Sonographic measurement of cervical length as a predictor of preterm delivery: a systematic review

Barros-Silva, Joana; Pedrosa, Ana Catarina; Matias, Alexandra

doi:10.1515/jpm-2013-0115

Cited by 34 publications

(26 citation statements)

References 3 publications

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“…Sonographic measurement of cervical length (CL) at mid-gestation has been shown to be predictive of PTB in singleton 11, 23-28 and twin gestations 12, 29-39 . This, in turn, has led to the relatively common practice of serial monitoring of CL during the second trimester in women at risk of PTB, including women with twin gestations.…”

Section: Introductionmentioning

confidence: 99%

Serial cervical length determination in twin pregnancies reveals 4 distinct patterns with prognostic significance for preterm birth

Melamed

Pittini

Hiersch

et al. 2016

American Journal of Obstetrics and Gynecology

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BACKGROUND Women with a twin gestation are at increased risk for preterm birth, and sonographic cervical length is a powerful predictor for spontaneous preterm birth. Obstetricians frequently monitor cervical length in multiple gestations; yet, the optimal method to integrate and interpret the results of serial sonographic cervical length has not been determined. OBJECTIVE To determine whether there are different patterns of cervical shortening in twin gestations, and whether such patterns are related to the risk of preterm birth. STUDY DESIGN We conducted a retrospective study of all women with twins followed in a single tertiary referral center during 2012-2014. All women underwent serial measurements of cervical length every 2-3 weeks starting from 14-18 weeks and until 28-32 weeks of gestation. Changes in cervical length were analyzed and classified into distinct patterns that were initially identified by visual inspection of all individual cases. Each pattern was then characterized by several parameters including information about when cervical shortening began, the rate of shortening, and whether a plateau was observed. Locally weighted regression mean profiles were generated to describe each pattern of cervical length over time. The association of these patterns with spontaneous preterm birth was determined. The specific characteristics of each pattern that further determined the risk of preterm birth were identified using multivariable logistic regression analysis. RESULTS We studied 441 women who had a total of 2,826 measurements of cervical length done. Overall, 4 main patterns of change in cervical length were identified: Pattern I - stable cervix (n=196), Pattern II - early and rapid shortening (n=18), Pattern III - late shortening (n=109), and Pattern IV – early shortening with a plateau (n=118). The rate of preterm birth at <34 weeks was lowest in cases of Pattern I (11.7%), followed by Pattern IV (14.4%) and Pattern III (20.2%), and was highest for women with Pattern II (44.4%) (p<0.001). In cases with Pattern III (late shortening), the most important factors affecting the risk of preterm birth were the shortening rate, the gestational age at the onset of cervical shortening and the initial plateau of cervical length. In the case of Pattern IV (early shortening with a plateau), it was only the new plateau at which cervical shortening stopped that was associated with the risk of preterm birth. CONCLUSIONS Changes in sonographic cervical length over time in twin gestations can be classified into four patterns, each associated with a different risk of preterm birth.

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Section: Introductionmentioning

confidence: 99%

Serial cervical length determination in twin pregnancies reveals 4 distinct patterns with prognostic significance for preterm birth

Melamed

Pittini

Hiersch

et al. 2016

American Journal of Obstetrics and Gynecology

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“…48–50 Despite providing useful insights concerning diverse populations, designs and analytical methods, prior reviews 9–12, 17, 44, 48–52 failed to consider PCCR with most investigators focusing entirely on CL as measured by TVU. 17, 44, 49–51 Reports from five investigative teams 9–12, 48, 52, 53 over the past 15 years did not cite Papiernik et al’s screening paper from 1986 27 but considered some of the hypotheses which form the basis for the present analysis. The first was Leitich and colleagues from Austria who concluded dilatation of the internal cervical os to be among the most effective markers for preterm delivery.…”

