Association between cervical length and gestational age at birth in singleton pregnancies: a multicentric prospective cohort study in the Brazilian population
Abstract Background Short cervical length measured during the second trimester of pregnancy is an important risk factor for spontaneous preterm birth (sPTB). The aim of this study is to identify the association between mid-pregnancy cervical length (CL) and gestational age at birth in asymptomatic s...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-03-01
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| Series: | Reproductive Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12978-022-01557-w |
| _version_ | 1827979439333441536 |
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| author | Thais Valéria Silva Anderson Borovac-Pinheiro José Guilherme Cecatti Ben Willem Mol Fabricio Silva Costa Marcelo Santucci França Renato Teixeira Souza Roland Devlieger Renato Passini Rodolfo Carvalho Pacagnella The P5 working group |
| author_facet | Thais Valéria Silva Anderson Borovac-Pinheiro José Guilherme Cecatti Ben Willem Mol Fabricio Silva Costa Marcelo Santucci França Renato Teixeira Souza Roland Devlieger Renato Passini Rodolfo Carvalho Pacagnella The P5 working group |
| author_sort | Thais Valéria Silva |
| collection | DOAJ |
| description | Abstract Background Short cervical length measured during the second trimester of pregnancy is an important risk factor for spontaneous preterm birth (sPTB). The aim of this study is to identify the association between mid-pregnancy cervical length (CL) and gestational age at birth in asymptomatic singleton pregnant women. Methods This is a prospective cohort study involving singleton pregnant women who participated in the screening phase of a Brazilian multicenter randomized controlled trial (P5 trial) between July 2015 and March 2019. Transvaginal ultrasound to measure CL was performed from 18 to 22 + 6 weeks. Women with CL ≤ 30 mm received vaginal progesterone (200 mg/day) until 36 weeks’ gestation. For this analysis we considered all women with CL ≤ 30 mm receiving progesterone and a random selection of women with CL > 30 mm, keeping the populational distribution of CL. We obtained prognostic effectiveness data (area under receive operating characteristic curve (AUC), sensitivity and specificity and estimated Kaplan–Meier curves for preterm birth using different CL cutoff points. Results We report on 3139 women and identified a negative association between cervical length and sPTB. CL ≤ 25 mm was associated with sPTB < 28, sPTB < 34 and sPTB < 37 weeks, whereas a CL 25–30 mm was directly associated with late sPTB. CL by transvaginal ultrasound presented an AUC of 0.82 to predict sPTB < 28 weeks and 0.67 for sPTB < 34 weeks. Almost half of the sPTB occurred in nulliparous women and CL ≤ 30 mm was associated with sPTB at < 37 weeks (OR = 7.84; 95%CI = 5.5–11.1). The number needed to screen to detect one sPTB < 34 weeks in women with CL ≤ 25 mm is 121 and we estimated that 248 screening tests are necessary to prevent one sPTB < 34 weeks using progesterone prophylaxis. Conclusions CL measured by transvaginal ultrasound should be used to predict sPTB < 34 weeks. Women with CL ≤ 30 mm are at increased risk for late sPTB. |
| first_indexed | 2024-04-09T21:37:51Z |
| format | Article |
| id | doaj.art-5415677cb49646dc8b247aca6c235336 |
| institution | Directory Open Access Journal |
| issn | 1742-4755 |
| language | English |
| last_indexed | 2024-04-09T21:37:51Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Reproductive Health |
| spelling | doaj.art-5415677cb49646dc8b247aca6c2353362023-03-26T11:12:27ZengBMCReproductive Health1742-47552023-03-0120111010.1186/s12978-022-01557-wAssociation between cervical length and gestational age at birth in singleton pregnancies: a multicentric prospective cohort study in the Brazilian populationThais Valéria Silva0Anderson Borovac-Pinheiro1José Guilherme Cecatti2Ben Willem Mol3Fabricio Silva Costa4Marcelo Santucci França5Renato Teixeira Souza6Roland Devlieger7Renato Passini8Rodolfo Carvalho Pacagnella9The P5 working groupDepartment of Obstetrics and Gynecology, School of Medicine, University of CampinasDepartment of Obstetrics and Gynecology, School of Medicine, University of CampinasDepartment of Obstetrics and Gynecology, School of Medicine, University of CampinasDepartment of Obstetrics and Gynaecology, Monash