J Korean Med Sci.  2017 Mar;32(3):488-494. 10.3346/jkms.2017.32.3.488.

Maternal Characteristics, Short Mid-Trimester Cervical Length, and Preterm Delivery

• Cho SH
• Park KH
• Jung EY
• Joo JK
• Jang JA
• Yoo HN

• KMID: 2366646
• DOI: http://doi.org/10.3346/jkms.2017.32.3.488

Abstract

We aimed to determine the maternal characteristics (demographics, an obstetric history, and prior cervical excisional procedure) associated with a short mid-trimester cervical length (CL, defined as a CL of ≤ 25 mm) and whether having a short cervix explains the association between these maternal characteristics and spontaneous preterm delivery (SPTD, defined as a delivery before 34 weeks). This is a single-center retrospective cohort study of 3,296 consecutive women with a singleton pregnancy who underwent routine CL measurement between 20 and 24 weeks. Data were collected on maternal age, weight, height, parity, obstetric history (nulliparity; a history of at least 1 SPTD; and at least 1 term birth and no preterm birth [low-risk history group]), and prior cervical excisional procedure. In the multivariate regression analysis, an obstetric history, prior cervical excisional procedure, and gestational age at measurement were the variables significantly associated with short CL. In contrast, maternal weight, height, age, and parity were not significantly associated with short CL. By using the likelihood of SPTD as an outcome variable, logistic regression indicated that short CL and obstetric history, but not prior cervical excisional procedure, were significantly associated with SPTD after adjustment for potential confounders. A history of SPTD and prior cervical excisional procedure were associated with an increased risk of a short mid-trimester CL. A history of SPTD, but not prior cervical excisional procedure, is associated with an increased risk of SPTD, independent of a short CL.

Keyword

Mid-Trimester; Preterm Birth; Obstetric History; Prior Cervical Excisional Procedure; Short Cervical Length; Sonographic Cervical Length

MeSH Terms

Cervix Uteri
Cohort Studies
Female
Gestational Age
Humans
Logistic Models
Maternal Age
Parity
Pregnancy
Premature Birth
Retrospective Studies
Term Birth

Figure

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  Fig. 1 Distribution of CL at 20–24 weeks of gestation in 3,296 asymptomatic singleton pregnancies. A normal distribution is displayed as a solid line. CL = cervical length.

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  Fig. 2 Box plots for CLs at 20–24 weeks of gestation. (A) For 3,296 asymptomatic singleton women with nulliparous status, a previous spontaneous preterm delivery (SPTD), and prior term births only. The women with a previous SPTD have significantly lower mid-trimester CLs than the women with nulliparous status or prior term births only (P = 0.001 and P < 0.001, respectively, by analysis of variance with Bonferroni correction). (B) In women with or without a history of cervical surgery. The mean CL is significantly shorter in the women who had undergone a prior cervical excisional procedure than in those who had not undergone a prior cervical surgery (P < 0.001). CL = cervical length.

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