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Timing of mid-trimester cervical length shortening in high-risk women.
Szychowski, J M; Owen, J; Hankins, G; Iams, J; Sheffield, J; Perez-Delboy, A; Berghella, V; Wing, D A; Guzman, E R.
Afiliação
  • Szychowski JM; University of Alabama at Birmingham, Department of Biostatistics, Birmingham, Alabama 35249-7333, USA.
Ultrasound Obstet Gynecol ; 33(1): 70-5, 2009 Jan.
Article em En | MEDLINE | ID: mdl-19072745
OBJECTIVE: To examine the natural history of cervical length shortening in women who had experienced at least one prior spontaneous preterm birth at between 17+0 and 33+6 weeks' gestation. METHODS: This was an analysis of prerandomization data from the multicenter Vaginal Ultrasound Cerclage Trial. Serial cervical length was measured by transvaginal sonography in 1014 high-risk women at 16+0 to 22+6 weeks. We performed survival analyses in which the outcome was cervical length shortening<25 mm and data were censored if this did not occur before 22+6 weeks' gestation. The incidence of cervical length shortening and the time to shortening were compared for women whose earliest prior preterm birth was in the mid-trimester, defined as <24 weeks, vs. those at weeks 24-33. Similar comparisons were performed based on each patient's most recent birth history. RESULTS: Time to cervical length shortening by survival analysis was significantly shorter (hazard ratio (HR)=2.2, P<0.0001) and the relative risk (RR) of shortening significantly higher (RR=1.8, P<0.0001) for women whose earliest prior spontaneous preterm birth was at <24 weeks. A larger effect was observed for women whose most recent birth was at <24 weeks (HR=2.8, P<0.0001; RR=2.1, P<0.0001). The observed hazard ratios remained significant after adjusting for confounders in a multivariable Cox proportional hazards model. CONCLUSION: Women with a prior spontaneous preterm birth at <24 weeks are at a higher risk of cervical shortening, and do so at a higher rate and at an earlier gestational age, than do women with a later preterm birth history.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Incompetência do Colo do Útero / Colo do Útero / Ultrassonografia Pré-Natal / Trabalho de Parto Prematuro Tipo de estudo: Clinical_trials / Diagnostic_studies / Etiology_studies / Prognostic_studies / Risk_factors_studies Limite: Female / Humans / Newborn / Pregnancy Idioma: En Ano de publicação: 2009 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Incompetência do Colo do Útero / Colo do Útero / Ultrassonografia Pré-Natal / Trabalho de Parto Prematuro Tipo de estudo: Clinical_trials / Diagnostic_studies / Etiology_studies / Prognostic_studies / Risk_factors_studies Limite: Female / Humans / Newborn / Pregnancy Idioma: En Ano de publicação: 2009 Tipo de documento: Article