Section: Introductionmentioning

confidence: 93%

“…8 Finally, Barros-Silva and colleagues from Portugal reported inconsistent findings in comparing combined screening targets to short CL alone in three studies, and recommended combining CL “with other markers (sonographic, biochemical and/or clinical) that reflect the multiplicity of mechanisms involved in the pathogenesis of SPTD”. 53(5) …”

Section: Introductionmentioning

confidence: 99%

Precocious cervical ripening as a screening target to predict spontaneous preterm delivery among asymptomatic singleton pregnancies: a systematic review

Reeves

Owen

et al. 2015

American Journal of Obstetrics and Gynecology

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Routine second-trimester transvaginal ultrasonographic (TVU) screening for short cervical length (CL) predicts spontaneous preterm delivery (SPTD), albeit with limited sensitivity (35–40%) and moderate positive likelihood ratio (LR+: 4–6). However, CL describes one of multidimensional changes associated with precocious cervical ripening (PCCR), which also include cervical softening, cervical funneling (CF), and dilation. PCCR, a precursor and a strong predictor for SPTD, was proposed as a potential screening target. We hypothesized that screening for composite measures of PCCR (e.g. CL, CF, cervical consistency, and dilation) using either digital exam (DE) or TVU would improve prediction of SPTD compared to screening for short CL alone. We searched PubMed and EMBASE electronic databases for observational cohort studies to evaluate cervical screening in asymptomatic obstetric populations. Multidimensional composite cervical measures were assessed in 10 datasets (n=22,050 pregnancies) and 12 publications. Appreciable heterogeneity in cervical measurements, data quality, and outcomes across studies prevented quantitative meta-analysis. Only one study reported intra- and inter-observer reliability of cervical measurements. The prevalence of CF ranged from 0.7% to 9.1%. Five studies compared composite measures of PCCR (i.e., CL and CF) to short CL alone, and consistently reported improved screening performance. Among three TVU studies, gains in sensitivity ranged from 5% to 27%, and increases in LR+ ranged from 3 to 16. Our findings suggest composite measures of PCCR might serve as valuable screening targets. High-quality interdisciplinary studies integrating epidemiologic approaches are needed to test this hypothesis and accelerate the translation of advances in cervical pathophysioloy into effective preventive interventions.

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“…Meta-analysis of 18 studies, performed by Barros-Silva et al, confirmed that shortening of cervical length in the second trimester is highly predictive of spontaneous preterm delivery. The cut-off range varied from 10 mm to 30 mm, but the value of 25 mm (10th percentile) was used the most frequently [4] . Iams et al found that the relative risk of preterm delivery increased as the length of the cervix decreased.…”

Section: Commentmentioning

confidence: 99%

The T/QRS ratio values in pregnancies complicated by threatened preterm labour treated with intravenous infusions of fenoterol

Fuchs¹,

Pomorski²,

Grobelak³

et al. 2014

Journal of Perinatal Medicine

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The T/QRS ratio is one of the methods used for non-invasive foetal distress assessment that can be used in antepartum foetal monitoring in complicated pregnancies. Raised values of the T/QRS ratio in the foetus during tocolysis with fenoterol and next its fall to values observed in physiological pregnancies may indicate transient worsening of fetal well-being, however, additional research is required.

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Sonographic measurement of cervical length as a predictor of preterm delivery: a systematic review

Abstract: We conclude that a short cervix is predictive of preterm delivery and can identify women that may benefit from preventive and therapeutic measures, however, a negative result is not always reassuring.

Cited by 34 publications

References 3 publications

Serial cervical length determination in twin pregnancies reveals 4 distinct patterns with prognostic significance for preterm birth

Serial cervical length determination in twin pregnancies reveals 4 distinct patterns with prognostic significance for preterm birth

Precocious cervical ripening as a screening target to predict spontaneous preterm delivery among asymptomatic singleton pregnancies: a systematic review

The T/QRS ratio values in pregnancies complicated by threatened preterm labour treated with intravenous infusions of fenoterol

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