loading page

Reviewing short cervix in singleton pregnancies: a multicentric prospective cohort study in the Brazilian population
  • +7
  • Thaís Silva,
  • Anderson Pinheiro,
  • Jose Cecatti,
  • Ben Mol,
  • Fabrício Da Silva Costa,
  • Marcelo Franca,
  • Renato Souza,
  • Roland Devlieger,
  • Renato Passini Jr,
  • Rodolfo Pacagnella
Thaís Silva
University of Pernambuco

Corresponding Author:[email protected]

Author Profile
Anderson Pinheiro
Universidade Estadual de Campinas
Author Profile
Jose Cecatti
Univesity of Campinas
Author Profile
Ben Mol
Monash University Medical Centre
Author Profile
Fabrício Da Silva Costa
Monash University Faculty of Medicine Nursing and Health Sciences
Author Profile
Marcelo Franca
Federal University of Sao Paulo
Author Profile
Renato Souza
State University of Campinas
Author Profile
Roland Devlieger
University Hospital Gasthuisberg, Katholieke Universiteit Leuven
Author Profile
Renato Passini Jr
Universidade Estadual de Campinas
Author Profile
Rodolfo Pacagnella
University of Campinas, School of Medicine
Author Profile

Abstract

Objective: To identify the association between cervical length (CL) and gestational age at birth. Design: Prospective cohort study. Setting: Seventeen Brazilian reference hospitals. Population: A cohort of 3139 asymptomatic singleton pregnant women who participated in the screening phase of a Brazilian multicenter randomized controlled trial (P5 trial). Methods: Transvaginal ultrasound (TVU) to measure CL was performed from 18 to 22+6 weeks. Women with CL ≤ 30 mm received vaginal progesterone (200 mg/day) until 36 weeks’ gestation. Main Outcome Measures: Area under receive operating characteristic curve (AUC), sensitivity, specificity, Kaplan-Meier curves for preterm birth (PTB), number needed to screen (NNS). Results: CL ≤25mm was associated with extremely severe, severe, moderate and late PTB, whereas a CL 25–30mm was directly associated with late sPTB. The AUC to predict sPTB<28 weeks was 0.82 and for sPTB<34 weeks was 0.67. Almost half of the sPTB occurred in nulliparous women and CL ≤30mm was associated with sPTB <37 weeks (OR = 7.84; 95%CI = 5.5–11.1). The NNS to detect one sPTB <34 weeks in women with CL ≤25mm is 121 and 248 screening tests are necessary to prevent one sPTB <34 weeks using vaginal progesterone prophylaxis. Conclusions: CL measured by TVU is associated with sPTB <34 weeks. Women with CL ≤30mm are at increased risk for late sPTB. Funding: Bill & Melinda Gates Foundation [OPP1107597], the Brazilian Ministry of Health, and the Brazilian National Council for Scientific and Technological Development (CNPq) [401615/20138]. Keywords: cervical length; number needed to screen; preterm birth; short cervix.