Cervical funneling or intra-amniotic debris and preterm birth in nulliparous women with midtrimester cervical length less than 30 mm

the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units (MFMU) Network

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: To evaluate whether the presence of cervical funneling or intra-amniotic debris identified in the second trimester is associated with a higher rate of preterm birth (PTB) in asymptomatic nulliparous pregnant women with a midtrimester cervical length (CL) less than 30 mm (i.e. below the 10th percentile). Methods: This was a secondary cohort analysis of data from a multicenter trial in nulliparous women between 16 and 22 weeks' gestation with a singleton gestation and CL less than 30 mm on transvaginal ultrasound, randomized to treatment with either 17-alpha-hydroxyprogesterone caproate or placebo. Sonographers were centrally certified in CL measurement, as well as in identification of intra-amniotic debris and cervical funneling. Univariable and multivariable analysis was performed to assess the associations of cervical funneling and intra-amniotic debris with PTB. Results: Of the 657 women randomized, 112 (17%) had cervical funneling only, 33 (5%) had intra-amniotic debris only and 45 (7%) had both on second-trimester ultrasound. Women with either of these findings had a shorter median CL than those without (21.0 mm vs 26.4 mm; P < 0.001). PTB prior to 37 weeks was more likely in women with cervical funneling (37% vs 21%; odds ratio (OR), 2.2 (95% CI, 1.5–3.3)) or intra-amniotic debris (35% vs 23%; OR, 1.7 (95% CI, 1.1–2.9)). Results were similar for PTB before 34 and before 32 weeks' gestation. After multivariable adjustment that included CL, PTB < 34 and < 32 weeks continued to be associated with the presence of intra-amniotic debris (adjusted OR (aOR), 1.85 (95% CI, 1.00–3.44) and aOR, 2.78 (95% CI, 1.42–5.45), respectively), but not cervical funneling (aOR, 1.17 (95% CI, 0.63–2.17) and aOR, 1.45 (95% CI, 0.71–2.96), respectively). Conclusions: Among asymptomatic nulliparous women with midtrimester CL less than 30 mm, the presence of intra-amniotic debris, but not cervical funneling, is associated with an increased risk for PTB before 34 and 32 weeks' gestation, independently of CL.

Original languageEnglish (US)
Pages (from-to)757-762
Number of pages6
JournalUltrasound in Obstetrics and Gynecology
Volume52
Issue number6
DOIs
StatePublished - Dec 1 2018

Fingerprint

Premature Birth
Second Pregnancy Trimester
Pregnancy
Odds Ratio
Cervical Length Measurement
Multicenter Studies
Pregnant Women
Cohort Studies
Placebos

Keywords

  • cervical funnel
  • intra-amniotic debris
  • preterm birth
  • short cervix

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Reproductive Medicine
  • Radiology Nuclear Medicine and imaging
  • Obstetrics and Gynecology

