Prediction of spontaneous preterm birth among nulliparous women with a short cervix

William A. Grobman, Yinglei Lai, Jay D. Iams, Uma M. Reddy, Brian M. Mercer, George Saade, Alan T. Tita, Dwight J. Rouse, Yoram Sorokin, Ronald J. Wapner, Kenneth J. Leveno, Sean C. Blackwell, M. Sean Esplin, Jorge E. Tolosa, John M. Thorp, Steve N. Caritis

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

Objectives - The purpose of this study was to evaluate whether demographic and sonographic factors associated with spontaneous preterm birth among nulliparous women with a cervical length of less than 30 mm could be combined into an accurate prediction model for spontaneous preterm birth. Methods - We conducted a secondary analysis of a trial of nulliparous women with a singleton gestation and a cervical length of less than 30 mm on transvaginal sonography between 16 and 22 weeks who lacked other risk factors for spontaneous (eg, prior cervical excisional procedure) or medically indicated (eg, chronic hypertension) preterm birth, who were randomized to either 17α-hydroxyprogesterone caproate treatment or a placebo. Risk factors associated with spontaneous preterm birth within the entire cohort were identified by univariable analysis. Factors significantly associated (P < .05) with spontaneous preterm birth were included in a multivariable logistic regression analysis to determine whether an accurate prediction model could be developed. Results - Of the 657 randomized patients, 109 (16.6%) had spontaneous preterm birth before 37 weeks' gestation. Logistic regression analysis revealed only cervical length (odds ratio, 1.06 per 1-mm decrease; 95% confidence interval, 1.02-1.10) to be associated with spontaneous preterm birth. The area under the receiver operating characteristic curve based on this regression was low (0.63; 95% confidence interval, 0.58-0.69). Results were similar for the outcome of spontaneous preterm birth before 34 weeks. Conclusions - An accurate prediction model for spontaneous preterm birth among nulliparous women with a short cervix could not be developed.

Original languageEnglish (US)
Pages (from-to)1293-1297
Number of pages5
JournalJournal of Ultrasound in Medicine
Volume35
Issue number6
DOIs
StatePublished - Jun 1 2016

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Keywords

  • Cervical length
  • Obstetric ultrasound
  • Prediction
  • Spontaneous preterm birth

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Grobman, W. A., Lai, Y., Iams, J. D., Reddy, U. M., Mercer, B. M., Saade, G., Tita, A. T., Rouse, D. J., Sorokin, Y., Wapner, R. J., Leveno, K. J., Blackwell, S. C., Esplin, M. S., Tolosa, J. E., Thorp, J. M., & Caritis, S. N. (2016). Prediction of spontaneous preterm birth among nulliparous women with a short cervix. Journal of Ultrasound in Medicine, 35(6), 1293-1297. https://doi.org/10.7863/ultra.15.08035