Edgar Hernandez-Andrade1,2, Eli Maymon2,3,4, Suchaya Luewan2,3,5, Gaurav Bhatti2,3, Mohammad Mehrmohammadi6, Offer Erez2,4, Percy Pacora2,3, Bogdan Done2,3, Sonia S Hassan2,3,7, Roberto Romero1,8,9,10. 1. Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Wayne State University/Hutzel Women's Hospital, 3990 John R, Box 4, Bethesda, MD and Detroit, MI 48201, USA. 2. Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA. 3. Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD and Detroit, MI, USA. 4. Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel. 5. Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. 6. Department of Biomedical Engineering, College of Engineering, Wayne State University, Detroit, MI, USA. 7. Department of Physiology, Wayne State University School of Medicine, Detroit, MI, USA. 8. Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA. 9. Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA. 10. Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA.
Abstract
OBJECTIVE: To determine whether a soft cervix identified by shear-wave elastography between 18 and 24 weeks of gestation is associated with increased frequency of spontaneous preterm delivery (sPTD). MATERIALS AND METHODS: This prospective cohort study included 628 consecutive women with a singleton pregnancy. Cervical length (mm) and softness [shear-wave speed: (SWS) meters per second (m/s)] of the internal cervical os were measured at 18-24 weeks of gestation. Frequency of sPTD <37 (sPTD<37) and <34 (sPTD<34) weeks of gestation was compared among women with and without a short (≤25 mm) and/or a soft cervix (SWS <25th percentile). RESULTS: There were 31/628 (4.9%) sPTD<37 and 12/628 (1.9%) sPTD<34 deliveries. The combination of a soft and a short cervix increased the risk of sPTD<37 by 18-fold [relative risk (RR) 18.0 (95% confidence interval [CI], 7.7-43.9); P<0.0001] and the risk of sPTD<34 by 120-fold [RR 120.0 (95% CI 12.3-1009.9); P<0.0001] compared to women with normal cervical length. A soft-only cervix increased the risk of sPTD<37 by 4.5-fold [RR 4.5 (95% CI 2.1-9.8); P=0.0002] and of sPTD<34 by 21-fold [RR 21.0 (95% CI 2.6-169.3); P=0.0003] compared to a non-soft cervix. CONCLUSIONS: A soft cervix at 18-24 weeks of gestation increases the risk of sPTD <37 and <34 weeks of gestation independently of cervical length.
OBJECTIVE: To determine whether a soft cervix identified by shear-wave elastography between 18 and 24 weeks of gestation is associated with increased frequency of spontaneous preterm delivery (sPTD). MATERIALS AND METHODS: This prospective cohort study included 628 consecutive women with a singleton pregnancy. Cervical length (mm) and softness [shear-wave speed: (SWS) meters per second (m/s)] of the internal cervical os were measured at 18-24 weeks of gestation. Frequency of sPTD <37 (sPTD<37) and <34 (sPTD<34) weeks of gestation was compared among women with and without a short (≤25 mm) and/or a soft cervix (SWS <25th percentile). RESULTS: There were 31/628 (4.9%) sPTD<37 and 12/628 (1.9%) sPTD<34 deliveries. The combination of a soft and a short cervix increased the risk of sPTD<37 by 18-fold [relative risk (RR) 18.0 (95% confidence interval [CI], 7.7-43.9); P<0.0001] and the risk of sPTD<34 by 120-fold [RR 120.0 (95% CI 12.3-1009.9); P<0.0001] compared to women with normal cervical length. A soft-only cervix increased the risk of sPTD<37 by 4.5-fold [RR 4.5 (95% CI 2.1-9.8); P=0.0002] and of sPTD<34 by 21-fold [RR 21.0 (95% CI 2.6-169.3); P=0.0003] compared to a non-soft cervix. CONCLUSIONS: A soft cervix at 18-24 weeks of gestation increases the risk of sPTD <37 and <34 weeks of gestation independently of cervical length.
Entities:
Keywords:
Acoustic radiation force impulse; cervical stiffness; dynamic elastography; preterm labor; progesterone; short cervix; ultrasound
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