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- W2781796103 abstract "To evaluate whether transvaginal ultrasound (TVU) cervical length (CL) is predictive of asymptomatic cervical dilation in singleton pregnancies Secondary analysis of a randomized controlled trial of pessary for preterm birth prevention in singleton pregnancies with a TVU CL≤25mm between 18 0/7-23 6/7 weeks, without prior spontaneous PTB. As part of the trial, participants had a manual vaginal exam to determine Bishop score. Receiver operating characteristic curve (ROCC) was used to determine a TVU CL cut off that was predictive of manual cervical dilation ≥1cm. Primary outcome was increased risk of manual cervical dilation ≥1cm based on TVU CL measured by odds ratio (OR). Secondary outcomes were gestational age (GA) at delivery, PTB<37 and <34 weeks, survival curve for GA at delivery by TVU CL, and birth weight compared by TVU CL. Continuous variables compared with t-test and categorical variables with chi-square analysis/Fishers exact as appropriate, Kaplan Meir survival curve for preterm birth by CL. P<0.05 significant. Of 122 women randomized, 119 had both TVU CL measurement and manual cervical exam documented. By ROCC, a TVU CL ≤11mm was best predictive of cervical dilation ≥1cm in otherwise asymptomatic women with a sensitivity of 75% and specificity of 80% with an area under the curve of 0.73(0.55-0.91, p=.009) (Figure A). Demographic/obstetric characteristics between women with a TVU CL >11mm vs ≤11mm were similar (Table). A TVU CL ≤11mm was associated with an OR of 12.29 (3.05-49.37) for manual cervical dilation ≥1cm. A TVU CL ≤11mm was also associated with a lower mean GA of delivery (29.9±6.6 vs 35.6±7.2wks, p<.001), increased incidence of PTB<37 weeks (77% vs 31%, p<.001; survival curve log rank p<.001), <34 weeks (63% vs 22%, p<.001), and lower mean birthweight (1552±1047 vs 2560±1072g, p<.001) (Table, Figure). Transvaginal ultrasound cervical length ≤11mm is associated with asymptomatic manual cervical dilation ≥1cm and poor obstetric outcomes. A transvaginal ultrasound cervical length ≤11mm may warrant a physical exam to evaluate for the possibility of a physical exam-indicated cerclage.View Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
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- W2781796103 date "2018-01-01" @default.
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- W2781796103 title "697: Second trimester cervical length ≤11mm is associated with asymptomatic manual cervical dilation and poor obstetric outcomes" @default.
- W2781796103 doi "https://doi.org/10.1016/j.ajog.2017.11.227" @default.
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