J Korean Med Sci.  2007 Feb;22(1):89-93. 10.3346/jkms.2007.22.1.89.

Prediction of Prolonged Pregnancy in Nulliparous Women by Transvaginal Ultrasonographic Measurement of Cervical Length at 20-24 Weeks and 37 Weeks

Affiliations
  • 1Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea. pkh0419@snubh.org

Abstract

This study was done to evaluate transvaginal ultrasonographic measurement of cervical length at 20 to 24 weeks and 37 weeks as a predictor of prolonged pregnancy (defined as a pregnancy that extended beyond 41+2 weeks of gestation [289 days]) in nulliparous women. This prospective observational study enrolled 149 consecutive nulliparous women with singleton gestation at 37 weeks. Cervical length was measured by transvaginal ultrasonography at 20 to 24 weeks and 37 weeks. Cervical length at 37 weeks, but not at 20 to 24 weeks, was significantly longer in women delivered at >41+2 weeks than in those delivered at < or =41+2 weeks (p<0.005). There was a significant correlation between cervical length at 37 weeks and gestational age at delivery (Pearson correlation coefficient, r=0.387, p<0.0001). In the receiver operating curve, the best cut-off value of cervical length at 37 weeks for the prediction of prolonged pregnancy was 30 mm, with a sensitivity of 78% and a specificity of 62%. Cervical length assessed by transvaginal ultrasonography at 37 weeks can predict the likelihood of prolonged pregnancy in nulliparous women. However, there is no association between cervical length at 20 to 24 weeks and the occurrence of prolonged pregnancy.

Keyword

Pregnancy, Prolonged; 37-week Scan; Cervix Uteri; Cervical Length; Primiparity; Parity

MeSH Terms

Vagina
ROC Curve
Prospective Studies
Pregnancy, Prolonged/*diagnosis
Pregnancy
Humans
Gestational Age
Female
Cervix Uteri/*anatomy & histology/*ultrasonography
Adult

Figure

  • Fig. 1 Receiver operating characteristic curve analysis for sonographically measured cervical length at 37 weeks in predicting prolonged pregnancy. Number next to solid dot represents cervical length (mm) at 37 weeks (area under the curve 0.702, SE 0.060, p<0.005).

  • Fig. 2 Sonographically measured cervical length at 37 weeks and gestational age at delivery. There was a significant positive correlation between sonographically measured cervical length at 37 weeks and gestational age at delivery (r=0.387, p<0.0001).


