The risk of spontaneous preterm delivery within 14 days in asymptomatic patients with sonographic cervical length <15mm is low (original) (raw)
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International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2015
Background: Objectives of current study were (i) To correlate the Cervical Length (CL) measured digitally and by transvaginal sonography (TVS) at 16 to 24 weeks with outcome of pregnancy (ii) Estimate risk of spontaneous preterm labour (PTL) based on CL measurements and (iii) study intervention in short CL and their effect on maternal and neonatal outcome. Methods: Women with singleton pregnancy at POG 16-24 weeks with history of previous preterm birth or mid trimester abortions were included in the study and subjected to digital assessment of CL followed by TVS measurement. In patients with TVS CL ≤25 mm, intervention in the form of progesterone or cerclage with progesterone was done. The outcome of the pregnancy in the form of delivery before completed 37 weeks or at and after 37 weeks was noted. Results: Twenty two subjects out of total 153 subjects (14.4%) had preterm delivery. The incidence of preterm delivery in study was 14.4%. Using Receiver Operating Characteristics (ROC) Curve, cut off value of digital CL was found to be 1.5 cm. The sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy of digital CL ≤1.5 cm in prediction of PTL were 72.7 %, 37.4%, 16.3%, 89.1% and 42.5% respectively. Cut off value of TVS CL by ROC curve was found to be 2.85 cm. The sensitivity, specificity, PPV, NPV and accuracy of CL (TVS) of ≤2.85 cm in prediction of PTL is 81.8%, 68.7%, 30.5%, 95.7%, 70.6% respectively. The outcome in form of PTL in 30 subjects, who had TVS CL ≤2.5 cm in both the intervention groups (McDonald stitch with progesterone and progesterone alone) was comparable (P value 0.60 not significant). Conclusions: The CL, both digitally and by TVS, was inversely correlated with the probability of preterm delivery so that the shorter the cervix, the greater the likelihood of preterm delivery. TVS CL is more predictive of preterm delivery than digital CL when performed between 16-24 weeks in asymptomatic high risk women. Intervention in short CL in form of McDonald's stitch application with progesterone and progesterone alone have similar efficacy for prevention of PTL.
American journal of obstetrics and gynecology, 2016
Preterm birth remains a major cause of neonatal morbidity and mortality worldwide. Short cervical length as measured by transvaginal ultrasound in the second trimester represents the single most predictive risk factor for spontaneous preterm birth. Previous studies have addressed, in part, the limitations of transvaginal ultrasound availability by utilizing a cervicometer to screen patients for short cervix, identifying those patients who may not benefit from transvaginal ultrasound cervical length screening. In view of the prior studies indicating that a cervicometer measurement may have a high negative predictive value for a sonographically short cervix, we sought to identify the ideal cervicometer threshold value in a prospective, multicenter study. The primary objective was to determine the cervicometer cervical length measurement threshold that provides a high negative predictive value for the identification of patients who are highly unlikely to have a transvaginal ultrasound ...
Implementation of a Universal Cervical Length Screening Program for the Prevention of Preterm Birth
American Journal of Perinatology, 2014
Spontaneous preterm birth (PTB) is a leading cause of neonatal morbidity and mortality in developed as well as developing countries. 1 Until recently, transvaginal ultrasound (TVU) cervical length (CL) screening for the prediction and prevention of PTB has only been recommended for singleton gestations with a prior spontaneous PTB to identify candidates for cerclage placement. 2-4 However, a short cervix in the second trimester is a powerful predictor of spontaneous PTB regardless of obstetrical history. 5,6 Recent randomized trials have demonstrated that daily administration of vaginal progesterone in singleton gestations with a short CL can reduce the incidence of spontaneous PTB by approximately 45%. 7,8 As more than 85% of spontaneous PTBs occur in women without a prior spontaneous PTB, 8 universal TVU CL screening between 18 and 24 weeks' gestation may identify "low-risk" women (i.e., singletons without prior spontaneous PTB) who are candidates for vaginal progesterone. In addition, universal TVU CL screening and treatment with vaginal progesterone in women with a short CL has been shown to be cost saving compared with other screening Keywords ► preterm birth ► cervical length ► universal screening ► vaginal progesterone
Obstetrics & Gynecology Science, 2017
Objective To assess the predictive capacity of cervical length (CL) measurement underwent during the second trimester ultrasound for prediction preterm birth <32, 34, and 37 weeks of gestation in an unselected risk population. Methods A retrospective cohort study was performed with 751 singleton pregnancies between 20 and 24+6 weeks of gestation. The CL measurement (mm) using the transvaginal route was obtained in a sagittal view and the calipers positioned to measure the linear distance between the triangular area of echodensity at the external os and the internal os. To compare the preterm (<37 weeks) and term births (≥37 weeks), we used unpaired t test. We assessed whether the CL measurement was dependent of gestational age by performing a linear regression and assessing the coefficient of determination (R²). We additionally assessed the accuracy of CL measurement to predict preterm birth by assessing the area under receiver operating characteristics curves with its respective confidence intervals (CIs) 95%. Results Preterm birth <37 weeks was found in 13.6% (102/751) of pregnant women. Short cervix (≤25 mm) was found in 2.7% (20/751) of pregnancies. Only 30% (6/20) of pregnant women with short cervix have used progesterone to prevent preterm birth. There was a weak correlation between CL measurement and gestational age at delivery (R 2 =0.01, P=0.002). Receiver operating characteristics curve analysis of the ability of CL measurement to predict preterm birth <32, 34, and 37 weeks, showed an area under the curve of 0.693 (95% CI, 0.512 to 0.874), 0.472 (95% CI, 0.353 to 0.591), 0.490 (95% CI, 0.426 to 0.555), respectively. Conclusion There was a weak correlation between CL measurement and gestational age at delivery. In an unselected population, CL measurement screening at 20 to 24+6 weeks of gestation does not seem to be a good predictor of preterm birth.
