Does Shortened Midtrimester Cervical Length Predict Preterm Birth?
BACKGROUND AND PURPOSE:
O’Connell et al. (American Journal of Perinatology, 2018) studied whether midtrimester cervical length (CL) is correlated with improved prediction of preterm delivery in women presenting with preterm labor
Retrospective cohort study
Women with a singleton gestation who underwent routine CL screening (transvaginal)
Between 18 and 24 weeks of gestation
Evaluated later in pregnancy for preterm labor
Stratification based on midtrimester CL quartile
Delivery <37 weeks (primary outcome)
Delivery <34 weeks
Delivery within 7 days of evaluation
Receiver operating characteristic (ROC) curves were used for multivariable equations and to test the significance of CL in predicting preterm labor
460 women were evaluated for preterm labor and had midtrimester CL measurements available
15% delivered preterm
Median cervical lengths (interquartile ranges)
1st quartile: 3.4 cm (3.1–3.6 cm)
2nd quartile: 4.1 cm (4.0–4.2 cm)
3rd quartile: 4.6 cm (4.4–4.7cm)
4th quartile: 5.3 cm (5.0–5.7 cm)
Shortened midtrimester CL was associated with preterm birth (p value =0.028)
After controlling for insurance status, nulliparity, cervical dilation and effacement on presentation, and receipt of antenatal steroids, midtrimester cervical length quartile was not associated with preterm birth <37 weeks, preterm birth <34 weeks or delivery within 7 days of presentation
Incidence of preterm birth <34 weeks was no different across the cervical length quartiles
Including CL as a factor did not improve the performance of a predictive model for women presenting at risk for preterm birth
The area under the ROC curve was not improved (0.775 vs. 0.786, p = 0.20)
Once adjusted for other important clinical factors, CL was not associated with not a helpful predictor for preterm birth
The addition of midtrimester CL variable to an existing model does not improve prediction of preterm birth
Learn More – Primary Sources:
Is Midtrimester Cervical Length Associated with Preterm Birth in Women Evaluated for Preterm Labor?
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