OBJECTIVE: Cervical insufficiency can be unexpected in a woman with a previous term birth. Our objective was to determine what risk factors, if any, place women with a term delivery at risk for cervical insufficiency in a subsequent pregnancy. STUDY DESIGN: Demographic characteristics were collected for a cohort of women with at least 1 previous term birth followed by cervical insufficiency (subject group) and for uncomplicated multiparous women (control group). Multiparous women with cervical insufficiency (subjects; n = 49) were compared with multiparous women who were experiencing repeat term birth with no history of cervical insufficiency (control group; n = 49). RESULTS: Patients with cervical insufficiency were similar to control subjects demographically. No difference was noted in previous cervical procedures or spontaneous preterm deliveries. Multivariate logistic regression analysis identified a history of curettage (odds ratio, 4.6; 95% CI, 1.7-12.5), precipitous delivery (odds ratio, 6.8; 95% CI, 1.6-29.6), and prolonged second stage of labor (odds ratio, 24.9; 95% CI, 2.4-253) as independent predictors of cervical insufficiency. CONCLUSION: Multiparous women who experience cervical insufficiency after a term birth are more likely to have had a previous precipitous delivery, a prolonged second stage of labor, or a previous curettage compared with multiparous women who experience a repeat term birth with no cervical insufficiency.
OBJECTIVE:Cervical insufficiency can be unexpected in a woman with a previous term birth. Our objective was to determine what risk factors, if any, place women with a term delivery at risk for cervical insufficiency in a subsequent pregnancy. STUDY DESIGN: Demographic characteristics were collected for a cohort of women with at least 1 previous term birth followed by cervical insufficiency (subject group) and for uncomplicated multiparous women (control group). Multiparous women with cervical insufficiency (subjects; n = 49) were compared with multiparous women who were experiencing repeat term birth with no history of cervical insufficiency (control group; n = 49). RESULTS:Patients with cervical insufficiency were similar to control subjects demographically. No difference was noted in previous cervical procedures or spontaneous preterm deliveries. Multivariate logistic regression analysis identified a history of curettage (odds ratio, 4.6; 95% CI, 1.7-12.5), precipitous delivery (odds ratio, 6.8; 95% CI, 1.6-29.6), and prolonged second stage of labor (odds ratio, 24.9; 95% CI, 2.4-253) as independent predictors of cervical insufficiency. CONCLUSION: Multiparous women who experience cervical insufficiency after a term birth are more likely to have had a previous precipitous delivery, a prolonged second stage of labor, or a previous curettage compared with multiparous women who experience a repeat term birth with no cervical insufficiency.
Authors: Lisa D Levine; Mary D Sammel; Adi Hirshberg; Michal A Elovitz; Sindhu K Srinivas Journal: Am J Obstet Gynecol Date: 2014-09-30 Impact factor: 8.661