Prediction of spontaneous preterm birth among nulliparous women with a short cervix

William A. Grobman; Yinglei Lai; Jay D. Iams; Uma M. Reddy; Brian M. Mercer; George Saade; Alan T. Tita; Dwight J. Rouse; Yoram Sorokin; Ronald J. Wapner; Kenneth J. Leveno; Sean C. Blackwell; M. Sean Esplin; Jorge E. Tolosa; John M. Thorp; Steve N. Caritis

doi:10.7863/ultra.15.08035

Prediction of spontaneous preterm birth among nulliparous women with a short cervix

William A. Grobman^*, Yinglei Lai, Jay D. Iams, Uma M. Reddy, Brian M. Mercer, George Saade, Alan T. Tita, Dwight J. Rouse, Yoram Sorokin, Ronald J. Wapner, Kenneth J. Leveno, Sean C. Blackwell, M. Sean Esplin, Jorge E. Tolosa, John M. Thorp, Steve N. Caritis

^*Corresponding author for this work

Obstetrics and Gynecology

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

28 Scopus citations

Abstract

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.

Original language	English (US)
Pages (from-to)	1293-1297
Number of pages	5
Journal	Journal of Ultrasound in Medicine
Volume	35
Issue number	6
DOIs	https://doi.org/10.7863/ultra.15.08035
State	Published - Jun 1 2016

Funding

We thank the subcommittee members who participated in protocol development and coordination between clinical research centers (Gail Mallett, RN, BSN, CCRC, and Cynthia Milluzzi, RN), protocol/data management and statistical analysis (Elizabeth Thom, PhD), and protocol development and oversight (Catherine Y. Spong, MD). The project described was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD; HD21410, UL1 RR024153, UL1 TR000005, HD27869, HD27915, HD27917, HD34116, HD34208, 5UL1RR025764, HD36801, HD40500, HD40512, HD40544, M01 RR00080, UL1 RR024989 [National Center for Research Resources), HD40545, HD40560, HD40485, HD53097, and HD53118). Comments and views of the authors do not necessarily represent views of the NICHD.

Keywords

Cervical length
Obstetric ultrasound
Prediction
Spontaneous preterm birth

ASJC Scopus subject areas

Radiological and Ultrasound Technology
Radiology Nuclear Medicine and imaging

Access to Document

10.7863/ultra.15.08035

Cite this

Grobman, W. A., Lai, Y., Iams, J. D., Reddy, U. M., Mercer, B. M., Saade, G., Tita, A. T., Rouse, D. J., Sorokin, Y., Wapner, R. J., Leveno, K. J., Blackwell, S. C., Esplin, M. S., Tolosa, J. E., Thorp, J. M., & Caritis, S. N. (2016). Prediction of spontaneous preterm birth among nulliparous women with a short cervix. Journal of Ultrasound in Medicine, 35(6), 1293-1297. https://doi.org/10.7863/ultra.15.08035

@article{4a4d7e48bf0a4a628db44852d05fb0f9,

title = "Prediction of spontaneous preterm birth among nulliparous women with a short cervix",

abstract = "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.",

keywords = "Cervical length, Obstetric ultrasound, Prediction, Spontaneous preterm birth",

author = "Grobman, {William A.} and Yinglei Lai and Iams, {Jay D.} and Reddy, {Uma M.} and Mercer, {Brian M.} and George Saade and Tita, {Alan T.} and Rouse, {Dwight J.} and Yoram Sorokin and Wapner, {Ronald J.} and Leveno, {Kenneth J.} and Blackwell, {Sean C.} and Esplin, {M. Sean} and Tolosa, {Jorge E.} and Thorp, {John M.} and Caritis, {Steve N.}",

note = "Publisher Copyright: {\textcopyright}2016 by the American Institute of Ultrasound in Medicine.",

year = "2016",

month = jun,

day = "1",

doi = "10.7863/ultra.15.08035",

language = "English (US)",

volume = "35",

pages = "1293--1297",

journal = "Journal of Ultrasound in Medicine",

issn = "0278-4297",

publisher = "John Wiley and Sons Ltd",

number = "6",

}

Grobman, WA, Lai, Y, Iams, JD, Reddy, UM, Mercer, BM, Saade, G, Tita, AT, Rouse, DJ, Sorokin, Y, Wapner, RJ, Leveno, KJ, Blackwell, SC, Esplin, MS, Tolosa, JE, Thorp, JM & Caritis, SN 2016, 'Prediction of spontaneous preterm birth among nulliparous women with a short cervix', Journal of Ultrasound in Medicine, vol. 35, no. 6, pp. 1293-1297. https://doi.org/10.7863/ultra.15.08035

TY - JOUR

T1 - Prediction of spontaneous preterm birth among nulliparous women with a short cervix

AU - Grobman, William A.

AU - Lai, Yinglei

AU - Iams, Jay D.

AU - Reddy, Uma M.

AU - Mercer, Brian M.

AU - Saade, George

AU - Tita, Alan T.

AU - Rouse, Dwight J.

AU - Sorokin, Yoram

AU - Wapner, Ronald J.

AU - Leveno, Kenneth J.

AU - Blackwell, Sean C.

AU - Esplin, M. Sean

AU - Tolosa, Jorge E.

AU - Thorp, John M.

AU - Caritis, Steve N.

PY - 2016/6/1

Y1 - 2016/6/1

N2 - 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.

AB - 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.

KW - Cervical length

KW - Obstetric ultrasound

KW - Prediction

KW - Spontaneous preterm birth

UR - http://www.scopus.com/inward/record.url?scp=84971246026&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84971246026&partnerID=8YFLogxK

U2 - 10.7863/ultra.15.08035

DO - 10.7863/ultra.15.08035

M3 - Article

C2 - 27151903

AN - SCOPUS:84971246026

SN - 0278-4297

VL - 35

SP - 1293

EP - 1297

JO - Journal of Ultrasound in Medicine

JF - Journal of Ultrasound in Medicine

IS - 6

ER -

Prediction of spontaneous preterm birth among nulliparous women with a short cervix

Abstract

Funding

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this