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Prediction of Spontaneous Preterm Birth Among Nulliparous Women With a Short Cervix
Author(s) -
Grobman William A.,
Lai Yinglei,
Iams Jay D.,
Reddy Uma M.,
Mercer Brian M.,
Saade George,
Tita Alan T.,
Rouse Dwight J.,
Sorokin Yoram,
Wapner Ronald J.,
Leveno Kenneth J.,
Blackwell Sean C.,
Esplin M. Sean,
Tolosa Jorge E.,
Thorp John M.,
Caritis Steve N.
Publication year - 2016
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.7863/ultra.15.08035
Subject(s) - medicine , obstetrics , confidence interval , odds ratio , logistic regression , cervix , gestation , spontaneous conception , premature birth , gynecology , randomized controlled trial , gestational age , pregnancy , fertility , population , surgery , cancer , environmental health , biology , genetics
Objectives The purpose of this study was to evaluate whether demographic and sonographic factors associated with spontaneous preterm birth among nulliparous women with a cervical length of less than 30 mm could be combined into an accurate prediction model for spontaneous preterm birth. Methods We conducted a secondary analysis of a trial of nulliparous women with a singleton gestation and a cervical length of less than 30 mm on transvaginal sonography between 16 and 22 weeks who lacked other risk factors for spontaneous (eg, prior cervical excisional procedure) or medically indicated (eg, chronic hypertension) preterm birth, who were randomized to either 17α‐hydroxyprogesterone caproate treatment or a placebo. Risk factors associated with spontaneous preterm birth within the entire cohort were identified by univariable analysis. Factors significantly associated ( P < .05) with spontaneous preterm birth were included in a multivariable logistic regression analysis to determine whether an accurate prediction model could be developed. Results Of the 657 randomized patients, 109 (16.6%) had spontaneous preterm birth before 37 weeks' gestation. Logistic regression analysis revealed only cervical length (odds ratio, 1.06 per 1‐mm decrease; 95% confidence interval, 1.02–1.10) to be associated with spontaneous preterm birth. The area under the receiver operating characteristic curve based on this regression was low (0.63; 95% confidence interval, 0.58–0.69). Results were similar for the outcome of spontaneous preterm birth before 34 weeks. Conclusions An accurate prediction model for spontaneous preterm birth among nulliparous women with a short cervix could not be developed.