Change in cervical length after arrested preterm labor and risk of preterm birth

K. N. Rennert; S. H. Breuking; E. Schuit; M. N. Bekker; M. Woiski; M. A. de Boer; M. Sueters; H. C.J. Scheepers; M. T.M. Franssen; E. Pajkrt; B. W.J. Mol; M. Kok; F. J.R. Hermans

doi:10.1002/uog.23653

Change in cervical length after arrested preterm labor and risk of preterm birth

K. N. Rennert, S. H. Breuking, E. Schuit, M. N. Bekker, M. Woiski, M. A. de Boer, M. Sueters, H. C.J. Scheepers, M. T.M. Franssen, E. Pajkrt, B. W.J. Mol, M. Kok, F. J.R. Hermans^*

^*Corresponding author for this work

Reproductive Origins of Adult Health and Disease (ROAHD)

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Objective: To assess the association between preterm birth and cervical length after arrested preterm labor in high-risk pregnant women.

Methods: In this post-hoc analysis of a randomized clinical trial, transvaginal cervical length was measured in women whose contractions had ceased 48 h after admission for threatened preterm labor. At admission, women were defined as having a high risk of preterm birth based on a cervical length of < 15 mm or a cervical length of 15–30 mm with a positive fetal fibronectin test. Logistic regression analysis was used to investigate the association of cervical length measured at least 48 h after admission and of the change in cervical length between admission and at least 48 h later, with preterm birth before 34 weeks' gestation and delivery within 7 days after admission.

Results: A total of 164 women were included in the analysis. Women whose cervical length increased between admission for threatened preterm labor and 48 h later (32%; n = 53) were found to have a lower risk of preterm birth before 34 weeks compared with women whose cervical length did not change (adjusted odds ratio (aOR), 0.24 (95% CI, 0.09–0.69)). The risk in women with a decrease in cervical length between the two timepoints was not different from that in women with no change in cervical length (aOR, 1.45 (95% CI, 0.62–3.41)). Moreover, greater absolute cervical length after 48 h was associated with a lower risk of preterm birth before 34 weeks (aOR, 0.90 (95% CI, 0.84–0.96)) and delivery within 7 days after admission (aOR, 0.91 (95% CI, 0.82–1.02)). Sensitivity analysis in women randomized to receive no intervention showed comparable results.

Conclusion: Our study suggests that the risk of preterm birth before 34 weeks is lower in women whose cervical length increases between admission for threatened preterm labor and at least 48 h later when contractions had ceased compared with women in whom cervical length does not change or decreases.

Original language	English
Pages (from-to)	750-756
Number of pages	7
Journal	Ultrasound in Obstetrics and Gynecology
Volume	58
Issue number	5
DOIs	https://doi.org/10.1002/uog.23653
Publication status	Published - Nov-2021

Keywords

arrested preterm labor
cervical length
change in cervical length
preterm birth
threatened preterm labor

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Rennert, K. N., Breuking, S. H., Schuit, E., Bekker, M. N., Woiski, M., de Boer, M. A., Sueters, M., Scheepers, H. C. J., Franssen, M. T. M., Pajkrt, E., Mol, B. W. J., Kok, M., & Hermans, F. J. R. (2021). Change in cervical length after arrested preterm labor and risk of preterm birth. Ultrasound in Obstetrics and Gynecology, 58(5), 750-756. https://doi.org/10.1002/uog.23653

@article{dff39199ad274809accc0f253e3e7037,

title = "Change in cervical length after arrested preterm labor and risk of preterm birth",

abstract = "Objective: To assess the association between preterm birth and cervical length after arrested preterm labor in high-risk pregnant women.Methods: In this post-hoc analysis of a randomized clinical trial, transvaginal cervical length was measured in women whose contractions had ceased 48 h after admission for threatened preterm labor. At admission, women were defined as having a high risk of preterm birth based on a cervical length of < 15 mm or a cervical length of 15–30 mm with a positive fetal fibronectin test. Logistic regression analysis was used to investigate the association of cervical length measured at least 48 h after admission and of the change in cervical length between admission and at least 48 h later, with preterm birth before 34 weeks' gestation and delivery within 7 days after admission.Results: A total of 164 women were included in the analysis. Women whose cervical length increased between admission for threatened preterm labor and 48 h later (32%; n = 53) were found to have a lower risk of preterm birth before 34 weeks compared with women whose cervical length did not change (adjusted odds ratio (aOR), 0.24 (95% CI, 0.09–0.69)). The risk in women with a decrease in cervical length between the two timepoints was not different from that in women with no change in cervical length (aOR, 1.45 (95% CI, 0.62–3.41)). Moreover, greater absolute cervical length after 48 h was associated with a lower risk of preterm birth before 34 weeks (aOR, 0.90 (95% CI, 0.84–0.96)) and delivery within 7 days after admission (aOR, 0.91 (95% CI, 0.82–1.02)). Sensitivity analysis in women randomized to receive no intervention showed comparable results.Conclusion: Our study suggests that the risk of preterm birth before 34 weeks is lower in women whose cervical length increases between admission for threatened preterm labor and at least 48 h later when contractions had ceased compared with women in whom cervical length does not change or decreases.",

keywords = "arrested preterm labor, cervical length, change in cervical length, preterm birth, threatened preterm labor",

author = "Rennert, {K. N.} and Breuking, {S. H.} and E. Schuit and Bekker, {M. N.} and M. Woiski and {de Boer}, {M. A.} and M. Sueters and Scheepers, {H. C.J.} and Franssen, {M. T.M.} and E. Pajkrt and Mol, {B. W.J.} and M. Kok and Hermans, {F. J.R.}",

