The capacity of mid-pregnancy cervical length to predict preterm birth in low-risk women: a national cohort study

van der Ven, Jeanine; van Os, Melanie A.; Kazemier, Brenda M.; Kleinrouweler, Emily; Verhoeven, Corine J.; de Miranda, Esteriek; van Wassenaer-Leemhuis, Aleid G.; Kuiper, Petra N.; Porath, Martina; Willekes, Christine; Woiski, Mallory D.; Sikkema, Marko J.; Roumen, Frans J.M.E.; Bossuyt, Patrick M.; Haak, Monique C.; de Groot, Christianne J.M.; Mol, Ben W.J.; Pajkrt, Eva

Abstract

Introduction. We investigated the predictive capacity of mid-trimester cervical length (CL) measurement for spontaneous and iatrogenic preterm birth. Material and methods. We performed a prospective observational cohort study in nulliparous women and low-risk multiparous women with a singleton pregnancy between 16+0 and 21+6 weeks of gestation. We assessed the prognostic capacity of transvaginally measured mid-trimester CL for spontaneous and iatrogenic preterm birth (<37 weeks) using likelihood ratios (LR) and receiver-operating-characteristic analysis. We calculated numbers needed to screen to prevent one preterm birth assuming different treatment effects. Main outcome measures were preterm birth <32, <34 and <37 weeks. Results. We studied 11 943 women, of whom 666 (5.6%) delivered preterm: 464 (3.9%) spontaneous and 202 (1.7%) iatrogenic. Mean CL was 44.1 mm (SD 7.8 mm). In nulliparous women, the LRs for spontaneous preterm birth varied between 27 (95% CI 7.7-95) for a CL ≤ 20 mm, and 2.0 (95% CI 1.6-2.5) for a CL between 30 and 35 mm. For low-risk multiparous women, these LRs were 37 (95% CI 7.5-182) and 1.5 (95% CI 0.97-2.2), respectively. Using a cut-off for CL ≤ 30 mm, 28 (6.0%) of 464 women with spontaneous preterm birth were identified. The number needed to screen to prevent one case of preterm birth was 618 in nulliparous women and 1417 for low-risk multiparous women (40% treatment effect, cut-off 30 mm). Conclusion. In women at low risk of preterm birth, CL predicts spontaneous preterm birth. However, its isolated use as a screening tool has limited value due to low sensitivity.

Citation

van der Ven, J., van Os, M. A., Kazemier, B. M., Kleinrouweler, E., Verhoeven, C. J., de Miranda, E., …Pajkrt, E. (2015). The capacity of mid-pregnancy cervical length to predict preterm birth in low-risk women: a national cohort study. Acta Obstetricia et Gynecologica Scandinavica, 94(11), 1223-1234. https://doi.org/10.1111/aogs.12721

• Journal Article Type: Article
• Acceptance Date: Jul 28, 2015
• Online Publication Date: Sep 18, 2015
• Publication Date: 2015-11
• Deposit Date: Aug 6, 2023
• Journal: Acta Obstetricia et Gynecologica Scandinavica
• Print ISSN: 0001-6349
• Electronic ISSN: 1600-0412
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 94
• Issue: 11
• Pages: 1223-1234
• DOI: https://doi.org/10.1111/aogs.12721
• Public URL: https://nottingham-repository.worktribe.com/output/23513661
• Publisher URL: https://obgyn.onlinelibrary.wiley.com/doi/10.1111/aogs.12721