UniversityMaternal Fetal Medicine Unit, Gold Coast University Hospital and School of Medicine, Griffith UniversityScreening and Prevention of Preterm Birth Sector, Fetal Medicine Discipline, Obstetrics Department, Escola Paulista de Medicina, Federal University of Sao PauloDepartment of Obstetrics and Gynecology, School of Medicine, University of CampinasDepartment of Obstetrics and Gynaecology, University Hospitals KU LeuvenDepartment of Obstetrics and Gynecology, School of Medicine, University of CampinasDepartment of Obstetrics and Gynecology, School of Medicine, University of CampinasAbstract Background Short cervical length measured during the second trimester of pregnancy is an important risk factor for spontaneous preterm birth (sPTB). The aim of this study is to identify the association between mid-pregnancy cervical length (CL) and gestational age at birth in asymptomatic singleton pregnant women. Methods This is a prospective cohort study involving singleton pregnant women who participated in the screening phase of a Brazilian multicenter randomized controlled trial (P5 trial) between July 2015 and March 2019. Transvaginal ultrasound to measure CL was performed from 18 to 22 + 6 weeks. Women with CL ≤ 30 mm received vaginal progesterone (200 mg/day) until 36 weeks’ gestation. For this analysis we considered all women with CL ≤ 30 mm receiving progesterone and a random selection of women with CL > 30 mm, keeping the populational distribution of CL. We obtained prognostic effectiveness data (area under receive operating characteristic curve (AUC), sensitivity and specificity and estimated Kaplan–Meier curves for preterm birth using different CL cutoff points. Results We report on 3139 women and identified a negative association between cervical length and sPTB. CL ≤ 25 mm was associated with sPTB < 28, sPTB < 34 and sPTB < 37 weeks, whereas a CL 25–30 mm was directly associated with late sPTB. CL by transvaginal ultrasound presented an AUC of 0.82 to predict sPTB < 28 weeks and 0.67 for sPTB < 34 weeks. Almost half of the sPTB occurred in nulliparous women and CL ≤ 30 mm was associated with sPTB at < 37 weeks (OR = 7.84; 95%CI = 5.5–11.1). The number needed to screen to detect one sPTB < 34 weeks in women with CL ≤ 25 mm is 121 and we estimated that 248 screening tests are necessary to prevent one sPTB < 34 weeks using progesterone prophylaxis. Conclusions CL measured by transvaginal ultrasound should be used to predict sPTB < 34 weeks. Women with CL ≤ 30 mm are at increased risk for late sPTB.https://doi.org/10.1186/s12978-022-01557-wCervical lengthNumber needed to screenPreterm birthShort cervixPregnancy |
| spellingShingle | Thais Valéria Silva Anderson Borovac-Pinheiro José Guilherme Cecatti Ben Willem Mol Fabricio Silva Costa Marcelo Santucci França Renato Teixeira Souza Roland Devlieger Renato Passini Rodolfo Carvalho Pacagnella The P5 working group Association between cervical length and gestational age at birth in singleton pregnancies: a multicentric prospective cohort study in the Brazilian population Reproductive Health Cervical length Number needed to screen Preterm birth Short cervix Pregnancy |
| title | Association between cervical length and gestational age at birth in singleton pregnancies: a multicentric prospective cohort study in the Brazilian population |
| title_full | Association between cervical length and gestational age at birth in singleton pregnancies: a multicentric prospective cohort study in the Brazilian population |
| title_fullStr | Association between cervical length and gestational age at birth in singleton pregnancies: a multicentric prospective cohort study in the Brazilian population |
| title_full_unstemmed | Association between cervical length and gestational age at birth in singleton pregnancies: a multicentric prospective cohort study in the Brazilian population |
| title_short | Association between cervical length and gestational age at birth in singleton pregnancies: a multicentric prospective cohort study in the Brazilian population |
| title_sort | association between cervical length and gestational age at birth in singleton pregnancies a multicentric prospective cohort study in the brazilian population |
| topic | Cervical length Number needed to screen Preterm birth Short cervix Pregnancy |
| url | https://doi.org/10.1186/s12978-022-01557-w |
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