Second trimester cervical length measurement for prediction spontaneous preterm birth in an unselected risk population
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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 (R2=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.
Abstract
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 (R2=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.
참고문헌 (18)
- Iams JD, "Primary, secondary, and tertiary interventions to reduce the morbidity and mortality of preterm birth", Lancet, 371, pp.164~175 (2008)
- Manuck TA, "Preterm neonatal morbidity and mortality by gestational age: a contemporary cohort", Am J Obstet Gynecol, 215, pp.103~ (2016)
- Heath VC, "Cervical length at 23 weeks of gestation: prediction of spontaneous preterm delivery", Ultrasound Obstet Gynecol, 12, pp.312~317 (1998)
- Miller ES, "Second-trimester cervical length screening among asymptomatic women:an evaluation of risk-based strategies", Obstet Gynecol, 126, pp.61~66 (2015)
- Fonseca EB, "Progesterone and the risk of preterm birth among women with a short cervix", N Engl J Med, 357, pp.462~469 (2007)
- Cahill AG, "Universal cervical length screening and treatment with vaginal progesterone to prevent preterm birth: a decision and economic analysis", Am J Obstet Gynecol, 202, pp.548~ (2010)
- Sonek J, "Cervical sonography: a review", Ultrasound Obstet Gynecol, 11, pp.71~78 (1998)
- Sotiriadis A, "Synthesizing Evidence from Diagnostic Accuracy TEsts: the SEDATE guideline", Ultrasound Obstet Gynecol, 47, pp.386~395 (2016)
- Hamilton BE, "Births: preliminary data for 2006", Natl Vital Stat Rep, 56, pp.1~18 (2007)
- Leal MD, "Prevalence and risk factors related to preterm birth in Brazil", Reprod Health, 13(Suppl 3), pp.127~ (2016)
- Romero R, "Vaginal progesterone decreases preterm birth ≤ 34 weeks of gestation in women with a singleton pregnancy and a short cervix: an updated meta-analysis including data from the OPPTIMUM study", Ultrasound Obstet Gynecol, 48, pp.308~317 (2016)
- Society for Maternal-Fetal Medicine, "The role of routine cervical length screening in selected high- and low-risk women for preterm birth prevention", Am J Obstet Gynecol, 215, pp.B2~B7 (2016)
- Temming LA, "Universal cervical length screening:implementation and outcomes", Am J Obstet Gynecol, 214, pp.523~ (2016)
- Son M, "A universal mid-trimester transvaginal cervical length screening program and its associated reduced preterm birth rate", Am J Obstet Gynecol, 214, pp.365~ (2016)
- Hassan SS, "Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized, double-blind, placebo-controlled trial", Ultrasound Obstet Gynecol, 38, pp.18~31 (2011)
- Alberto Borges Peixoto, "Reference values for the cervical length measurement in the second trimester of pregnancy using the transvaginal ultrasound in a large Brazilian population", Obstetrics & Gynecology Science, 59(4), pp.303~306 (2016), 대한산부인과학회[DOI]
- Hughes K, "Cervical length as a predictor for spontaneous preterm birth in high-risk singleton pregnancy:current knowledge", Ultrasound Obstet Gynecol, 48, pp.7~15 (2016)
- Celik E, "Cervical length and obstetric history predict spontaneous preterm birth: development and validation of a model to provide individualized risk assessment", Ultrasound Obstet Gynecol, 31, pp.549~554 (2008)