Maternal-fetal medicine (Wolters Kluwer Health, Inc.) · 2026
Gestational Trimester-Specific Changes in Cervical Length and Their Predictive Value for Preterm Delivery.
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Zhang Qidi, Han Xinyue, Yang Huixia, Shi Chunyan, Zhu Yuchun, Wang Linlin, Wei Yumei
Аннотация
OBJECTIVE: To investigate gestational age-specific variations in cervical length (CL) and evaluate the predictive ability of CL for preterm delivery (PTD) across different trimesters.
METHODS: This retrospective longitudinal study included a total of 8659 women who delivered singleton live births between June 1, 2022, and December 31, 2024, at Peking University First Hospital. Associations between CL measured at ≤ 19+6, 20-24+6, and 28-33+6 gestational weeks and PTD were evaluated using receiver operating characteristic curve analysis and log-rank tests.
RESULTS: CL showed substantial variability across gestational ages, with pronounced shortening observed during 28-33+6 weeks. Significant differences in CL distribution between women with PTD and those with term delivery emerged as early as 20-24+6 weeks. The predictive value of CL for PTD increased with advancing gestational age. Optimal CL thresholds for predicting PTD ≤ 34+6 weeks were 28 mm, 15 mm, and 10 mm at ≤ 19+6, 20-24+6, and 28-33+6 weeks, respectively, while corresponding thresholds for PTD < 37 weeks were 28 mm, 26 mm, and 10 mm. Women with CL below these cut-offs had significantly lower probabilities of term delivery. The 26-mm threshold at mid-gestation (20-24+6 weeks) closely aligned with the conventional 25-mm definition of short cervix, supporting the validity of the minimum P approach. The consistent 10-mm threshold in late gestation suggests that lower diagnostic cut-offs after 28 weeks may be required to guide clinical management.
CONCLUSION: CL progressively decreases with increasing gestational age and has emerged as a more potent predictor of PTD after 20 weeks of gestation. A short cervix in late pregnancy may be more appropriately defined as < 10 mm at 28-33+6 gestational weeks.
METHODS: This retrospective longitudinal study included a total of 8659 women who delivered singleton live births between June 1, 2022, and December 31, 2024, at Peking University First Hospital. Associations between CL measured at ≤ 19+6, 20-24+6, and 28-33+6 gestational weeks and PTD were evaluated using receiver operating characteristic curve analysis and log-rank tests.
RESULTS: CL showed substantial variability across gestational ages, with pronounced shortening observed during 28-33+6 weeks. Significant differences in CL distribution between women with PTD and those with term delivery emerged as early as 20-24+6 weeks. The predictive value of CL for PTD increased with advancing gestational age. Optimal CL thresholds for predicting PTD ≤ 34+6 weeks were 28 mm, 15 mm, and 10 mm at ≤ 19+6, 20-24+6, and 28-33+6 weeks, respectively, while corresponding thresholds for PTD < 37 weeks were 28 mm, 26 mm, and 10 mm. Women with CL below these cut-offs had significantly lower probabilities of term delivery. The 26-mm threshold at mid-gestation (20-24+6 weeks) closely aligned with the conventional 25-mm definition of short cervix, supporting the validity of the minimum P approach. The consistent 10-mm threshold in late gestation suggests that lower diagnostic cut-offs after 28 weeks may be required to guide clinical management.
CONCLUSION: CL progressively decreases with increasing gestational age and has emerged as a more potent predictor of PTD after 20 weeks of gestation. A short cervix in late pregnancy may be more appropriately defined as < 10 mm at 28-33+6 gestational weeks.