Sonographic cervical length in singleton pregnancies with intact membranes presenting with threatened preterm labor

Abstract

Objective: Less than 10% of women presenting with preterm contractions progress to active labor and delivery. This study investigates whether cervical length measurements by ultrasound can discriminate between true and false labor in women presenting with threatened preterm labor.

Methods: Cervical length was measured by transvaginal ultrasound in 253 women with singleton pregnancies presenting with painful uterine contractions at a median age of 31 (range, 24-35) weeks of gestation. Women presenting in active labor, defined by the presence of cervical dilatation of >or = 3 cm, those with ruptured membranes and those that underwent prior or subsequent cervical cerclage were excluded from the study. The clinical management was determined by the attending obstetrician without taking into account the cervical length. Primary outcome of the study was delivery within 7 days of presentation based on the results of randomized studies on the use of tocolytics in women with preterm labor that reported a prolongation of pregnancy by 7 days.

Results: Delivery within 7 days of presentation occurred in 21/253 (8.3%) pregnancies and this was inversely related to cervical length. Receiver-operating characteristics (ROC) curves established a cervical length of 15 mm as the most relevant cut-off level for the prediction of preterm delivery within 7 days. In 217 cases the cervical length was > or = 15 mm and only four of these (1.8%) delivered within 7 days. In the 36 women with cervical length < 15 mm, delivery occurred in 17 (47.2%) within 7 days. Logistic regression analysis demonstrated that significant independent contribution in the prediction of delivery within 7 days was provided by cervical length, contraction frequency at presentation, previous history of preterm delivery and vaginal bleeding. There was no significant contribution from gestation at presentation, ethnic origin, maternal age, parity, cigarette smoking or the administration of tocolysis, antibiotics or steroids. Similar results were shown in a subanalysis of 162 patients presenting at a gestational age below 32 weeks: 9/19 patients (47.4%) with a cervical length below 15 mm delivered within 7 days compared to 3/143 (2.1%) with a cervical length > or = 15 mm. Univariate as well as multivariate analyses confirmed cervical length to be a significant independent predictor of delivery within 7 days in this population.

Conclusions: Sonographic measurement of cervical length helps to avoid overdiagnosis of preterm labor in women with preterm contractions and intact membranes.