TY - JOUR
T1 - Cervical funneling or intra-amniotic debris and preterm birth in nulliparous women with midtrimester cervical length less than 30 mm
AU - the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units (MFMU) Network
AU - Saade, G. R.
AU - Thom, E. A.
AU - Grobman, W. A.
AU - Iams, J. D.
AU - Mercer, B. M.
AU - Reddy, U. M.
AU - Tita, A. T.N.
AU - Rouse, D. J.
AU - Sorokin, Y.
AU - Wapner, R. J.
AU - Leveno, K. J.
AU - Blackwell, S. C.
AU - Esplin, M. S.
AU - Tolosa, J. E.
AU - Thorp, J. M.
AU - Caritis, S. N.
AU - Vandorsten, J. P.
AU - Moss, J.
AU - Salazar, A.
AU - Hankins, G.
AU - Olson, G.
AU - Jackson, A.
AU - Sutherland, C.
AU - Peaceman, A.
AU - Dinsmoor, M.
AU - Mallett, G.
AU - Senka, J.
AU - Johnson, F.
AU - Cline, D.
AU - Latimer, C.
AU - Frantz, S.
AU - Fyffe, S.
AU - Shubert, P.
AU - Gerwig, L.
AU - Milluzzi, C.
AU - Dalton, W.
AU - Russo, J.
AU - Myers, S.
AU - Waters, T.
AU - Dotson, T.
AU - Andrews, W.
AU - Northen, A.
AU - Sheppard, J.
AU - Grant, J.
AU - Allard, D.
AU - Hunt, J.
AU - Tillinghast, J.
AU - Bethelemy, M.
AU - Gardner, D.
AU - Plante, L.
N1 - Publisher Copyright:
Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
PY - 2018/12
Y1 - 2018/12
N2 - Objective: To evaluate whether the presence of cervical funneling or intra-amniotic debris identified in the second trimester is associated with a higher rate of preterm birth (PTB) in asymptomatic nulliparous pregnant women with a midtrimester cervical length (CL) less than 30 mm (i.e. below the 10th percentile). Methods: This was a secondary cohort analysis of data from a multicenter trial in nulliparous women between 16 and 22 weeks' gestation with a singleton gestation and CL less than 30 mm on transvaginal ultrasound, randomized to treatment with either 17-alpha-hydroxyprogesterone caproate or placebo. Sonographers were centrally certified in CL measurement, as well as in identification of intra-amniotic debris and cervical funneling. Univariable and multivariable analysis was performed to assess the associations of cervical funneling and intra-amniotic debris with PTB. Results: Of the 657 women randomized, 112 (17%) had cervical funneling only, 33 (5%) had intra-amniotic debris only and 45 (7%) had both on second-trimester ultrasound. Women with either of these findings had a shorter median CL than those without (21.0 mm vs 26.4 mm; P < 0.001). PTB prior to 37 weeks was more likely in women with cervical funneling (37% vs 21%; odds ratio (OR), 2.2 (95% CI, 1.5–3.3)) or intra-amniotic debris (35% vs 23%; OR, 1.7 (95% CI, 1.1–2.9)). Results were similar for PTB before 34 and before 32 weeks' gestation. After multivariable adjustment that included CL, PTB < 34 and < 32 weeks continued to be associated with the presence of intra-amniotic debris (adjusted OR (aOR), 1.85 (95% CI, 1.00–3.44) and aOR, 2.78 (95% CI, 1.42–5.45), respectively), but not cervical funneling (aOR, 1.17 (95% CI, 0.63–2.17) and aOR, 1.45 (95% CI, 0.71–2.96), respectively). Conclusions: Among asymptomatic nulliparous women with midtrimester CL less than 30 mm, the presence of intra-amniotic debris, but not cervical funneling, is associated with an increased risk for PTB before 34 and 32 weeks' gestation, independently of CL.
AB - Objective: To evaluate whether the presence of cervical funneling or intra-amniotic debris identified in the second trimester is associated with a higher rate of preterm birth (PTB) in asymptomatic nulliparous pregnant women with a midtrimester cervical length (CL) less than 30 mm (i.e. below the 10th percentile). Methods: This was a secondary cohort analysis of data from a multicenter trial in nulliparous women between 16 and 22 weeks' gestation with a singleton gestation and CL less than 30 mm on transvaginal ultrasound, randomized to treatment with either 17-alpha-hydroxyprogesterone caproate or placebo. Sonographers were centrally certified in CL measurement, as well as in identification of intra-amniotic debris and cervical funneling. Univariable and multivariable analysis was performed to assess the associations of cervical funneling and intra-amniotic debris with PTB. Results: Of the 657 women randomized, 112 (17%) had cervical funneling only, 33 (5%) had intra-amniotic debris only and 45 (7%) had both on second-trimester ultrasound. Women with either of these findings had a shorter median CL than those without (21.0 mm vs 26.4 mm; P < 0.001). PTB prior to 37 weeks was more likely in women with cervical funneling (37% vs 21%; odds ratio (OR), 2.2 (95% CI, 1.5–3.3)) or intra-amniotic debris (35% vs 23%; OR, 1.7 (95% CI, 1.1–2.9)). Results were similar for PTB before 34 and before 32 weeks' gestation. After multivariable adjustment that included CL, PTB < 34 and < 32 weeks continued to be associated with the presence of intra-amniotic debris (adjusted OR (aOR), 1.85 (95% CI, 1.00–3.44) and aOR, 2.78 (95% CI, 1.42–5.45), respectively), but not cervical funneling (aOR, 1.17 (95% CI, 0.63–2.17) and aOR, 1.45 (95% CI, 0.71–2.96), respectively). Conclusions: Among asymptomatic nulliparous women with midtrimester CL less than 30 mm, the presence of intra-amniotic debris, but not cervical funneling, is associated with an increased risk for PTB before 34 and 32 weeks' gestation, independently of CL.
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U2 - 10.1002/uog.18960
DO - 10.1002/uog.18960
M3 - Article
C2 - 29155504
AN - SCOPUS:85055700851
SN - 0960-7692
VL - 52
SP - 757
EP - 762
JO - Ultrasound in Obstetrics and Gynecology
JF - Ultrasound in Obstetrics and Gynecology
IS - 6
ER -