Cervical funneling or intra‐amniotic debris and preterm birth in nulliparous women with midtrimester cervical length less than 30 mm Academic Article uri icon

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abstract

  • OBJECTIVE: To evaluate whether the presence of cervical funneling or intra-amniotic debris identified in the second trimester is associated with a higher rate of preterm birth (PTB) in asymptomatic nulliparous pregnant women with a midtrimester cervical length (CL) less than 30 mm (i.e. below the 10th percentile). METHODS: This was a secondary cohort analysis of data from a multicenter trial in nulliparous women between 16 and 22 weeks' gestation with a singleton gestation and CL less than 30 mm on transvaginal ultrasound, randomized to treatment with either 17-alpha-hydroxyprogesterone caproate or placebo. Sonographers were centrally certified in CL measurement, as well as in identification of intra-amniotic debris and cervical funneling. Univariable and multivariable analysis was performed to assess the associations of cervical funneling and intra-amniotic debris with PTB. RESULTS: Of the 657 women randomized, 112 (17%) had cervical funneling only, 33 (5%) had intra-amniotic debris only and 45 (7%) had both on second-trimester ultrasound. Women with either of these findings had a shorter median CL than those without (21.0 mm vs 26.4 mm; P < 0.001). PTB prior to 37 weeks was more likely in women with cervical funneling (37% vs 21%; odds ratio (OR), 2.2 (95% CI, 1.5-3.3)) or intra-amniotic debris (35% vs 23%; OR, 1.7 (95% CI, 1.1-2.9)). Results were similar for PTB before 34 and before 32 weeks' gestation. After multivariable adjustment that included CL, PTB < 34 and < 32 weeks continued to be associated with the presence of intra-amniotic debris (adjusted OR (aOR), 1.85 (95% CI, 1.00-3.44) and aOR, 2.78 (95% CI, 1.42-5.45), respectively), but not cervical funneling (aOR, 1.17 (95% CI, 0.63-2.17) and aOR, 1.45 (95% CI, 0.71-2.96), respectively). CONCLUSIONS: Among asymptomatic nulliparous women with midtrimester CL less than 30 mm, the presence of intra-amniotic debris, but not cervical funneling, is associated with an increased risk for PTB before 34 and 32 weeks' gestation, independently of CL. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

authors

  • Saade, GR
  • Thom, EA
  • Grobman, WA
  • Iams, JD
  • Mercer, BM
  • Reddy, UM
  • Tita, ATN
  • Rouse, DJ
  • Sorokin, Y
  • Wapner, RJ
  • Leveno, KJ
  • Blackwell, SC
  • Esplin, MS
  • Tolosa, JE
  • Thorp, JM
  • Caritis, SN
  • Vandorsten, JP
  • Moss, J
  • Salazar, A
  • Hankins, G
  • Olson, G
  • Jackson, A
  • Sutherland, C
  • Peaceman, A
  • Dinsmoor, M
  • Mallett, G
  • Senka, J
  • Johnson, F
  • Cline, D
  • Latimer, C
  • Frantz, S
  • Fyffe, S
  • Shubert, P
  • Gerwig, L
  • Milluzzi, C
  • Dalton, W
  • Russo, J
  • Myers, S
  • Waters, T
  • Dotson, T
  • Andrews, W
  • Northen, A
  • Sheppard, J
  • Grant, J
  • Rouse, D
  • Allard, D
  • Hunt, J
  • Tillinghast, J
  • Bethelemy, M
  • Gardner, D
  • Duquette, C
  • Hauff, N
  • Norman, Geoffrey
  • King, M
  • Allen, D
  • Smith, T
  • Miller, R
  • Bousleiman, S
  • Plante, L
  • Tocci, C
  • Ranzini, A
  • Lake, M
  • Hoffman, M
  • Lynch, S
  • Dashe, J
  • Moseley, L
  • Kingsbery, J
  • Bludau, V
  • Benezue, R
  • Ortiz, F
  • Givens, P
  • Rech, B
  • Moran, C
  • Reed, P
  • Hill, K
  • Varner, MW
  • Weaver, A
  • Alexander, S
  • Thompson‐Garbrecht, D
  • Miller, J
  • Acosta, R
  • Flores, C
  • Ricon, M
  • Smith, W
  • Butcher, S
  • Segel, S
  • Pereira, L
  • Dorman, K
  • Pena‐Centeno, K
  • Clark, K
  • Timlin, S
  • Birkland, MH
  • Simhan, H
  • Cotroneo, P
  • Zubic, R
  • Nowinski, D
  • Gilbert, S
  • Lozitska, A
  • Lai, Y
  • Spong, C
  • Tolivaisa, S

publication date

  • December 2018