Timing of mid-trimester cervical length shortening in high-risk women.
Publication/Presentation Date
1-1-2009
Abstract
OBJECTIVE: To examine the natural history of cervical length shortening in women who had experienced at least one prior spontaneous preterm birth at between 17+0 and 33+6 weeks' gestation.
METHODS: This was an analysis of prerandomization data from the multicenter Vaginal Ultrasound Cerclage Trial. Serial cervical length was measured by transvaginal sonography in 1014 high-risk women at 16+0 to 22+6 weeks. We performed survival analyses in which the outcome was cervical length shortening< 25 mm and data were censored if this did not occur before 22+6 weeks' gestation. The incidence of cervical length shortening and the time to shortening were compared for women whose earliest prior preterm birth was in the mid-trimester, defined as < 24 weeks, vs. those at weeks 24-33. Similar comparisons were performed based on each patient's most recent birth history.
RESULTS: Time to cervical length shortening by survival analysis was significantly shorter (hazard ratio (HR)=2.2, P< 0.0001) and the relative risk (RR) of shortening significantly higher (RR=1.8, P< 0.0001) for women whose earliest prior spontaneous preterm birth was at < 24 weeks. A larger effect was observed for women whose most recent birth was at < 24 weeks (HR=2.8, P< 0.0001; RR=2.1, P< 0.0001). The observed hazard ratios remained significant after adjusting for confounders in a multivariable Cox proportional hazards model.
CONCLUSION: Women with a prior spontaneous preterm birth at < 24 weeks are at a higher risk of cervical shortening, and do so at a higher rate and at an earlier gestational age, than do women with a later preterm birth history.
Volume
33
Issue
1
First Page
70
Last Page
75
ISSN
1469-0705
Published In/Presented At
Szychowski, J. M., Owen, J., Hankins, G., Iams, J., Sheffield, J., Perez-Delboy, A., Berghella, V., Wing, D. A., Guzman, E. R., & Vaginal Ultrasound Cerclage Trial Consortium (2009). Timing of mid-trimester cervical length shortening in high-risk women. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 33(1), 70–75. https://doi.org/10.1002/uog.6283
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
19072745
Department(s)
Administration and Leadership
Document Type
Article