International Journal of Biomedicine. 2018;8(4):321-323.
Originally published December 15, 2018
The aim of this study was to examine the potential value of routine measurement of cervical length (CL) in singleton pregnancy at 11 to 14 weeks of gestation for predicting the risk for spontaneous preterm delivery (PD).
Materials and Methods: CL was assessed using transvaginal sonography (TVS) in the gestational period between 11 and 14 week in 1517 women. Childbirth at 22-36 weeks was considered as PD. The control group included pregnant women who gave birth within 37 weeks or more.
Results: The mean age of mothers was 25.3±4.9 years (age range of 17 to 43). Among them, 846 (55.8%) women were primiparous and 671 (44.2%) - multiparous. The average CL was 38.9±4.3 mm (range of 18 to 49 mm). The area under the ROC curve of the corresponding relationship between the CL forecast and the probability of PD occurrence was 0.84. When selecting the threshold value of the function at the point 35 mm, we predicted a high risk of PD with a sensitivity of 66.2% and a specificity of 84.2%. At the CL value of 30 mm, the sensitivity of the method was 51.5%, specificity 98.7%. For CL: OR=0.79, 95% CI: 0.75-0.83; P=0.0001. Thus, the most optimal cut-off CL is the threshold value of 30mm.
Conclusion: TVS is an objective, reproducible and reliable method for assessing the cervix uteri and can predict the risk of PD.
1. Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet. 2008;371(9606):75-84. doi:10.1016/S0140-6736(08)60074-4. PubMed
2. Son M, Miller ES. Predicting preterm birth: Cervical length and fetal fibronectin. Semin Perinatol. 2017;41(8):445-51. doi:10.1053/j.semperi.2017.08.002. PubMed
3. Martynenko PG, Volkov VG. [Prediction of preterm labor on the basis of the most significant risk factors]. Akush Ginekol (Mosk). 2012;1:103-7. [Article in Russian].
4. Crane JM, Hutchens D. Transvaginal sonographic measurement of cervical length to predict preterm birth in asymptomatic women at increased risk: a systematic review. Ultrasound Obstet Gynecol. 2008;31:579-87 doi: 10.1002/uog.5323. PubMed
5. Martynenko PG, Volkov VG, Zaikina FY, Kuzmina IV, Loginova TA. [New aspects of the prevention of premature delivery among women with symptoms of threatened abortion]. J New Med Tech. 2010;17(4):151-3. [Article in Russian].
6. Berghella V, Baxter JK, Hendrix NW. Cervical assessment by ultrasound for preventing preterm delivery. Cochrane Database Syst Rev. 2013;31(1):CD007235. doi: 10.1002/14651858.CD007235.pub3. PubMed
7. Bohîlțea RE, Munteanu O, Turcan N, Baros A, Bodean O, Voicu D, et al. A debate about ultrasound and anatomic aspects of the cervix in spontaneous preterm birth. J Med Life. 2016;9(4):342-7. PubMed
8. Volkov VG, Zaikina FY, Kultygina SV. Modern approaches to the prediction of occurrence of preterm birth. J New Med Tech. 2009;16(4):112-3. [Article in Russian].
9. Romero R, Nicolaides K, Conde-Agudelo A, Tabor A, O'Brien JM, Cetingoz E, et al. Vaginal progesterone in women with an asymptomatic sonographic short cervix in the midtrimester decreases preterm delivery and neonatal morbidity: a systematic review and metaanalysis of individual patient data. Am J Obstet Gynecol. 2012;206(2):124.e1–19. doi.org/10.1016/j.ajog.2011.12.003. PubMed
10. Hassan SS, Romero R, Vidyadhari D, Fusey S, Baxter JK, Khandelwal M, et al. 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. 2011;38(1):18-31. doi: 10.1002/uog.9017. PubMed
11. Greco E, Lange A, Ushakov F, Calvo JR, Nicolaides KH. Prediction of spontaneous preterm delivery from endocervical length at 11 to 13 weeks. Prenat Diagn. 2011;31(1):84-9. doi: 10.1002/pd.2640. PubMed
12. Akhilgova ZS. [Periodontitis diseases and premature parturition (literature review)]. J New Med Tech, eEdition. 2018;1:15(7-5). doi: 10.24411/2075-4094-2018-15982. [Article in Russian].
13. Markovskaya TV, Michalevich SI, Yakutovskaya SL, Mardas AV, Markovskaya KS. [Possibilities of modern obstetrics at premature birth]. Med Novosti. 2015;2:11-6. [Article in Russian].
14. Lim K, Butt K, Crane JM; DIAGNOSTIC IMAGING COMMITTEE; FAMILY PHYSICIANS ADVISORY COMMITTEE; MATERNAL FETAL MEDICINE COMMITTEE. SOGC Clinical Practice Guideline. Ultrasonographic cervical length assessment in predicting preterm birth in singleton pregnancies. J Obstet Gynaecol Can. 2011;33(5):486-499. doi: 10.1016/S1701-2163(16)34884-8.. PubMed
15. Meertens LJE, van Montfort P, Scheepers HCJ, van Kuijk SMJ, Aardenburg R, Langenveld J, et al. Prediction models for the risk of spontaneous preterm birth based on maternal characteristics: a systematic review and independent external validation. Acta Obstet Gynecol Scand. 2018;97(8):907–920. doi:10.1111/aogs.13358. PubMed
Received October 31, 2018.
Accepted November 15, 2018.
©2018 International Medical Research and Development Corporation.