You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.


ABOUT JAMA
Advanced Search

Welcome   | My Account | E-mail Alerts | Access Rights | Sign In


  Vol. 286 No. 11, September 19, 2001 TABLE OF CONTENTS
  JAMA
  •  Online Features
  Original Contribution
 This Article
 •Full text
 •PDF
 •Send to a friend
 • Save in My Folder
 •Save to citation manager
 •Permissions
 Citing Articles
 •Citation map
 •Citing articles on HighWire
 •Citing articles on ISI (47)
 •Contact me when this article is cited
 Related Content
 •Related article
 •Similar articles in JAMA
 Topic Collections
 •Pregnancy and Breast Feeding
 •Ultrasonography
 •Alert me on articles by topic

Mid-Trimester Endovaginal Sonography in Women at High Risk for Spontaneous Preterm Birth

John Owen, MD; Nicole Yost, MD; Vincenzo Berghella, MD; Elizabeth Thom, PhD; Melissa Swain, RN; Gary A. Dildy III, MD; Menachem Miodovnik, MD; Oded Langer, MD; Baha Sibai, MD; Donald McNellis, MD; for the National Institute of Child Health and Human Development, Maternal-Fetal Medicine Units Network

JAMA. 2001;286:1340-1348.

Context  Although shortened cervical length has been consistently associated with spontaneous preterm birth, it is not known when in gestation this risk factor becomes apparent.

Objective  To determine whether sonographic cervical findings between 16 weeks' and 18 weeks 6 days' gestation predict spontaneous preterm birth and whether serial evaluations up to 23 weeks 6 days' gestation improve prediction in high-risk women.

Design, Setting, and Participants  Blinded observational study performed between March 1997 and November 1999 at 9 university-affiliated medical centers in the United States in 183 women with singleton gestations who previously had experienced a spontaneous birth before 32 weeks' gestation.

Observation  Certified sonologists performed 590 endovaginal sonographic examinations at 2-week intervals. Cervical length was measured from the external os to the functional internal os along a closed endocervical canal. Funneling and dynamic cervical shortening were also recorded.

Main Outcome Measure  Spontaneous preterm birth before 35 weeks' gestation, analyzed by selected cutoff values of cervical length.

Results  Forty-eight women (26%) experienced spontaneous preterm birth before 35 weeks' gestation. A cervical length of less than 25 mm at the initial sonographic examination was associated with a relative risk (RR) for spontaneous preterm birth of 3.3 (95% confidence interval [CI], 2.1-5.0; sensitivity = 19%; specificity = 98%; positive predictive value = 75%). After controlling for cervical length, neither funneling (P = .24) nor dynamic shortening (P = .054) were significant independent predictors of spontaneous preterm birth. However, using the shortest ever observed cervical length on serial evaluations, after any dynamic shortening, the RR of a cervical length of less than 25 mm for spontaneous preterm birth increased to 4.5 (95% CI, 2.7-7.6; sensitivity = 69%; specificity = 80%; positive predictive value = 55%). Compared with a single cervical measurement at 16 weeks' to 18 weeks 6 days' gestation, serial measurements at up to 23 weeks 6 days significantly improved the prediction of spontaneous preterm birth in a receiver operating characteristic curve analysis (P = .03).

Conclusions  Cervical length assessed by endovaginal sonography between 16 weeks' and 18 weeks 6 days' gestation, augmented by serial evaluations, predicts spontaneous preterm birth before 35 weeks' gestation in high-risk women.


Author Affiliations: Department of Obstetrics and Gynecology, University of Alabama at Birmingham (Dr Owen); Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas (Dr Yost); Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, Pa (Dr Berghella); George Washington University Biostatistics Center, Bethesda, Md (Dr Thom); Department of Obstetrics and Gynecology, Wake Forest University, Winston-Salem, NC (Ms Swain); Department of Obstetrics and Gynecology, University of Utah, Salt Lake City (Dr Dildy); Department of Obstetrics and Gynecology, University of Cincinnati, Ohio (Dr Miodovnik); Department of Obstetrics and Gynecology, University of Texas, San Antonio (Dr Langer); Department of Obstetrics and Gynecology, University of Tennessee, Memphis (Dr Sibai); and the National Institute of Child Health and Human Development, Bethesda, Md (Dr McNellis). Dr Dildy is now with the Louisiana State University, Baton Rouge; Drs Miodovnik and Langer are now with Columbia University, New York City, NY; Dr Sibai is now with the University of Cincinnati, Ohio; and Dr McNellis is retired.


RELATED ARTICLE

September 19, 2001
JAMA. 2001;286(11):1389-1390.
EXTRACT | FULL TEXT  


THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Gestational Age at Cervical Length Measurement and Incidence of Preterm Birth
Berghella et al.
Obstet Gynecol 2007;110:311-317.
ABSTRACT | FULL TEXT  

Prediction and Prevention of Recurrent Spontaneous Preterm Birth
Spong
Obstet Gynecol 2007;110:405-415.
ABSTRACT | FULL TEXT  

Natural History of Cervical Funneling in Women at High Risk for Spontaneous Preterm Birth
Berghella et al.
Obstet Gynecol 2007;109:863-869.
ABSTRACT | FULL TEXT  

Effect of coitus on recurrent preterm birth.
Yost et al.
Obstet Gynecol 2006;107:793-797.
ABSTRACT | FULL TEXT  

Transvaginal Ultrasonography of the Cervix to Predict Preterm Birth in Women With Uterine Anomalies
Airoldi et al.
Obstet Gynecol 2005;106:553-556.
ABSTRACT | FULL TEXT  

Does Progesterone Treatment Influence Risk Factors for Recurrent Preterm Delivery?
Meis et al.
Obstet Gynecol 2005;106:557-561.
ABSTRACT | FULL TEXT  

Cerclage for Short Cervix on Ultrasonography: Meta-Analysis of Trials Using Individual Patient-Level Data
Berghella et al.
Obstet Gynecol 2005;106:181-189.
ABSTRACT | FULL TEXT  

Second-Trimester Cervical Sonography: Features Other Than Cervical Length to Predict Spontaneous Preterm Birth
Yost et al.
Obstet Gynecol 1999;103:457-462.
ABSTRACT | FULL TEXT  





HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | SUBMIT | SUBSCRIBE | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 2001 American Medical Association. All Rights Reserved.