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Dynamic cervical change: is real‐time sonographic cervical shortening predictive of preterm delivery in patients with symptoms of preterm labor?
Author(s) -
Jenkins S. M.,
Kurtzman J. T.,
Osann K.
Publication year - 2006
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.2741
Subject(s) - medicine , gestation , gestational age , prospective cohort study , odds ratio , preterm delivery , predictive value of tests , cervical insufficiency , obstetrics , pregnancy , cervix , surgery , genetics , biology , cancer
Abstract Objectives To determine prospectively if dynamic cervical change (spontaneous real‐time cervical shortening) is predictive of preterm delivery at < 37 weeks' gestation in patients with symptoms of preterm labor. Methods This was a prospective study of patients at 23–34 weeks' gestation who were symptomatic for preterm labor. Patients underwent a 10‐min real‐time sonographic cervical length assessment with measurements taken at 1‐min intervals. The presence or absence of dynamic cervical change, defined as real‐time changes in cervical length observable to the naked eye of the sonologist during the examination, was recorded. Gestational age at delivery was obtained from medical records. Preterm delivery was defined as delivery at < 37 weeks' gestation. Dynamic cervical change and initial and minimum cervical lengths were assessed for prediction of preterm delivery. Results Seventy‐six patients were enrolled, and 66 were available for outcome analysis. Thirty‐one patients (47%) exhibited dynamic cervical change. Patients with dynamic change had shorter initial cervical lengths (27 mm vs. 36 mm, P = 0.001), shorter minimum cervical lengths (20 vs. 33 mm, P < 0.001) and larger changes in cervical length during the examination period (10 vs. 4 mm, P < 0.001). In the subgroup of patients with an initial cervical length > 30 mm, those with dynamic change delivered earlier than did those without dynamic change (36.8 vs. 38.6 weeks, P = 0.02), and a higher percentage delivered preterm (27% vs. 11%, odds ratio (OR), 3.0 (0.5–17.0)). Multivariate analysis showed that minimum cervical length was a better predictor of preterm delivery than was initial cervical length. Conclusions Dynamic cervical change occurs frequently in association with shortened cervical length. In patients with longer initial cervical lengths, dynamic change may increase the risk for preterm delivery. When dynamic change is noted in a patient with preterm labor symptoms, use of the minimum cervical length observed may be better compared with initial cervical length for determining preterm delivery risk. Copyright © 2006 ISUOG. Published by John Wiley & Sons, Ltd.