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Am J Perinatol 2016; 33(04): 350-355
DOI: 10.1055/s-0035-1564425
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Predictive Value of Initial Cervical Length for Subsequent Cervical Length Shortening in Women with a Prior Preterm Birth

Akila Subramaniam
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Lorie M. Harper
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Jeff M. Szychowski
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
John Owen
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
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Publikationsverlauf

15. Juni 2015

30. Juli 2015

Publikationsdatum:
13. Oktober 2015 (online)

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Abstract

Objective The objective of this study was to estimate the predictive value of the initial cervical length (CL) for later CL shortening in women at high risk for recurrent spontaneous preterm birth (SPTB).

Materials and Methods We conducted a secondary analysis of a multicenter randomized trial of high-risk women with CL screening scheduled at least every 2 weeks from 160/7 to 226/7 weeks. Primary outcome was CL < 25 mm or SPTB before follow-up CL; the risk of this outcome was analyzed by initial CL at 160/7 to 216/7 weeks using multivariable logistic regression and receiver operator curves.

Results A total of 786 women were identified in the parent trial; 197 (25.0%) developed CL shortening < 23 weeks, 3 (0.4%) delivered within 2 weeks of initial CL measurement (< 24 weeks), and 586 (74.6%) maintained CL ≥ 25 mm. The covariate-adjusted receiver operator characteristics curve had moderate predictive value (area under the curve = 0.748) but did not reveal a clinically useful CL cutoff. Evaluation of selected CL cutoffs demonstrated that an initial CL ≥39 mm had the greatest negative predictive value (85.1%). No CL cutoff existed above which there was no CL shortening, although at ≥ 39 mm only two patients (1.1%) shortened within 2 weeks as compared with 32 (7.1%) patients whose initial CL was < 39 mm (p < 0.001).

Conclusion In high-risk patients whose initial CL is ≥ 39 mm, CL shortening or delivery is uncommon in the following 2 weeks. Patients with initial CL above this threshold may require less frequent surveillance.

Keywords

cervical length shortening - predictive value - sonographic surveillance

Note

This article was presented as a poster presentation at the 34th Annual Meeting of the Society for Maternal-Fetal Medicine in New Orleans, LA, February 3–8, 2014.


 

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