Prediction of preterm delivery with transvaginal ultrasonography of the cervix in patients with high-risk pregnancies: Does cerclage prevent prematurity?

Vincenzo Berghella, Sean F. Daly, Jorge Tolosa, Michelle M. DiVito, Robert Chalmers, Nidhi Garg, Aman Bhullar, Ronald J. Wapner

Research output: Contribution to journalArticle

137 Citations (Scopus)

Abstract

OBJECTIVES: We sought to determine the predictive accuracy for preterm delivery of transvaginal ultra- sonography of the cervix between 14 and 24 weeks' gestation in high-risk patients and to determine whether cerclage prevents preterm delivery in patients with ultrasonographic cervical changes. STUDY DESIGN: Patients with asymptomatic singleton pregnancies at high risk for preterm delivery were followed prospectively from 14 weeks' to 23 weeks 6 days' gestation with transvaginal ultrasonography of the cervix. The subgroup of patients with either a cervical length of 25% or both was offered McDonald salvage cerclage, which was performed at the discretion of the patient and the obstetrician. The 2 groups (with and without cerclage) were compared for the primary outcome of preterm delivery at 25% or both were 74%, 70%, 37%, and 92%, respectively. Of 63 pregnancies in which there were cervical changes, 39 underwent cerclage and 24 did not. These 2 groups were similar for demographic characteristics, risk factors, and transvaginal ultrasonographic cervical length and funneling but dissimilar for gestational age at identification of cervical changes (18.3 vs 21.2 weeks' gestation in the groups with and without cerclage, respectively; P <.001). Multivariate logistic regression analysis after adjustment for gestational age at cervical changes showed no difference in the rate of preterm delivery be- tween the groups with and without cerclage (odds ratio, 1.1; 95% confidence interval, 0.3-4.6). Stratified analysis of patients identified between 18 and 24 weeks revealed 22 pregnancies with cerclage and 22 pregnancies without cerclage, which was similar for all characteristics studied. The incidence of preterm delivery remained similar (27% vs 23%, respectively; P= .7), as did days from cervical changes to delivery (111 vs 96, respectively; P= .2). CONCLUSIONS: Transvaginal ultrasonography of the cervix between 14 and 24 weeks' gestation is a good predictor of preterm delivery in high-risk pregnancies. Cerclage may not prevent preterm delivery in patients identified to be at high risk for this outcome by transvaginal ultrasonography.

Original languageEnglish (US)
Pages (from-to)809-815
Number of pages7
JournalAmerican Journal of Obstetrics and Gynecology
Volume181
Issue number4
DOIs
StatePublished - 1999
Externally publishedYes

Fingerprint

High-Risk Pregnancy
Cervix Uteri
Ultrasonography
Pregnancy
Gestational Age
Polysorbates
Logistic Models
Odds Ratio
Regression Analysis
Demography
Confidence Intervals
Incidence

Keywords

  • Cerclage
  • Preterm delivery
  • Risk prediction
  • Transvaginal ultrasonography
  • Uterine cervix

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology

Cite this

Prediction of preterm delivery with transvaginal ultrasonography of the cervix in patients with high-risk pregnancies : Does cerclage prevent prematurity? / Berghella, Vincenzo; Daly, Sean F.; Tolosa, Jorge; DiVito, Michelle M.; Chalmers, Robert; Garg, Nidhi; Bhullar, Aman; Wapner, Ronald J.

In: American Journal of Obstetrics and Gynecology, Vol. 181, No. 4, 1999, p. 809-815.

Research output: Contribution to journalArticle

Berghella, Vincenzo ; Daly, Sean F. ; Tolosa, Jorge ; DiVito, Michelle M. ; Chalmers, Robert ; Garg, Nidhi ; Bhullar, Aman ; Wapner, Ronald J. / Prediction of preterm delivery with transvaginal ultrasonography of the cervix in patients with high-risk pregnancies : Does cerclage prevent prematurity?. In: American Journal of Obstetrics and Gynecology. 1999 ; Vol. 181, No. 4. pp. 809-815.
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abstract = "OBJECTIVES: We sought to determine the predictive accuracy for preterm delivery of transvaginal ultra- sonography of the cervix between 14 and 24 weeks' gestation in high-risk patients and to determine whether cerclage prevents preterm delivery in patients with ultrasonographic cervical changes. STUDY DESIGN: Patients with asymptomatic singleton pregnancies at high risk for preterm delivery were followed prospectively from 14 weeks' to 23 weeks 6 days' gestation with transvaginal ultrasonography of the cervix. The subgroup of patients with either a cervical length of 25{\%} or both was offered McDonald salvage cerclage, which was performed at the discretion of the patient and the obstetrician. The 2 groups (with and without cerclage) were compared for the primary outcome of preterm delivery at 25{\%} or both were 74{\%}, 70{\%}, 37{\%}, and 92{\%}, respectively. Of 63 pregnancies in which there were cervical changes, 39 underwent cerclage and 24 did not. These 2 groups were similar for demographic characteristics, risk factors, and transvaginal ultrasonographic cervical length and funneling but dissimilar for gestational age at identification of cervical changes (18.3 vs 21.2 weeks' gestation in the groups with and without cerclage, respectively; P <.001). Multivariate logistic regression analysis after adjustment for gestational age at cervical changes showed no difference in the rate of preterm delivery be- tween the groups with and without cerclage (odds ratio, 1.1; 95{\%} confidence interval, 0.3-4.6). Stratified analysis of patients identified between 18 and 24 weeks revealed 22 pregnancies with cerclage and 22 pregnancies without cerclage, which was similar for all characteristics studied. The incidence of preterm delivery remained similar (27{\%} vs 23{\%}, respectively; P= .7), as did days from cervical changes to delivery (111 vs 96, respectively; P= .2). CONCLUSIONS: Transvaginal ultrasonography of the cervix between 14 and 24 weeks' gestation is a good predictor of preterm delivery in high-risk pregnancies. Cerclage may not prevent preterm delivery in patients identified to be at high risk for this outcome by transvaginal ultrasonography.",
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T1 - Prediction of preterm delivery with transvaginal ultrasonography of the cervix in patients with high-risk pregnancies

