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- Title
The predictive value of sequential cervical length screening in singleton pregnancies after cerclage: a retrospective cohort study.
- Authors
Pils, Sophie; Eppel, Wolfgang; Promberger, Regina; Winter, Max-Paul; Seemann, Rudolf; Ott, Johannes
- Abstract
<bold>Background: </bold>There are few valid predictors for preterm delivery after cerclage. Experience with a screening program that included four sequential cervical length measurements in singleton pregnancies after cerclage is reviewed.<bold>Methods: </bold>In this retrospective cohort study, 88 singleton pregnancies after cerclage were included. Cervical length (CL) measurements were performed perioperatively and at weeks 16 + 0, 18 + 0, 20 + 0, and 22 + 0 by transvaginal ultrasound. Predictive factors for early preterm delivery included patient characteristics, obstetric history and CL measurements and were analyzed separately for women with ultrasound-indicated cerclage and those with history-indicated cerclage. Women with emergency cerclage were excluded.<bold>Results: </bold>In women with delivery <35 weeks, CL declined from the 16 + 0 to the 22 + 0 weeks of gestation (p = 0.009). In univariate analysis, all CL measurements were predictive for delivery <35 weeks in women who underwent ultrasound-indicated cerclage and in women who received a history-indicated cerclage, whereas in multivariate analysis only CL three to six days after cerclage remained significant (odds ratio 0.85, 95% CI 0.73-0.98). In women with ultrasound-indicated cerclage, optimized cut-off was ≤ 20 mm (specificity 83.8%, sensitivity 84.2%).<bold>Conclusions: </bold>CL measured three to six days after cerclage placement provides the best information about the risk for delivery <35 weeks.
- Subjects
PREGNANCY; MEDICAL screening; CERVICAL cerclage; COHORT analysis; TRANSVAGINAL ultrasonography; CERVIX uteri; FETAL ultrasonic imaging; GESTATIONAL age; PREMATURE labor; SURGICAL complications; UTERINE cervix incompetence; PREDICTIVE tests; RETROSPECTIVE studies; ODDS ratio; DIAGNOSIS
- Publication
BMC Pregnancy & Childbirth, 2016, Vol 16, p1
- ISSN
1471-2393
- Publication type
journal article
- DOI
10.1186/s12884-016-0866-3