Predictive Value of Midtrimester Universal Cervical Length Screening Based on Parity.

Autor: Rosenbloom JI; Department of Obstetrics and Gynecology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA., Raghuraman N; Department of Obstetrics and Gynecology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA., Temming LA; Department of Obstetrics and Gynecology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA., Stout MJ; Department of Obstetrics and Gynecology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA., Tuuli MG; Department of Obstetrics and Gynecology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA., Dicke JM; Department of Obstetrics and Gynecology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA., Macones GA; Department of Obstetrics and Gynecology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA., Cahill AG; Department of Obstetrics and Gynecology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA.
Jazyk: angličtina
Zdroj: Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine [J Ultrasound Med] 2020 Jan; Vol. 39 (1), pp. 147-154. Date of Electronic Publication: 2019 Jul 08.
DOI: 10.1002/jum.15091
Abstrakt: Objectives: To evaluate the effect of parity on performance characteristics of midtrimester cervical length (CL) in predicting spontaneous preterm birth (sPTB) before 37 weeks.
Methods: This was a retrospective cohort study of 13,508 women with no history of sPTB undergoing universal transvaginal CL screening at 17 to 23 weeks' gestation from 2011 to 2016. Patients who declined screening or with unknown delivery outcomes were excluded. Areas under the receiver operator characteristic curves were used to assess and compare the predictive ability of CL screening for sPTB. The sensitivity, specificity, and positive and negative predictive values were estimated for specific CL cutoffs for prediction of sPTB.
Results: There were 20,100 patients, of whom 2087 (10%) declined screening and 4505 (22%) did not meet inclusion criteria. Of the remaining 13,508 patients, 43% were nulliparous. The incidence rates of sPTB were 6.5% in nulliparas and 4.9% in multiparas (P < .001). The mean CLs were 39.9 mm in nulliparas and 41.8 mm in multiparas (P < .001), and those of the first percentiles were 19.0 mm in nulliparas and 24.0 mm in multiparas. Cervical length was significantly more predictive of sPTB in nulliparas (area under the curve, 0.67; 95% confidence interval, 0.63-0.70; versus 0.61, 95% confidence interval, 0.57-0.63; P = .008). At CL cutoffs of 10, 15, 20, and 25 mm or less, the sensitivity was lower in multiparas, and the specificity was comparable between the groups.
Conclusions: Midtrimester CL is less predictive of sPTB in multiparas compared to nulliparas. The poor predictive ability, especially in multiparas, calls into question the value of universal CL screening in this population.
(© 2019 by the American Institute of Ultrasound in Medicine.)
Databáze: MEDLINE
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