Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC · 2025
Association of Second and Early Third Trimester Cervical Length With Prolonged Pregnancy in Asymptomatic Women at Risk of Preterm Birth.
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Crane Joan, O'Brien Donnette
Аннотация
OBJECTIVES: To determine if transvaginal ultrasound cervical length (CL) in the second (T2) (160-236 weeks) or early third trimester (T3) (240-296 weeks) in individuals at increased risk of preterm birth (PTB) is associated with prolonged pregnancy (≥410 weeks), and if there is a specific CL cut-off that is predictive.
METHODS: This retrospective cohort study included individuals with singleton gestations; and a history of spontaneous PTB, excisional treatment of the cervix or uterine anomaly, undergoing transvaginal ultrasound CL 160-296 weeks. Results were divided by CL quartile in T2 and T3 separately.
RESULTS: Overall, 914 individuals were included, 514 having CL assessment in T2 and 857 in T3. In T2, those with CL in quartiles 2, 3, and 4 were more likely to have a prolonged pregnancy compared with quartile 1 (adjusted OR [aOR] 2.47, P = 0.049; aOR 3.15, P = 0.009; aOR 2.73, P = 0.028, respectively). However, the T2 receiver operator characteristic (ROC) area under the curve (AUC) (0.572) did not reach statistical significance (P = 0.057). In T3, those with CL in quartiles 3 and 4 were more likely to have a prolonged pregnancy compared with quartile 1 (aOR 2.42, P = 0.021; and aOR 3.10, P = 0.002, respectively). The T3 ROC curve reached statistical significance (P = 0.002, AUC = 0.622) but did not meet the criteria for a good screening test based on the AUC value. Subgroup analysis of those with a previous spontaneous PTB found the T2 ROC curve to be promising (AUC = 0.700, P = 0.013).
CONCLUSIONS: In individuals at risk of PTB, longer CL in T3 may be a better predictor of prolonged pregnancy than T2 but does not appear to be a good screening test in either gestational period. Further research is suggested in those with a history of PTB.
METHODS: This retrospective cohort study included individuals with singleton gestations; and a history of spontaneous PTB, excisional treatment of the cervix or uterine anomaly, undergoing transvaginal ultrasound CL 160-296 weeks. Results were divided by CL quartile in T2 and T3 separately.
RESULTS: Overall, 914 individuals were included, 514 having CL assessment in T2 and 857 in T3. In T2, those with CL in quartiles 2, 3, and 4 were more likely to have a prolonged pregnancy compared with quartile 1 (adjusted OR [aOR] 2.47, P = 0.049; aOR 3.15, P = 0.009; aOR 2.73, P = 0.028, respectively). However, the T2 receiver operator characteristic (ROC) area under the curve (AUC) (0.572) did not reach statistical significance (P = 0.057). In T3, those with CL in quartiles 3 and 4 were more likely to have a prolonged pregnancy compared with quartile 1 (aOR 2.42, P = 0.021; and aOR 3.10, P = 0.002, respectively). The T3 ROC curve reached statistical significance (P = 0.002, AUC = 0.622) but did not meet the criteria for a good screening test based on the AUC value. Subgroup analysis of those with a previous spontaneous PTB found the T2 ROC curve to be promising (AUC = 0.700, P = 0.013).
CONCLUSIONS: In individuals at risk of PTB, longer CL in T3 may be a better predictor of prolonged pregnancy than T2 but does not appear to be a good screening test in either gestational period. Further research is suggested in those with a history of PTB.