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

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abstract

  • ABSTRACTObjectiveTo 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).MethodsThis 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.ResultsOf 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).ConclusionsAmong 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

  • Norman, Geoffrey
  • 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

publication date

  • December 2018