Cite this

the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units (MFMU) Network (2018). Cervical funneling or intra-amniotic debris and preterm birth in nulliparous women with midtrimester cervical length less than 30 mm. Ultrasound in Obstetrics and Gynecology, 52(6), 757-762. https://doi.org/10.1002/uog.18960
the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units (MFMU) Network. / Cervical funneling or intra-amniotic debris and preterm birth in nulliparous women with midtrimester cervical length less than 30 mm. In: Ultrasound in Obstetrics and Gynecology. 2018 ; Vol. 52, No. 6. pp. 757-762.
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title = "Cervical funneling or intra-amniotic debris and preterm birth in nulliparous women with midtrimester cervical length less than 30 mm",
abstract = "Objective: To evaluate whether the presence of cervical funneling or intra-amniotic debris identified in the second trimester is associated with a higher rate of preterm birth (PTB) in asymptomatic nulliparous pregnant women with a midtrimester cervical length (CL) less than 30 mm (i.e. below the 10th percentile). Methods: This was a secondary cohort analysis of data from a multicenter trial in nulliparous women between 16 and 22 weeks' gestation with a singleton gestation and CL less than 30 mm on transvaginal ultrasound, randomized to treatment with either 17-alpha-hydroxyprogesterone caproate or placebo. Sonographers were centrally certified in CL measurement, as well as in identification of intra-amniotic debris and cervical funneling. Univariable and multivariable analysis was performed to assess the associations of cervical funneling and intra-amniotic debris with PTB. Results: Of the 657 women randomized, 112 (17{\%}) had cervical funneling only, 33 (5{\%}) had intra-amniotic debris only and 45 (7{\%}) had both on second-trimester ultrasound. Women with either of these findings had a shorter median CL than those without (21.0 mm vs 26.4 mm; P < 0.001). PTB prior to 37 weeks was more likely in women with cervical funneling (37{\%} vs 21{\%}; odds ratio (OR), 2.2 (95{\%} CI, 1.5–3.3)) or intra-amniotic debris (35{\%} vs 23{\%}; OR, 1.7 (95{\%} CI, 1.1–2.9)). Results were similar for PTB before 34 and before 32 weeks' gestation. After multivariable adjustment that included CL, PTB < 34 and < 32 weeks continued to be associated with the presence of intra-amniotic debris (adjusted OR (aOR), 1.85 (95{\%} CI, 1.00–3.44) and aOR, 2.78 (95{\%} CI, 1.42–5.45), respectively), but not cervical funneling (aOR, 1.17 (95{\%} CI, 0.63–2.17) and aOR, 1.45 (95{\%} CI, 0.71–2.96), respectively). Conclusions: Among asymptomatic nulliparous women with midtrimester CL less than 30 mm, the presence of intra-amniotic debris, but not cervical funneling, is associated with an increased risk for PTB before 34 and 32 weeks' gestation, independently of CL.",
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the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units (MFMU) Network 2018, 'Cervical funneling or intra-amniotic debris and preterm birth in nulliparous women with midtrimester cervical length less than 30 mm', Ultrasound in Obstetrics and Gynecology, vol. 52, no. 6, pp. 757-762. https://doi.org/10.1002/uog.18960

Cervical funneling or intra-amniotic debris and preterm birth in nulliparous women with midtrimester cervical length less than 30 mm. / the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units (MFMU) Network.

In: Ultrasound in Obstetrics and Gynecology, Vol. 52, No. 6, 01.12.2018, p. 757-762.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cervical funneling or intra-amniotic debris and preterm birth in nulliparous women with midtrimester cervical length less than 30 mm

AU - the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units (MFMU) Network

AU - Saade, G. R.

AU - Thom, E. A.

AU - Grobman, William A

AU - Iams, J. D.

AU - Mercer, B. M.

AU - Reddy, U. M.

AU - Tita, A. T.N.

AU - Rouse, D. J.

AU - Sorokin, Y.

AU - Wapner, R. J.

AU - Leveno, K. J.

AU - Blackwell, S. C.

AU - Esplin, M. S.

AU - Tolosa, J. E.

AU - Thorp, J. M.

AU - Caritis, S. N.

AU - Vandorsten, J. P.

AU - Moss, J.

AU - Salazar, A.

AU - Hankins, G.

AU - Olson, G.

AU - Jackson, A.

AU - Sutherland, C.

AU - Peaceman, Alan M

AU - Dinsmoor, M.

AU - Mallett, G.

AU - Senka, J.

AU - Johnson, F.

AU - Cline, D.

AU - Latimer, C.

AU - Frantz, S.

AU - Fyffe, S.

AU - Shubert, P.

AU - Gerwig, L.

AU - Milluzzi, C.

AU - Dalton, W.

AU - Russo, J.

AU - Myers, S.

AU - Waters, T.

AU - Dotson, T.

AU - Andrews, W.

AU - Northen, A.

AU - Sheppard, J.

AU - Grant, J.

AU - Rouse, D.

AU - Allard, D.

AU - Hunt, J.

AU - Tillinghast, J.

AU - Bethelemy, M.

