Abstract
Objective:
To compare the anterior uterocervical angle and cervical length as predictors of spontaneous preterm delivery in patients with transvaginal cerclage.
Study design:
We retrospectively evaluated a cohort of 142 pregnant women with transvaginal cerclage placed over a 5-year period (2010 to 2015) were evaluated. Cervical morphology characteristics were measured from endovaginal imaging, including cervical length, cerclage height, funnel volume and anterior uterocervical angle prior to cerclage placement (UCA 1), shortly after cerclage placement (UCA 2) and the last image prior to delivery (UCA 3). Cerclage failure was defined as delivery prior to 36 weeks. Univariate analysis, receiver operator characteristic curves and binary logistic regression were used for statistical analysis. Statistical significance was defined as a P<0.05.
Results:
Among the 142 women with a transvaginal cerclage, 38% had cerclage failure. The mean gestational age at birth was 29.3±5.2 weeks in the failure group compared with 37.9±2.8 weeks in those that did not fail (P<0.001). Univariate analysis identified cervical length (P=0.034) and UCA 3 (P<0.001) as significantly associated with gestational age at birth. Receiver operator characteristic curves demonstrated improved prediction of delivery prior to 34 weeks at UCA 3=108o (97% sensitivity, 65% specificity) compared to a cervical length of 25 mm. At <28 weeks, optimal performance of UCA 3 was found at 112o (100% sensitivity, 62% specificity) compared with cervical length of 25 mm (29% sensitivity, 39% specificity). Binary logistic regression revealed UCA 3>108o conferred an OR 35.1 (95% CI 7.7 to 160.3) for delivery prior to 34 weeks, and UCA 3>112o an OR 42.0 (95% CI 5.3 to 332.1) for delivery prior to 28 weeks. In comparison, CL<25 mm had an OR 4.7 (95% CI 1.8 to 12.2) for delivery prior to 34 weeks and OR 6.0 (95% CI 1.9 to 19.3) prior to 28 weeks.
Conclusions:
In patients with transvaginal cerclage, an increasingly obtuse anterior uterocervical angle reflects an increased risk of cerclage failure in the mid-trimester. Utilization of UCA measurement as a surveillance tool may improve identification of patients at risk for cerclage failure.
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References
Martin JA . Measuring gestational age in vital statistics data: transitioning to the obstetric estimate. Natl Vital Stat Rep 2015; 64: 1–65.
Behrman RE, Butler AS . Preterm birth: causes, consequences, and prevention. National Academies Press: Washington, DC, 2007.
Fonseca EB, Celik E, Parra M, Singh M, Nicolaides KH, Fetal Medicine Foundation Second Trimester Screening Group. Progesterone and the risk of preterm birth among women with a short cervix. N Engl J Med 2007; 357: 462–469.
Berghella V, Rafael TJ, Szychowski JM, Rust OA, Owen J . Cerclage for short cervix on ultrasonography in women with singleton gestations and previous preterm birth: a meta-analysis. Obstet Gynecol 2011; 117: 663–671.
Newman RB, Goldenberg RL, Iams JD, Meis PJ, Mercer BM, Moawad AH et al. National Institute of Child Health and Human Development Maternal Fetal Medicine Unit Network. The length of the cervix and the risk of spontaneous premature delivery. N Engl J Med 1996; 334: 567–577.
Berghella V, Odibo AO, To MS, Rust OA, Althuisius SM . Cerclage for short cervix on ultrasonography: meta-analysis of trials using individual patient-level data. Obstet Gynecol 2005; 106: 181–189.
Greco E, Gupta R, Syngelaki A, Poon LC, Nicolaides KH . First-trimester screening for spontaneous preterm delivery with maternal characteristics and cervical length. Fetal Diagn Ther 2012; 31: 154–161.
To MS, Skentou CA, Royston P, Yu CK, Nicolaides KH . Prediction of patient-specific risk of early preterm delivery using maternal history and sonographic measurement of cervical length: a population-based prospective study. Ultrasound Obstet Gynecol 2006; 27: 362–367.
Manuck TA, Esplin MS, Biggio J, Bukowski R, Parry S, Zhang H et al. The phenotype of spontaneous preterm birth: application of a clinical phenotyping tool. Am J Obstet Gynecol 2015; 212: 487.e1–487.e11.
Sochacki-Wojcicka N, Wojcicki J, Bomba-Opon D, Wielgos M . Anterior cervical angle as a new biophysical ultrasound marker for prediction of spontaneous preterm birth. Ultrasound Obstet Gynecol 2015; 46: 377–378.
Dziadosz M, Bennett TA, Dolin C, West Honart A, Pham A, Lee SS et al. Uterocervical angle: a novel ultrasound screening tool to predict spontaneous preterm birth. Am J Obstet Gynecol 2016; 215 (3): 376 e1–376 e7.
Iams JD, Grobman WA, Lozitska A, Spong CY, Saade G, Mercer BM et al. Adherence to criteria for transvaginal ultrasound imaging and measurement of cervicallength. Am J Obstet Gynecol 2013; 209 (365): e1–e5.
Sheng JS, Schubert FP, Patil AS . Utility of volumetric assessment of cervical funneling to predict cerclage failure. J Matern Fetal Neonatal Med 2016 (e-pub ahead of print).
Arabin B, Alfirevic Z . Cervical pessaries for prevention of spontaneous preterm births: Past, present and future. Ultrasound Obstet Gynecol 2013; 44: 390–399.
Goya M, Pratcorona L, Merced C, Rodó C, Valle L, Romero A et alPesario Cervical para Evitar Prematuridad (PECEP) Trial Group. Cervical pessary in pregnant women with a short cervix (PECEP): an open-label randomized controlled trial. Lancet 2012; 379: 1800–1806. ?.
Fernandez M, House M, Jambawalikar S, Zork N, Vink J, Wapner R et al. Investigating the mechanical function of the cervix during pregnancy using finite element models derived from high-resolution 3D MRI. Comput Methods Biomech Biomed Engin 2016; 19: 404–417.
Cannie MM, Dobrescu O, Gucciardo L, Strizek B, Ziane S, Sakkas E et al, Arabin cervical pessary in women at high risk of preterm birth: a magnetic resonance imaging observational follow-up study. Ultrasound Obstet Gynecol 2013; 42: 426–433.
Myers KM, Feltovich H, Mazza E, Vink J, Bajka M, Wapner RJ et al. The mechanical role of the cervix in pregnancy. J Biomech 2015; 48: 1511–1523.
Jalal EM, Moretti F, Gruslin A . Predictors of outcomes of non elective cervical cerclages. J Obstetr Gynecol Can 2016; 38: 252–257.
American College of Obstetrics and Gynecology Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin Number 142, February, 2014: Cerclage for the management of cervical insufficiency. Obstet Gynecol 2014; 123: 372–379.
Terkildsen MF, Parilla BV, Kumar P, Grobman WA . Factors associated with success of emergent second trimester cerclage. Obstet Gynecol 2003; 101: 565–569.
Pils S, Eppel W, Promberger R, Winter MP, Seemann R, Ott J . The predictive value of sequential cervical length screening in singleton pregnancies after cerclage: a retrospective cohort study. BMC Pregnancy Childbirth 2016; 16: 1–7.
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Knight, J., Tenbrink, E., Sheng, J. et al. Anterior uterocervical angle measurement improves prediction of cerclage failure. J Perinatol 37, 375–379 (2017). https://doi.org/10.1038/jp.2016.241
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DOI: https://doi.org/10.1038/jp.2016.241