Ultrasound cervical length measurement for prediction of delivery before 32weeks in women with emergency cerclage for cervical insufficiency

Fuchs, Florent; Bouyer, Jean; Fernandez, Hervé; Gervaise, Amélie; Frydman, René; Senat, Marie-Victoire

doi:10.1016/j.ijgo.2010.04.022

« Previous Next »International Journal of Gynecology & Obstetrics
Volume 110, Issue 3 , Pages 245-248, September 2010

Ultrasound cervical length measurement for prediction of delivery before 32weeks in women with emergency cerclage for cervical insufficiency

Florent Fuchs
- Department of Obstetrics and Gynecology, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicêtre, France
- Reproduction and Child Development, CESP Centre for Research in Epidemiology and Population Health, U1018, Inserm, Villejuif, France
- Université Paris Sud 11, UMRS 1018, Villejuif, France
- Corresponding author. Hôpital Bicêtre - Service de Gynécologie-Obstétrique, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France. Tel.: +34 1 45 21 77 84; fax: +34 1 45 21 77 25.
Jean Bouyer
- Reproduction and Child Development, CESP Centre for Research in Epidemiology and Population Health, U1018, Inserm, Villejuif, France
- Université Paris Sud 11, UMRS 1018, Villejuif, France
- INED, Paris, France
Hervé Fernandez
- Department of Obstetrics and Gynecology, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicêtre, France
- Reproduction and Child Development, CESP Centre for Research in Epidemiology and Population Health, U1018, Inserm, Villejuif, France
- Université Paris Sud 11, UMRS 1018, Villejuif, France
Amélie Gervaise
- Department of Obstetrics and Gynecology, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicêtre, France
René Frydman
- Université Paris Sud 11, UMRS 1018, Villejuif, France
- INSERM U782, Université Paris-Sud, Clamart, France
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hôpital Antoine Béclère, Assistance Publique Hôpitaux de Paris (APHP), Clamart, France
Marie-Victoire Senat
- Department of Obstetrics and Gynecology, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicêtre, France
- Reproduction and Child Development, CESP Centre for Research in Epidemiology and Population Health, U1018, Inserm, Villejuif, France
- Université Paris Sud 11, UMRS 1018, Villejuif, France

Received 2 February 2010; received in revised form 7 April 2010; accepted 4 May 2010. published online 07 June 2010.

Abstract

Objective

To assess the accuracy of ultrasound cervical length for predicting delivery before 32weeks among women with a threatened second trimester fetal loss treated by emergency cervical cerclage, and to compare it with prediction based on clinically-assessed cervical dilation.

Methods

Retrospective study (1997–2006) of 70 women with singleton pregnancies who underwent emergency cervical cerclage and ultrasound cervical length measurement between 15 and 26weeks. The associations between cervical length and delivery before 32weeks were studied with univariate and multivariate regression. ROC curves were used to determine the most discriminating cut-off value.

Results

Although ultrasound cervical length measurement was significantly associated with early preterm delivery, its predictive accuracy was moderate with an area under the ROC curve (AUC) of 0.68 (95% CI, 0.54–0.82), which was similar (P=0.43) to the AUC of cervical dilation of 0.73 (95% CI, 0.61–0.85). The best cut-off value was 7mm, corresponding to a doubled risk of delivery before 32weeks. Its sensitivity was 52%, specificity 82%, PPV 62%, and NPV 76%. It was no more informative than cervical dilation of 3cm.

Conclusion

Ultrasound cervical length measurement does not predict early preterm birth better than clinically-assessed cervical dilation in women with an emergency cerclage.

Keywords: Bulging membranes, Midtrimester cervical dilation, Preterm birth, Threatened second trimester loss, Ultrasound measurement