William A Grobman1, Yinglei Lai2, Jay D Iams3, Uma M Reddy4, Brian M Mercer5, George Saade6, Alan T Tita7, Dwight J Rouse8, Yoram Sorokin9, Ronald J Wapner10, Kenneth J Leveno11, Sean C Blackwell12, M Sean Esplin13, Jorge E Tolosa14, John M Thorp15, Steve N Caritis16. 1. Departments of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois USA w-grobman@northwestern.edu. 2. George Washington University Biostatistics Center, Washington, DC USA. 3. Ohio State University, Columbus, Ohio USA. 4. Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland USA. 5. Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio USA. 6. University of Texas Medical Branch, Galveston, Texas USA. 7. University of Alabama at Birmingham, Birmingham, Alabama USA. 8. Brown University, Providence, Rhode Island USA. 9. Wayne State University, Detroit, Michigan USA. 10. Columbia University, New York, New York USA. 11. University of Texas Southwestern Medical Center, Dallas, Texas USA. 12. University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas USA. 13. University of Utah Health Sciences Center, Salt Lake City, Utah USA. 14. Oregon Health and Science University, Portland, Oregon USA. 15. University of North Carolina at Chapel Hill, Chapel Hill, North Carolina USA. 16. University of Pittsburgh, Pittsburgh, Pennsylvania USA.
Abstract
OBJECTIVES: The purpose of this study was to evaluate whether demographic and sonographic factors associated with spontaneous preterm birth among nulliparous women with a cervical length of less than 30 mm could be combined into an accurate prediction model for spontaneous preterm birth. METHODS: We conducted a secondary analysis of a trial of nulliparous women with a singleton gestation and a cervical length of less than 30 mm on transvaginal sonography between 16 and 22 weeks who lacked other risk factors for spontaneous (eg, prior cervical excisional procedure) or medically indicated (eg, chronic hypertension) preterm birth, who were randomized to either 17α-hydroxyprogesterone caproate treatment or a placebo. Risk factors associated with spontaneous preterm birth within the entire cohort were identified by univariable analysis. Factors significantly associated (P < .05) with spontaneous preterm birth were included in a multivariable logistic regression analysis to determine whether an accurate prediction model could be developed. RESULTS: Of the 657 randomized patients, 109 (16.6%) had spontaneous preterm birth before 37 weeks' gestation. Logistic regression analysis revealed only cervical length (odds ratio, 1.06 per 1-mm decrease; 95% confidence interval, 1.02-1.10) to be associated with spontaneous preterm birth. The area under the receiver operating characteristic curve based on this regression was low (0.63; 95% confidence interval, 0.58-0.69). Results were similar for the outcome of spontaneous preterm birth before 34 weeks. CONCLUSIONS: An accurate prediction model for spontaneous preterm birth among nulliparous women with a short cervix could not be developed.
RCT Entities:
OBJECTIVES: The purpose of this study was to evaluate whether demographic and sonographic factors associated with spontaneous preterm birth among nulliparous women with a cervical length of less than 30 mm could be combined into an accurate prediction model for spontaneous preterm birth. METHODS: We conducted a secondary analysis of a trial of nulliparous women with a singleton gestation and a cervical length of less than 30 mm on transvaginal sonography between 16 and 22 weeks who lacked other risk factors for spontaneous (eg, prior cervical excisional procedure) or medically indicated (eg, chronic hypertension) preterm birth, who were randomized to either 17α-hydroxyprogesterone caproate treatment or a placebo. Risk factors associated with spontaneous preterm birth within the entire cohort were identified by univariable analysis. Factors significantly associated (P < .05) with spontaneous preterm birth were included in a multivariable logistic regression analysis to determine whether an accurate prediction model could be developed. RESULTS: Of the 657 randomized patients, 109 (16.6%) had spontaneous preterm birth before 37 weeks' gestation. Logistic regression analysis revealed only cervical length (odds ratio, 1.06 per 1-mm decrease; 95% confidence interval, 1.02-1.10) to be associated with spontaneous preterm birth. The area under the receiver operating characteristic curve based on this regression was low (0.63; 95% confidence interval, 0.58-0.69). Results were similar for the outcome of spontaneous preterm birth before 34 weeks. CONCLUSIONS: An accurate prediction model for spontaneous preterm birth among nulliparous women with a short cervix could not be developed.
Authors: William A Grobman; Elizabeth A Thom; Catherine Y Spong; Jay D Iams; George R Saade; Brian M Mercer; Alan T N Tita; Dwight J Rouse; Yoram Sorokin; Ronald J Wapner; Kenneth J Leveno; Sean Blackwell; M Sean Esplin; Jorge E Tolosa; John M Thorp; Steve N Caritis; J Peter Van Dorsten Journal: Am J Obstet Gynecol Date: 2012-09-17 Impact factor: 8.661
Authors: William A Grobman; Sharon A Gilbert; Jay D Iams; Catherine Y Spong; George Saade; Brian M Mercer; Alan T N Tita; Dwight J Rouse; Yoram Sorokin; Kenneth J Leveno; Jorge E Tolosa; John M Thorp; Steve N Caritis; J Peter Van Dorsten Journal: Obstet Gynecol Date: 2013-06 Impact factor: 7.661
Authors: Jolande Y Vis; Rosanna A Kuin; William A Grobman; Ben Willem J Mol; Patrick M M Bossuyt; Brent C Opmeer Journal: Arch Gynecol Obstet Date: 2011-04-12 Impact factor: 2.344
Authors: K B Smith-Dupont; C E Wagner; J Witten; K Conroy; H Rudoltz; K Pagidas; V Snegovskikh; M House; K Ribbeck Journal: Sci Rep Date: 2017-09-04 Impact factor: 4.379
Authors: Jenna M Mennella; Lori A Underhill; Sophia Collis; Geralyn M Lambert-Messerlian; Richard Tucker; Beatrice E Lechner Journal: Reprod Sci Date: 2020-08-17 Impact factor: 3.060