Association of Cervical Length and Term Delivery after Elective Cerclage in Women with High Risk of Preterm Delivery

Sun Young Jung; Ju Young Kim; Seung Ju Jun; Suk Young Kim

doi:10.14734/PN.2017.28.4.115

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This article has been corrected. See "Erratum: Association of Cervical Length and Term Delivery after Elective Cerclage in Women with High Risk of Preterm Delivery" in Volume 29 on page 62.

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Jung, Kim, Jun, and Kim: Association of Cervical Length and Term Delivery after Elective Cerclage in Women with High Risk of Preterm Delivery

Original Article

Perinatology 2017;28(4):115-118.

Published online: 19 January 2017

DOI: https://doi.org/10.14734/PN.2017.28.4.115

Association of Cervical Length and Term Delivery after Elective Cerclage in Women with High Risk of Preterm Delivery

Sun Young Jung, MD, Ju Young Kim, MD, Seung Ju Jun, MD, PhD, Suk Young Kim, MD, PhD

Department of Pediatrics, Soonchunhyang University Hospital, Soonchunhyang University School of Medicine, Seoul, Korea

Correspondence to Suk Young Kim, MD, PhD Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Korea Tel: +82-32-460-2153 Fax: +82-32-460-3290 E-mail: ksyob@gilhospital.com

Received 16 January 20175 July 2017 Accepted 5 September 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

To analyze the association between cervical length (CL) and term delivery after elective cerclage in women with high risk of preterm delivery.

Methods

Medical records of 97 women with high risk of preterm delivery who underwent McDonald elective cerclage and delivered by a single surgeon between January 2003 and June 2012 were reviewed and analyzed. The subjects were grouped according to their preoperative CL as measured by ultrasonography, in which 2.5 cm was defined as short cervical length (SCL). We compared the clinical outcomes according to the SCL (≤2.5 cm vs. >2.5 cm) and predicted the optimal postoperative CL for term delivery after 37 weeks.

Results

Postoperative CL significantly differed (2.8 cm vs. 3.3 cm, P=0.003) by the SCL (n=40, n=57), while gestational age at delivery did not differ significantly between the two groups. Two thirds of the subjects who had postoperative CL longer than 3.1 cm maintained pregnancy until 37 weeks (sensitivity: 64%, specificity: 65%). After adjusting for confounding factors, we found that postoperative CL longer than 3.1 cm was associated with an average gestation period of 37 weeks or more (odds ratio=2.6, 95% confidence interval 1.2-6.0).

Conclusion

Postoperative CL over 3.1 cm was associated with term delivery after 37 weeks.

Keywords: Cervical Cerclage, Cervical length measurement, Uterine cervical incompetence, Premature birth

REFERENCES

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Fig. 1

Estimation of cervical length after cerclage to maintain pregnancy 37 weeks of gestation or more. The cut off value of cervical length after cerclage to maintain pregnancy 37 weeks of gestation or more was 3.1 cm. Sensitivity, 64%; Specificity 62%. Area under curve, 0.62; 95% confidence interval, 0.51 to 0.74; P-value was 0.041. ROC, receiver operating characteristic.

Table 1.

Clinical Characteristics of Cerclage Cases in Women at High Risk of Preterm Birth

Characteristics	Value (n=97)
Age (years)	32.5±4.6
Previous spontaneous preterm delivery	57 (58.8)
Gestational age at cerclage (weeks)	15.4±3.1
Gestational age at delivery (weeks)	34.6±6.1
Term delivery (≥37 weeks)	55 (56.7)
Preoperative cervical length (cm)	2.7±0.9
Postoperative cervical length (cm)	3.1±0.9
Interval from cerclage to delivery (weeks)	19.5±7.3

Values are presented as mean±standard deviation or number (%).

Table 2.

Comparison of Clinical Characteristics according to Short Cervical Length before Cerclage

	Short cervical length (≤2.5 cm) (n=40)	Non-short cervical length (>2.5 cm) (n=57)	P-value
Age (years)	32.5±4.5	32.4±4.6	0.927
Previous spontaneous preterm delivery	20 (50.0)	37 (64.9)	0.142
Gestational age at cerclage (weeks)	16.6±3.6	14.6±2.5	0.002
Gestational age at delivery (weeks)	34.2±6.3	35.0±6.0	0.508
Term delivery (≥37 weeks)	21 (52.5)	34 (59.6)	0.536
Interval from cerclage to delivery	17.5±7.6	21.0±6.8	0.025
(weeks)
Cervical length after cerclage (cm)	2.8±0.9	3.3±0.8	0.003

Values are presented as mean±standard deviation or number (%).

Table 3.

Comparison of Clinical Characteristics according to Estimated Postoperative Cervical Length for Term Delivery

	Postoperative cervical length <3.1 cm (n=47)	Postoperative cervical length ≥3.1 cm (n=50)	P- value
Age (years)	33.1±4.8	31.9±4.3	0.219
Previous spontaneous preterm delivery	25 (27.6)	32 (29.4)	0.308
Gestational age at cerclage (weeks)	) 15.7±3.4	15.2±2.9	0.485
Gestational age at delivery (weeks)	34.0±5.9	35.3±6.3	0.260
Term delivery (≥37 weeks)	21 (44.7)	24 (68.0)	0.021
Interval from cerclage to delivery (weeks)	18.4±7.3	20.5±7.2	0.163
Preoperative cervical length (cm)	2.3±0.9	3.0±0.7	<0.001
Short cervical length	53 (70.7)	19 (35.2)	<0.001

Values are presented as mean±standard deviation or number (%).

Table 4.

Logistic Regression Analysis of Affecting Factors for Term Delivery

	OR (95% CI)	P-value
Age	1.066 (0.971-1.172)	0.252
Previous spontaneous preterm delivery	0.702 (0.293-1.679)	0.668
Short cervical length	1.625 (0.355-7.435)	0.976
Preoperative cervical length ≥2.3 cm	2.189 (0.439-10.928)	0.182
Postoperative cervical length ≥3.1 cm	2.631 (1.151-6.015)	0.022

Abbreviations: OR, odds ratio; CI, confidence interval.

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