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Reference

1. Rand L, Robinson JN, Economy KE, Norwitz ER. Post-term induction of labor revisited. Obstet Gynecol. 2000. 96:779–783.
Article
2. Sanchez-Ramos L, Olivier F, Delke I, Kaunitz AM. Labor induction versus expectant management for postterm pregnancies: a systematic review with meta-analysis. Obstet Gynecol. 2003. 101:1312–1318.
Article
3. ACOG Practice Bulletin. Clinical management guidelines for obstetricians-gynecologists. Number 55, September 2004 (replaces practice pattern number 6, October 1997). Management of Postterm Pregnancy. Obstet Gynecol. 2004. 104:639–646.
4. Magann EF, McNamara MF, Whitworth NS, Chauhan SP, Thorpe RA, Morrison JC. Can we decrease postdatism in women with an unfavorable cervix and a negative fetal fibronectin test result at term by serial membrane sweeping? Am J Obstet Gynecol. 1998. 179:890–894.
Article
5. McKenna DS, Costa SW, Samuels P. Prostaglandin E2 cervical ripening without subsequent induction of labor. Obstet Gynecol. 1999. 94:11–14.
Article
6. Imai M, Tani A, Saito M, Saito K, Amano K, Nisijima M. Significance of fetal fibronectin and cytokine measurement in the cervicovaginal secretions of women at term in predicting term labor and postterm pregnancy. Eur J Obstet Gynecol Reprod Biol. 2001. 97:53–58.
Article
7. Lockwood CJ, Moscarelli RD, Wein R, Lynch L, Lapinski RH, Ghidini A. Low concentrations of vaginal fetal fibronectin as a predictor of deliveries occurring after 41 weeks. Am J Obstet Gynecol. 1994. 171:1–4.
Article
8. Vaisanen-Tommiska M, Nuutila M, Ylikorkala O. Cervical nitric oxide release in women postterm. Obstet Gynecol. 2004. 103:657–662.
9. Ramanathan G, Yu C, Osei E, Nicolaides KH. Ultrasound examination at 37 weeks' gestation in the prediction of pregnancy outcome: the value of cervical assessment. Ultrasound Obstet Gynecol. 2003. 22:598–603.
Article
10. Vimercati A, Greco P, Lopalco P, Loizzi V, Scioscia M, Mei L, Rossi AC, Selvaggi L. The value of ultrasonographic examination of the uterine cervix in predicting post-term pregnancy. J Perinat Med. 2001. 29:317–321.
Article
11. Iams JD, Goldenberg RL, Meis PJ, Mercer BM, Moawad A, Das A, Thom E, McNellis D, Copper RL, Johnson F, Roberts JM. The length of the cervix and the risk of spontaneous premature delivery. National Institute of Child Health and Human Development Maternal Fetal Medicine Unit Network. N Engl J Med. 1996. 334:567–572.
12. Carvalho MH, Bittar RE, Brizot ML, Maganha PP, Borges da Fonseca ES, Zugaib M. Cervical length at 11-14 weeks' and 22-24 weeks' gestation evaluated by transvaginal sonography, and gestational age at delivery. Ultrasound Obstet Gynecol. 2003. 21:135–139.
Article
13. Hassan SS, Romero R, Berry SM, Dang K, Blackwell SC, Treadwell MC, Wolfe HM. Patients with an ultrasonographic cervical length < or =15 mm have nearly a 50% risk of early spontaneous preterm delivery. Am J Obstet Gynecol. 2000. 182:1458–1467.
14. Murakawa H, Utumi T, Hasegawa I, Tanaka K, Fuzimori R. Evaluation of threatened preterm delivery by transvaginal ultrasonographic measurement of cervical length. Obstet Gynecol. 1993. 82:829–832.
15. Heath VC, Southall TR, Souka AP, Elisseou A, Nicolaides KH. Cervical length at 23 weeks of gestation: prediction of spontaneous preterm delivery. Ultrasound Obstet Gynecol. 1998. 12:312–317.
Article
16. To MS, Skentou C, Liao AW, Cacho A, Nicolaides KH. Cervical length and funneling at 23 weeks of gestation in the prediction of spontaneous early preterm delivery. Ultrasound Obstet Gynecol. 2001. 18:200–203.
Article
17. Ware V, Raynor BD. Transvaginal ultrasonographic cervical measurement as a predictor of successful labor induction. Am J Obstet Gynecol. 2000. 182:1030–1032.
Article
18. Gabriel R, Darnaud T, Chalot F, Gonzalez N, Leymarie F, Quereux C. Transvaginal sonography of the uterine cervix prior to labor induction. Ultrasound Obstet Gynecol. 2002. 19:254–257.
Article
19. Pandis GK, Papageorghiou AT, Ramanathan VG, Thompson MO, Nicolaides KH. Preinduction sonographic measurement of cervical length in the prediction of successful induction of labor. Ultrasound Obstet Gynecol. 2001. 18:623–628.
Article
20. Rane SM, Pandis GK, Guirgis RR, Higgins B, Nicolaides KH. Preinduction sonographic measurement of cervical length in prolonged pregnancy: the effect of parity in the prediction of induction-to-delivery interval. Ultrasound Obstet Gynecol. 2003. 22:40–44.
Article
21. Rozenberg P, Goffinet F, Hessabi M. Comparison of the Bishop score, ultrasonographically measured cervical length, and fetal fibronectin assay in predicting time until delivery and type of delivery at term. Am J Obstet Gynecol. 2000. 182:108–113.
Article
22. Romero R, Gomez R, Mazor M, Ghezzi F, Yoon BH. Elder MG, Lamont RF, Romero R, editors. The preterm labor syndrome. Preterm labor. 1997. New York: Churchill Livingstone;xii. 553.
23. Alfirevic Z, Walkinshaw SA. Management of post-term pregnancy: to induce or not? Br J Hosp Med. 1994. 52:218–221.
24. Mogren I, Stenlund H, Hogberg U. Recurrence of prolonged pregnancy. Int J Epidemiol. 1999. 28:253–257.
Article
25. Brieger GM, Ning XH, Dawkins RR, Ying KQ, Weng C, Chang AM, Haines CJ. Transvaginal sonographic assessment of cervical dynamics during the third trimester of normal pregnancy. Acta Obstet Gynecol Scand. 1997. 76:118–122.
Article
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