Timing of mid-trimester cervical length shortening in high-risk women

J. M. Szychowski, J. Owen, Gary Hankins, J. Iams, J. Sheffield, A. Perez-Delboy, V. Berghella, D. A. Wing, E. R. Guzman

Research output: Contribution to journalArticle

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Abstract

Objective: To examine the natural history of cervical length shortening in women who had experienced at least one prior spontaneous preterm birth at between 17 + 0 and 33 + 6 weeks' gestation. Methods: This was an analysis of prerandomization data from the multicenter Vaginal Ultrasound Cerclage Trial. Serial cervical length was measured by transvaginal sonography in 1014 high-risk women at 16 + 0 to 22 + 6 weeks. We performed survival analyses in which the outcome was cervical length shortening <25 mm and data were censored if this did not occur before 22 + 6 weeks' gestation. The incidence of cervical length shortening and the time to shortening were compared for women whose earliest prior preterm birth was in the mid-trimester, defined as <24 weeks, vs. those at weeks 24-33. Similar comparisons were performed based on each patient's most recent birth history. Results: Time to cervical length shortening by survival analysis was significantly shorter (hazard ratio (HR) = 2.2, P < 0.0001) and the relative risk (RR) of shortening significantly higher (RR = 1.8, P < 0.0001) for women whose earliest prior spontaneous preterm birth was at <24 weeks. A larger effect was observed for women whose most recent birth was at <24 weeks (HR = 2.8, P < 0.0001; RR = 2.1, P < 0.0001). The observed hazard ratios remained significant after adjusting for confounders in a multivariable Cox proportional hazards model. Conclusion: Women with a prior spontaneous preterm birth at <24 weeks are at a higher risk of cervical shortening, and do so at a higher rate and at an earlier gestational age, than do women with a later preterm birth history.

Original languageEnglish
Pages (from-to)70-75
Number of pages6
JournalUltrasound in Obstetrics and Gynecology
Volume33
Issue number1
DOIs
StatePublished - Jan 2009

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Premature Birth
Reproductive History
Survival Analysis
Pregnancy
Natural History
Proportional Hazards Models
Gestational Age
Ultrasonography
Parturition
Incidence

Keywords

  • Cervical length shortening
  • Mid-trimester birth
  • Preterm birth
  • Vaginal sonography

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology
  • Reproductive Medicine

Cite this

Szychowski, J. M., Owen, J., Hankins, G., Iams, J., Sheffield, J., Perez-Delboy, A., ... Guzman, E. R. (2009). Timing of mid-trimester cervical length shortening in high-risk women. Ultrasound in Obstetrics and Gynecology, 33(1), 70-75. https://doi.org/10.1002/uog.6283

Timing of mid-trimester cervical length shortening in high-risk women. / Szychowski, J. M.; Owen, J.; Hankins, Gary; Iams, J.; Sheffield, J.; Perez-Delboy, A.; Berghella, V.; Wing, D. A.; Guzman, E. R.

In: Ultrasound in Obstetrics and Gynecology, Vol. 33, No. 1, 01.2009, p. 70-75.

Research output: Contribution to journalArticle

Szychowski, JM, Owen, J, Hankins, G, Iams, J, Sheffield, J, Perez-Delboy, A, Berghella, V, Wing, DA & Guzman, ER 2009, 'Timing of mid-trimester cervical length shortening in high-risk women', Ultrasound in Obstetrics and Gynecology, vol. 33, no. 1, pp. 70-75. https://doi.org/10.1002/uog.6283
Szychowski JM, Owen J, Hankins G, Iams J, Sheffield J, Perez-Delboy A et al. Timing of mid-trimester cervical length shortening in high-risk women. Ultrasound in Obstetrics and Gynecology. 2009 Jan;33(1):70-75. https://doi.org/10.1002/uog.6283
Szychowski, J. M. ; Owen, J. ; Hankins, Gary ; Iams, J. ; Sheffield, J. ; Perez-Delboy, A. ; Berghella, V. ; Wing, D. A. ; Guzman, E. R. / Timing of mid-trimester cervical length shortening in high-risk women. In: Ultrasound in Obstetrics and Gynecology. 2009 ; Vol. 33, No. 1. pp. 70-75.
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abstract = "Objective: To examine the natural history of cervical length shortening in women who had experienced at least one prior spontaneous preterm birth at between 17 + 0 and 33 + 6 weeks' gestation. Methods: This was an analysis of prerandomization data from the multicenter Vaginal Ultrasound Cerclage Trial. Serial cervical length was measured by transvaginal sonography in 1014 high-risk women at 16 + 0 to 22 + 6 weeks. We performed survival analyses in which the outcome was cervical length shortening <25 mm and data were censored if this did not occur before 22 + 6 weeks' gestation. The incidence of cervical length shortening and the time to shortening were compared for women whose earliest prior preterm birth was in the mid-trimester, defined as <24 weeks, vs. those at weeks 24-33. Similar comparisons were performed based on each patient's most recent birth history. Results: Time to cervical length shortening by survival analysis was significantly shorter (hazard ratio (HR) = 2.2, P < 0.0001) and the relative risk (RR) of shortening significantly higher (RR = 1.8, P < 0.0001) for women whose earliest prior spontaneous preterm birth was at <24 weeks. A larger effect was observed for women whose most recent birth was at <24 weeks (HR = 2.8, P < 0.0001; RR = 2.1, P < 0.0001). The observed hazard ratios remained significant after adjusting for confounders in a multivariable Cox proportional hazards model. Conclusion: Women with a prior spontaneous preterm birth at <24 weeks are at a higher risk of cervical shortening, and do so at a higher rate and at an earlier gestational age, than do women with a later preterm birth history.",
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