Am J Perinatol 2020; 37(13): 1289-1295
DOI: 10.1055/s-0040-1710008
SMFM Fellowship Series Article

Predictors of Early Preterm Birth Despite Vaginal Progesterone Therapy in Singletons with Short Cervix

1  Division of Maternal Fetal Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
,
Mackenzie N. Naert
2  Department of Obstetrics Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
,
Nathan S. Fox
2  Department of Obstetrics Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
3  Mount Sinai School of Medicine—Obstetrics and Gynecology, Maternal Fetal Medicine Associates, PLLC, New York, New York
,
Sean Hennessy
4  Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
,
Inna Chervoneva
4  Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
,
Vincenzo Berghella
1  Division of Maternal Fetal Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
,
Amanda Roman
1  Division of Maternal Fetal Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
› Author Affiliations
Funding R.C.B. was supported by U.S. Department of Health and Human Services, National Institutes of Health, National Institute of General Medical (grant T32GM008562, PhRMA Foundation x, Faculty Development Award); S.H. was supported by grant T32GM075766.

Abstract

Objective This study aimed to identify the incidence of and risk factors for early preterm birth (PTB) (delivery <34 weeks) in women without prior PTB and current short cervix (≤20 mm) prescribed vaginal progesterone.

Study Design Retrospective cohort study of singletons without prior PTB diagnosed with short cervix (≤20 mm) between 180/7 and 236/7 weeks. Women who accepted vaginal progesterone and had delivery outcomes available were included. Demographic/obstetric history, cervical length, and pregnancy characteristics compared between women with early PTB versus delivery ≥34 weeks. Multiple logistic regression analysis used to identify predictors; odds ratio for significant factors used to generate a risk score. Risk score and risk of early PTB assessed with receiver operating characteristic curve (ROCC). Perinatal outcomes compared by risk score.

Results Among 109 patients included, 29 (27%) had a spontaneous PTB <34 weeks. In univariate analysis, only gestational age at ultrasound, presence funneling, and mean cervical length were significantly different between those with and without early sPTB. With multiple logistic regression analysis, only gestational age at diagnosis (odds ratio [OR]: 0.66; 95% confidence interval [CI]: 0.46–0.96; p = 0.028) and index cervical length (OR: 0.84; 95% CI: 0.76–0.93; p = 0.001) remained significantly associated with early PTB. ROCC for the risk score incorporating cervical length and gestational age was predictive of early PTB with an AUC of 0.76 (95% CI: 0.67–0.86; p < 0.001). A high-risk score was predictive of early PTB with a sensitivity of 79%, specificity of 75%, positive predictive value of 54%, and negative predictive value of 91%. Women with a high-risk score had worse perinatal outcomes compared with those with low-risk score.

Conclusion A total of 27% of patients with short cervix prescribed vaginal progesterone will have a sPTB < 34 weeks. Patients at high risk for early PTB despite vaginal progesterone therapy may be identified using gestational age and cervical length at diagnosis of short cervix. Given the narrow window for intervention after diagnosis of short cervix, this has important implications for clinical care.

Note

This study was presented at Society for Maternal Fetal Medicine Annual Pregnancy Meeting on February 2, 2018, Dallas, TX.




Publication History

Received: 13 November 2019

Accepted: 29 March 2020

Publication Date:
28 April 2020 (online)

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