OBJECTIVE: To understand the relationship between cervical length and the risk of prematurity in parous women without a history of preterm delivery.
METHODS: Data from 2,998 singleton pregnancies enrolled in a multicenter, observational cohort study were analyzed. We subgrouped the population into the following categories: those with history of at least one spontaneous preterm birth (n=467); nulliparous (n=1,237); and parous with a history of at least one term birth and no previous preterm birth (low-risk history group, n=1,284). The relationship between cervical length (measured between 22 and 22 6/7 weeks of gestation) and preterm birth was examined using logistic regression. Assuming a 40% risk reduction with the use of vaginal progesterone, we calculated the number needed to screen to prevent one preterm birth.
RESULTS: An inverse relationship between cervical length and risk of preterm birth was demonstrated for each subgroup. A short cervix (15 mm or less) was identified in only 0.93% of the low-risk group participants compared with 3.4% of the previous preterm birth group participants and 2.1% of nulliparous women. The overall rate of preterm birth was lowest (10.5%) in the low-risk history group; however, the rate of preterm birth for these women with a short cervix was 25%. For a cervical length cutoff of 15 mm or less, preventing one spontaneous delivery before 34 weeks of gestation would require screening 167 (95% confidence interval [CI] 112–317) women with a previous preterm birth, 344 (95% CI 249–555) nulliparous women, and 1,075 (95% CI 667–2,500) women at low risk.
CONCLUSIONS: Although ultrasonographic short cervix is a risk factor for preterm birth among parous women with exclusively term births, the incidence of a short cervix is very low. The number needed to screen to prevent one preterm birth is considerably greater for women who have a low-risk obstetric history.
LEVEL OF EVIDENCE: II
Although ultrasonographic short cervix is a risk factor for preterm birth among parous women with exclusively term births, the incidence of short cervix is very low.
Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Corresponding author: Francesca Facco, MD, Magee-Womens Hospital, Department of Obstetrics and Gynecology, 300 Halket Street, Room 2233, Pittsburgh, PA 15213; e-mail: firstname.lastname@example.org.
Financial Disclosure The authors did not report any potential conflicts of interest.