note = "Funding Information: B.W.J.M. is supported by a NHMRC Investigator grant (GNT1176437). B.W.J.M. reports consultancy for Guerbet, has been a member of the ObsEva advisory board and holds stock options for ObsEva. B.W.J.M. has received research funding from Guerbet and Merck. Publisher Copyright: {\textcopyright} 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.",

year = "2021",

month = nov,

doi = "10.1002/uog.23653",

language = "English",

volume = "58",

pages = "750--756",

journal = "Ultrasound in Obstetrics and Gynecology",

issn = "0960-7692",

publisher = "Wiley",

number = "5",

}

TY - JOUR

T1 - Change in cervical length after arrested preterm labor and risk of preterm birth

AU - Rennert, K. N.

AU - Breuking, S. H.

AU - Schuit, E.

AU - Bekker, M. N.

AU - Woiski, M.

AU - de Boer, M. A.

AU - Sueters, M.

AU - Scheepers, H. C.J.

AU - Franssen, M. T.M.

AU - Pajkrt, E.

AU - Mol, B. W.J.

AU - Kok, M.

AU - Hermans, F. J.R.

N1 - Funding Information: B.W.J.M. is supported by a NHMRC Investigator grant (GNT1176437). B.W.J.M. reports consultancy for Guerbet, has been a member of the ObsEva advisory board and holds stock options for ObsEva. B.W.J.M. has received research funding from Guerbet and Merck. Publisher Copyright: © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

PY - 2021/11

Y1 - 2021/11

N2 - Objective: To assess the association between preterm birth and cervical length after arrested preterm labor in high-risk pregnant women.Methods: In this post-hoc analysis of a randomized clinical trial, transvaginal cervical length was measured in women whose contractions had ceased 48 h after admission for threatened preterm labor. At admission, women were defined as having a high risk of preterm birth based on a cervical length of < 15 mm or a cervical length of 15–30 mm with a positive fetal fibronectin test. Logistic regression analysis was used to investigate the association of cervical length measured at least 48 h after admission and of the change in cervical length between admission and at least 48 h later, with preterm birth before 34 weeks' gestation and delivery within 7 days after admission.Results: A total of 164 women were included in the analysis. Women whose cervical length increased between admission for threatened preterm labor and 48 h later (32%; n = 53) were found to have a lower risk of preterm birth before 34 weeks compared with women whose cervical length did not change (adjusted odds ratio (aOR), 0.24 (95% CI, 0.09–0.69)). The risk in women with a decrease in cervical length between the two timepoints was not different from that in women with no change in cervical length (aOR, 1.45 (95% CI, 0.62–3.41)). Moreover, greater absolute cervical length after 48 h was associated with a lower risk of preterm birth before 34 weeks (aOR, 0.90 (95% CI, 0.84–0.96)) and delivery within 7 days after admission (aOR, 0.91 (95% CI, 0.82–1.02)). Sensitivity analysis in women randomized to receive no intervention showed comparable results.Conclusion: Our study suggests that the risk of preterm birth before 34 weeks is lower in women whose cervical length increases between admission for threatened preterm labor and at least 48 h later when contractions had ceased compared with women in whom cervical length does not change or decreases.

AB - Objective: To assess the association between preterm birth and cervical length after arrested preterm labor in high-risk pregnant women.Methods: In this post-hoc analysis of a randomized clinical trial, transvaginal cervical length was measured in women whose contractions had ceased 48 h after admission for threatened preterm labor. At admission, women were defined as having a high risk of preterm birth based on a cervical length of < 15 mm or a cervical length of 15–30 mm with a positive fetal fibronectin test. Logistic regression analysis was used to investigate the association of cervical length measured at least 48 h after admission and of the change in cervical length between admission and at least 48 h later, with preterm birth before 34 weeks' gestation and delivery within 7 days after admission.Results: A total of 164 women were included in the analysis. Women whose cervical length increased between admission for threatened preterm labor and 48 h later (32%; n = 53) were found to have a lower risk of preterm birth before 34 weeks compared with women whose cervical length did not change (adjusted odds ratio (aOR), 0.24 (95% CI, 0.09–0.69)). The risk in women with a decrease in cervical length between the two timepoints was not different from that in women with no change in cervical length (aOR, 1.45 (95% CI, 0.62–3.41)). Moreover, greater absolute cervical length after 48 h was associated with a lower risk of preterm birth before 34 weeks (aOR, 0.90 (95% CI, 0.84–0.96)) and delivery within 7 days after admission (aOR, 0.91 (95% CI, 0.82–1.02)). Sensitivity analysis in women randomized to receive no intervention showed comparable results.Conclusion: Our study suggests that the risk of preterm birth before 34 weeks is lower in women whose cervical length increases between admission for threatened preterm labor and at least 48 h later when contractions had ceased compared with women in whom cervical length does not change or decreases.

KW - arrested preterm labor

KW - cervical length

KW - change in cervical length

KW - preterm birth

KW - threatened preterm labor

U2 - 10.1002/uog.23653

DO - 10.1002/uog.23653

M3 - Article

C2 - 33860985

AN - SCOPUS:85118295911

SN - 0960-7692

VL - 58

SP - 750

EP - 756

JO - Ultrasound in Obstetrics and Gynecology

JF - Ultrasound in Obstetrics and Gynecology

IS - 5

ER -

Change in cervical length after arrested preterm labor and risk of preterm birth

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