Journal
ULTRASOUND IN OBSTETRICS & GYNECOLOGY
Volume 36, Issue 4, Pages 471-481Publisher
WILEY
DOI: 10.1002/uog.7673
Keywords
amniotic fluid sludge; cervical length; pregnancy; preterm delivery; preterm labor; transvaginal; ultrasound
Funding
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, DHHS
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Objective The aim of this study was to determine whether the risk of early spontaneous preterm delivery (PTD) in asymptomatic women with a sonographic cervical length of <= 15 mm in the mid-trimester changes as a function of gestational age at diagnosis. Methods This cohort study included 109 asymptomatic patients with a sonographic cervical length of <= 15 mm diagnosed at 14-24 weeks of gestation. Women with a multifetal gestation, cerclage and a cervical dilatation of > 2 cm were excluded. The study population was stratified by gestational age at diagnosis (< 20 weeks vs. 20-24 weeks) and by cervical length (<= 10 mm vs. 11-15 mm). The primary outcome variables were PTD at < 28 and < 32 weeks of gestation and the diagnosis-to-delivery interval. Results The median gestational age at diagnosis of a short cervix before 20 weeks and at 20-24 weeks was 18.9 and 22.7 weeks, respectively. Women diagnosed before 20 weeks had a higher rate of PTD at < 28 weeks (76.9% vs. 30.9%; P < 0.001) and at < 32 weeks (80.8% vs. 48.1%; P = 0.004), and a shorter median diagnosis-to-delivery interval (21 vs. 61.5 days, P 0.003) than those diagnosed at 20-24 weeks. The rate of amniotic fluid sludge was higher among patients diagnosed with a short cervix at < 20 weeks of gestation than in those in whom it was diagnosed between 20 and 24 weeks (92.3% vs. 48.2%; P < 0.001). Conclusions Asymptomatic women with a sonographic cervical length of < 15 mm diagnosed before 20 weeks of gestation have a dramatic and significantly higher risk of early preterm delivery than women diagnosed at 20-24 weeks. These findings can be helpful to physicians in counseling these patients, and may suggest different mechanisms of disease leading to a sonographic short cervix before or after 20 weeks of gestation. Copyright (C) 2010 ISUOG. Published by John Wiley & Sons, Ltd.
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