Cervical length for the prediction and prevention of preterm birth
Expert Review of Obstetrics & Gynecology, 2013
The risk of early birth increases markedly with decreasing cervical length (CL) in both singleton and multiple pregnancies. Transvaginal ultrasound of CL can be useful in determining women that are at risk of preterm delivery and may be helpful in preventing unnecessary intervention. Appropriate technique is essential for correct results. Factors that affect the value of CL in the prediction of spontaneous preterm delivery include gestational age, patient obstetrical and medical history, symptoms and the number of fetuses. The value of CL consists of identifying high-risk women for therapeutic strategies, to reduce the rate of spontaneous preterm birth, such as progestogens, cervical cerclage and more recently, cervical pessary. Progestogens and cervical cerclage are more effective in gestations with prior preterm birth.
Acta Obstetricia et Gynecologica Scandinavica, 2006
This randomized controlled trial compared the diagnostic accuracy of the sonographic assessment of cervical length and clinical digital examination of the cervix in the second trimester regarding the prediction of preterm delivery in a low-risk population. In total, 282 unselected, asymptomatic women with singleton pregnancy randomly underwent sonographic cervical length measurement (study group, n=138) or clinical digital examination (control group, n=144) in the second trimester. In the study group cervical length &amp;amp;amp;amp;amp;lt;or=5th percentile (&amp;amp;amp;amp;amp;lt;or=24 mm) for our population was defined as shortened. In the control group, Bishop score &amp;amp;amp;amp;amp;gt;or=95th percentile (&amp;amp;amp;amp;amp;gt;or=4) for our population was defined as high. The primary outcome measure was the diagnostic accuracy of both tests regarding the prediction of preterm delivery (&amp;amp;amp;amp;amp;lt;37 weeks). Shortened cervical length was found in 6/138 (4.3%) women whereas the high Bishop score was found in 17/144 (11.8%) (p=0.038, Fisher&amp;amp;amp;amp;amp;#39;s exact test). The incidence of preterm delivery was 5.7% (16/282). Regarding the prediction of preterm delivery, shortened cervical length and high Bishop score had sensitivity 57.1% versus 33.3% and positive predictive value 66.7% versus 17.6%. Shortened cervical length in comparison with high Bishop score had 12-fold higher positive likelihood ratio for preterm delivery in a low-risk population (37.4; 95%CI [8.2-170.7] versus 3.2; 95%CI [1.1-9.2]). Sonographic assessment of cervical length has better diagnostic accuracy in the prediction of preterm delivery compared to digital examination in a low-risk population.
Prediction of Preterm Birth: Nonsonographic Cervical Methods
Seminars in Perinatology, 2009
A short cervix in the second trimester is a powerful predictor of preterm birth risk. Multiple cervical length screens for patients in midpregnancy will likely become the standard of obstetrical care as a result of the development of effective methods (eg, cerclage, progesterone) to prevent early delivery in patients with a short cervix. Because of the high cost and infrastructure requirements, providing multiple cervical length evaluations through transvaginal ultrasound will likely be a significant barrier to universal screening. A cost-effective, low-technology method of cervical length screening is necessary to implement such programs. Available data suggest that digital examination is not sufficiently sensitive and reproducible to reliably screen for short cervix in presymptomatic patients in the mid trimester. New modalities for nonsonographic cervical length assessment (ie, Cervilenz) provide for a cost-effective, sensitive, and reproducible method of screening patients for short cervical length, which deserves further research in comparing its efficacy to sonographic cervical length.