T2 - Does cerclage prevent prematurity?

AU - Berghella, Vincenzo

AU - Daly, Sean F.

AU - Tolosa, Jorge

AU - DiVito, Michelle M.

AU - Chalmers, Robert

AU - Garg, Nidhi

AU - Bhullar, Aman

AU - Wapner, Ronald J.

PY - 1999

Y1 - 1999

N2 - OBJECTIVES: We sought to determine the predictive accuracy for preterm delivery of transvaginal ultra- sonography of the cervix between 14 and 24 weeks' gestation in high-risk patients and to determine whether cerclage prevents preterm delivery in patients with ultrasonographic cervical changes. STUDY DESIGN: Patients with asymptomatic singleton pregnancies at high risk for preterm delivery were followed prospectively from 14 weeks' to 23 weeks 6 days' gestation with transvaginal ultrasonography of the cervix. The subgroup of patients with either a cervical length of 25% or both was offered McDonald salvage cerclage, which was performed at the discretion of the patient and the obstetrician. The 2 groups (with and without cerclage) were compared for the primary outcome of preterm delivery at 25% or both were 74%, 70%, 37%, and 92%, respectively. Of 63 pregnancies in which there were cervical changes, 39 underwent cerclage and 24 did not. These 2 groups were similar for demographic characteristics, risk factors, and transvaginal ultrasonographic cervical length and funneling but dissimilar for gestational age at identification of cervical changes (18.3 vs 21.2 weeks' gestation in the groups with and without cerclage, respectively; P <.001). Multivariate logistic regression analysis after adjustment for gestational age at cervical changes showed no difference in the rate of preterm delivery be- tween the groups with and without cerclage (odds ratio, 1.1; 95% confidence interval, 0.3-4.6). Stratified analysis of patients identified between 18 and 24 weeks revealed 22 pregnancies with cerclage and 22 pregnancies without cerclage, which was similar for all characteristics studied. The incidence of preterm delivery remained similar (27% vs 23%, respectively; P= .7), as did days from cervical changes to delivery (111 vs 96, respectively; P= .2). CONCLUSIONS: Transvaginal ultrasonography of the cervix between 14 and 24 weeks' gestation is a good predictor of preterm delivery in high-risk pregnancies. Cerclage may not prevent preterm delivery in patients identified to be at high risk for this outcome by transvaginal ultrasonography.

AB - OBJECTIVES: We sought to determine the predictive accuracy for preterm delivery of transvaginal ultra- sonography of the cervix between 14 and 24 weeks' gestation in high-risk patients and to determine whether cerclage prevents preterm delivery in patients with ultrasonographic cervical changes. STUDY DESIGN: Patients with asymptomatic singleton pregnancies at high risk for preterm delivery were followed prospectively from 14 weeks' to 23 weeks 6 days' gestation with transvaginal ultrasonography of the cervix. The subgroup of patients with either a cervical length of 25% or both was offered McDonald salvage cerclage, which was performed at the discretion of the patient and the obstetrician. The 2 groups (with and without cerclage) were compared for the primary outcome of preterm delivery at 25% or both were 74%, 70%, 37%, and 92%, respectively. Of 63 pregnancies in which there were cervical changes, 39 underwent cerclage and 24 did not. These 2 groups were similar for demographic characteristics, risk factors, and transvaginal ultrasonographic cervical length and funneling but dissimilar for gestational age at identification of cervical changes (18.3 vs 21.2 weeks' gestation in the groups with and without cerclage, respectively; P <.001). Multivariate logistic regression analysis after adjustment for gestational age at cervical changes showed no difference in the rate of preterm delivery be- tween the groups with and without cerclage (odds ratio, 1.1; 95% confidence interval, 0.3-4.6). Stratified analysis of patients identified between 18 and 24 weeks revealed 22 pregnancies with cerclage and 22 pregnancies without cerclage, which was similar for all characteristics studied. The incidence of preterm delivery remained similar (27% vs 23%, respectively; P= .7), as did days from cervical changes to delivery (111 vs 96, respectively; P= .2). CONCLUSIONS: Transvaginal ultrasonography of the cervix between 14 and 24 weeks' gestation is a good predictor of preterm delivery in high-risk pregnancies. Cerclage may not prevent preterm delivery in patients identified to be at high risk for this outcome by transvaginal ultrasonography.

KW - Cerclage

KW - Preterm delivery

KW - Risk prediction

KW - Transvaginal ultrasonography

KW - Uterine cervix

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