): 1-8
- 2 Alfirevic Z, Stampalija T, Medley N. Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy. Cochrane Database Syst Rev 2017; 6: CD008991
- 3 Owen J, Hankins G, Iams JD. , et al. Multicenter randomized trial of cerclage for preterm birth prevention in high-risk women with shortened midtrimester cervical length. Am J Obstet Gynecol 2009; 201 (04) 375.e1-375.e8
- 4 Hassan SS, Romero R, Vidyadhari D. , et al; PREGNANT Trial. Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized, double-blind, placebo-controlled trial. Ultrasound Obstet Gynecol 2011; 38 (01) 18-31
- 5 Saccone G, Maruotti GM, Giudicepietro A, Martinelli P. ; Italian Preterm Birth Prevention (IPP) Working Group. Effect of cervical pessary on spontaneous preterm birth in women with singleton pregnancies and short cervical length: a randomized clinical trial. JAMA 2017; 318 (23) 2317-2324
- 6 Saccone G, Ciardulli A, Xodo S. , et al. Cervical pessary for preventing preterm birth in singleton pregnancies with short cervical length: a systematic review and meta-analysis. J Ultrasound Med 2017; 36 (08) 1535-1543
- 7 Dugoff L, Berghella V, Sehdev H, Mackeen AD, Goetzl L, Ludmir J. Prevention of preterm birth with pessary in singletons (PoPPS): randomized controlled trial. Ultrasound Obstet Gynecol 2018; 51 (05) 573-579
- 8 Berghella V, Ciardulli A, Rust OA. , et al. Cerclage for sonographic short cervix in singleton gestations without prior spontaneous preterm birth: systematic review and meta-analysis of randomized controlled trials using individual patient-level data. Ultrasound Obstet Gynecol 2017; 50 (05) 569-577
- 9 Pereira L, Cotter A, Gómez R. , et al. Expectant management compared with physical examination-indicated cerclage (EM-PEC) in selected women with a dilated cervix at 14(0/7)-25(6/7) weeks: results from the EM-PEC international cohort study. Am J Obstet Gynecol 2007; 197 (05) 483.e1-483.e8
- 10 Ayodele A, Fox NS, Gupta S. , et al. The association between fetal fibronectin, cervical length, and amniotic fluid sludge with histological indicators of placental inflammation in twin gestations. Am J Perinatol 2018; 35 (03) 242-246
- 11 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
- 12 Yost NP, Bloom SL, Twickler DM, Leveno KJ. Pitfalls in ultrasonic cervical length measurement for predicting preterm birth. Obstet Gynecol 1999; 93 (04) 510-516
- 13 Saccone G, Zullo F, Roman A. , et al. Risk of spontaneous preterm birth in IVF-conceived twin pregnancies. J Matern Fetal Neonatal Med 2019; 32 (03) 369-376
- 14 Miller ES, Grobman WA. The association between cervical excisional procedures, midtrimester cervical length, and preterm birth. Am J Obstet Gynecol 2014; 211 (03) 242.e1-242.e4
- 15 Enakpene CA, DiGiovanni L, Jones TN, Marshalla M, Mastrogiannis D, Della Torre M. Cervical cerclage for singleton pregnant patients on vaginal progesterone with progressive cervical shortening. Am J Obstet Gynecol 2018; 219 (04) 397.e1-397.e10