AU - Gardner, D.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Objective: To evaluate whether the presence of cervical funneling or intra-amniotic debris identified in the second trimester is associated with a higher rate of preterm birth (PTB) in asymptomatic nulliparous pregnant women with a midtrimester cervical length (CL) less than 30 mm (i.e. below the 10th percentile). Methods: This was a secondary cohort analysis of data from a multicenter trial in nulliparous women between 16 and 22 weeks' gestation with a singleton gestation and CL less than 30 mm on transvaginal ultrasound, randomized to treatment with either 17-alpha-hydroxyprogesterone caproate or placebo. Sonographers were centrally certified in CL measurement, as well as in identification of intra-amniotic debris and cervical funneling. Univariable and multivariable analysis was performed to assess the associations of cervical funneling and intra-amniotic debris with PTB. Results: Of the 657 women randomized, 112 (17%) had cervical funneling only, 33 (5%) had intra-amniotic debris only and 45 (7%) had both on second-trimester ultrasound. Women with either of these findings had a shorter median CL than those without (21.0 mm vs 26.4 mm; P < 0.001). PTB prior to 37 weeks was more likely in women with cervical funneling (37% vs 21%; odds ratio (OR), 2.2 (95% CI, 1.5–3.3)) or intra-amniotic debris (35% vs 23%; OR, 1.7 (95% CI, 1.1–2.9)). Results were similar for PTB before 34 and before 32 weeks' gestation. After multivariable adjustment that included CL, PTB < 34 and < 32 weeks continued to be associated with the presence of intra-amniotic debris (adjusted OR (aOR), 1.85 (95% CI, 1.00–3.44) and aOR, 2.78 (95% CI, 1.42–5.45), respectively), but not cervical funneling (aOR, 1.17 (95% CI, 0.63–2.17) and aOR, 1.45 (95% CI, 0.71–2.96), respectively). Conclusions: Among asymptomatic nulliparous women with midtrimester CL less than 30 mm, the presence of intra-amniotic debris, but not cervical funneling, is associated with an increased risk for PTB before 34 and 32 weeks' gestation, independently of CL.

AB - Objective: To evaluate whether the presence of cervical funneling or intra-amniotic debris identified in the second trimester is associated with a higher rate of preterm birth (PTB) in asymptomatic nulliparous pregnant women with a midtrimester cervical length (CL) less than 30 mm (i.e. below the 10th percentile). Methods: This was a secondary cohort analysis of data from a multicenter trial in nulliparous women between 16 and 22 weeks' gestation with a singleton gestation and CL less than 30 mm on transvaginal ultrasound, randomized to treatment with either 17-alpha-hydroxyprogesterone caproate or placebo. Sonographers were centrally certified in CL measurement, as well as in identification of intra-amniotic debris and cervical funneling. Univariable and multivariable analysis was performed to assess the associations of cervical funneling and intra-amniotic debris with PTB. Results: Of the 657 women randomized, 112 (17%) had cervical funneling only, 33 (5%) had intra-amniotic debris only and 45 (7%) had both on second-trimester ultrasound. Women with either of these findings had a shorter median CL than those without (21.0 mm vs 26.4 mm; P < 0.001). PTB prior to 37 weeks was more likely in women with cervical funneling (37% vs 21%; odds ratio (OR), 2.2 (95% CI, 1.5–3.3)) or intra-amniotic debris (35% vs 23%; OR, 1.7 (95% CI, 1.1–2.9)). Results were similar for PTB before 34 and before 32 weeks' gestation. After multivariable adjustment that included CL, PTB < 34 and < 32 weeks continued to be associated with the presence of intra-amniotic debris (adjusted OR (aOR), 1.85 (95% CI, 1.00–3.44) and aOR, 2.78 (95% CI, 1.42–5.45), respectively), but not cervical funneling (aOR, 1.17 (95% CI, 0.63–2.17) and aOR, 1.45 (95% CI, 0.71–2.96), respectively). Conclusions: Among asymptomatic nulliparous women with midtrimester CL less than 30 mm, the presence of intra-amniotic debris, but not cervical funneling, is associated with an increased risk for PTB before 34 and 32 weeks' gestation, independently of CL.

KW - cervical funnel

KW - intra-amniotic debris

KW - preterm birth

KW - short cervix

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U2 - 10.1002/uog.18960

DO - 10.1002/uog.18960

M3 - Article

VL - 52

SP - 757

EP - 762

JO - Ultrasound in Obstetrics and Gynecology

JF - Ultrasound in Obstetrics and Gynecology

SN - 0960-7692

IS - 6

ER -

the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units (MFMU) Network. Cervical funneling or intra-amniotic debris and preterm birth in nulliparous women with midtrimester cervical length less than 30 mm. Ultrasound in Obstetrics and Gynecology. 2018 Dec 1;52(6):757-762. https://doi.org/10.1002/uog.18960