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Obstetrics & Gynecology 2004;103:457-462
© 2004 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Second-Trimester Cervical Sonography: Features Other Than Cervical Length to Predict Spontaneous Preterm Birth

Nicole P. Yost, MD, John Owen, MD, Vincenzo Berghella, MD, Cora MacPherson, PhD, Melissa Swain, RN, Gary A. Dildy, III, MD, Menachem Miodovnik, MD, Oded Langer, MD and Baha Sibai, MD for the National Institute of Child Health Human Development, Maternal–Fetal Medicine Units Network*

From the Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, Pennsylvania; The Biostatistics Center, George Washington University, Bethesda, Maryland; Department of Obstetrics and Gynecology, Wake Forest University School of Medicine, Winston-Salem, North Carolina; Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah; Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, Ohio; Department of Obstetrics and Gynecology, University of Texas at San Antonio, San Antonio, Texas; and Department of Obstetrics and Gynecology, University of Tennessee, Memphis, Tennessee.

Address reprint requests to: Nicole P. Yost, MD, University of Texas Southwestern Medical Center, Department of Obstetrics and Gynecology, 5323 Harry Hines Boulevard, Dallas, TX 75390–9032; e-mail: Nicole.Yost{at}utsouthwestern.edu.

OBJECTIVE: To estimate whether cervical and lower uterine segment characteristics other than cervical length and funneling predict recurrent preterm birth.

METHODS: We conducted a secondary analysis of a multicenter, blinded observational study of 181 women with singletons and prior spontaneous preterm births. Endovaginal ultrasonic examinations were performed at 2-week intervals between 16 0/7 weeks and 23 6/7 weeks of gestation. Cervical canal contour (straight/curved), cervical position (horizontal/vertical), posterior cervical width, lower uterine segment thickness, vascularity, endocervical canal dilation, with or without associated membrane prolapse and chorioamnion visible at the internal os, were systematically assessed.

RESULTS: At the initial sonogram (16 0/7–18 6/7 weeks), membranes visible overlying the internal os (relative risk 1.9, confidence interval [CI] 1.2, 3.1) and canal dilation of 2–4 mm (relative risk 2.6, CI 1.4, 4.7) were significant predictors of spontaneous preterm birth of less than 35 weeks in univariate analyses. Only canal dilation remained statistically significant after controlling for cervical length (odds ratio 5.5, CI 1.1, 28.6).

CONCLUSION: Endocervical canal dilation of 2–4 mm during second-trimester endovaginal sonography was associated with an increased risk of recurrent preterm delivery independent of cervical length.

LEVEL OF EVIDENCE: II-2






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