First-Trimester Screening for Spontaneous Preterm Delivery with Maternal Characteristics and Cervical LengthGreco E. · Gupta R. · Syngelaki A. · Poon L.C.Y. · Nicolaides K.H.
aHarris Birthright Research Centre of Fetal Medicine, King’s College Hospital, and bDepartment of Fetal Medicine, University College Hospital, London, and cDepartment of Fetal Medicine, Medway Maritime Hospital, Gillingham, UK
Objective: It was the aim of this study to examine the potential value of cervical length at 11–13 weeks’ gestation in the prediction of spontaneous preterm delivery. Methods: This was a screening study for spontaneous preterm delivery in singleton pregnancies from cervical length measured by transvaginal ultrasound at 11–13 weeks’ gestation. The performance of screening for preterm delivery by cervical length alone and with maternal characteristics was estimated. Results: In the 9,974 pregnancies included in the study, spontaneous delivery before 34 weeks occurred in 104 (1.0%) cases. Multivariate regression analysis in the term delivery group demonstrated that for the log10 cervical length, significant independent contributions were provided by fetal crown-rump length, maternal height, age, racial origin and parity. The median cervical length multiple of the median (MoM), corrected for maternal characteristics, was significantly lower in the preterm (0.892 MoM, 95% CI 0.829–0.945) than in the term delivery group (0.994 MoM, 95% CI 0.919–1.082; p < 0.0001). In screening by a combination of maternal characteristics and cervical length, the estimated detection rate of preterm delivery was 54.8% (95% CI 44.7–64.6), at a false-positive rate of 10%. Conclusions: Effective first-trimester screening for spontaneous early preterm delivery can be provided by a combination of maternal characteristics and cervical length.
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