Gestational Age at Cervical Length Measurement and Incidence of Preterm Birth

Berghella, Vincenzo MD1; Roman, Amanda MD2; Daskalakis, Constantine ScD3; Ness, Amen MD, MSCP4; Baxter, Jason K. MD, MSCP1

Obstetrics & Gynecology:
doi: 10.1097/01.AOG.0000270112.05025.1d
Original Research
Abstract

OBJECTIVE: To estimate the risk of spontaneous preterm birth based on transvaginal ultrasound cervical length and gestational age at which cervical length was measured.

METHODS: Women at high risk for spontaneous preterm birth and with transvaginal ultrasound cervical length measurements between weeks 12 and 32 were identified at one institution between July 1995 and June 2005. Inclusion criteria for women at high risk for spontaneous preterm birth were prior spontaneous preterm birth at 14 to 35 weeks, cone biopsy, müllerian anomaly, or two or more dilation and evacuations. Women with multiple gestations, cerclage, indicated preterm birth, or fetal anomalies were excluded. Logistic regression was used to estimate the spontaneous preterm birth risk before 35, 32, and 28 weeks.

RESULTS: Seven hundred five women received 2,601 transvaginal ultrasound measurements for cervical length. The incidences of spontaneous preterm birth before 35, 32, and 28 weeks were 17.7, 10.6, and 6.7%, respectively. The risk of spontaneous preterm birth before 35 weeks decreased by approximately 6% for each additional millimeter of cervical length (odds ratio 0.94, 95% confidence interval, 0.92–0.95, P=.001) and by approximately 5% for each additional week of pregnancy at which the cervical length was measured (odds ratio 0.95, 95% confidence interval 0.92–0.98, P=.004). Similar results were obtained for spontaneous preterm birth before 32 and 28 weeks.

CONCLUSION: Gestational age at which transvaginal ultrasound cervical length is measured significantly affects the calculation of risk of spontaneous preterm birth. The spontaneous preterm birth risk increases as the length of the cervix declines and as the gestational age decreases. These spontaneous preterm birth risks are important for counseling and management for women with various degrees of short cervical length at different gestational ages.

LEVEL OF EVIDENCE: II

In Brief

Transvaginal ultrasound cervical length and the gestational age at which it is measured are both important for estimation of risk of spontaneous preterm birth.

Author Information

From the 1Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College, Thomas Jefferson University, Philadelphia Pennsylvania; 2Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas; 3Division of Biostatistics, Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania; and 4Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University, San Francisco, California.

Corresponding author: Vincenzo Berghella, MD Jefferson Medical College of Thomas Jefferson University, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, 834 Chestnut Street, Suite 400, Philadelphia, PA 19107; e-mail: vincenzo.berghella@jefferson.edu.

Financial Disclosure The authors have no potential conflicts of interest to disclose.

© 2007 The American College of Obstetricians and Gynecologists