Natural History of Cervical Funneling in Women at High Risk for Spontaneous Preterm Birth.
From: Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. vincenzo.berghella@jefferson.edu
Obstetrics and gynecology
- Publish Date: Apr 2007
- ISSN: 0029-7844
- Volume: 109
- Issue: 4
- Pages: 863-9
- Medium: Print
- Language: English
- Citation (JAMA): Berghella Vincenzo, Owen John, MacPherson Cora, et al. Natural History of Cervical Funneling in Women at High Risk for Spontaneous Preterm Birth.. Apr 2007;109:863-9
Abstract
OBJECTIVE: To estimate the natural history of funneling in the second trimester by transvaginal ultrasonograms and whether funneling increases the risk of spontaneous birth. METHODS: Secondary analysis of a blinded, multi-center observational study of women with at least one prior spontaneous preterm birth at 16.0-31.9 weeks who subsequently carried singleton gestations. Cervical length, funneling (membrane prolapse greater than or equal to 5 mm), funnel shape, and dynamic changes were recorded at 16-18 weeks, and then every 2 weeks until 23.9 weeks. Managing obstetricians were blinded to the ultrasonography results. The primary outcome was gestational age at delivery. RESULTS: Five hundred ninety scans were performed in 183 women, of which 60 (33%) had funneling observed on at least one of the serial evaluations. These 60 women delivered at an earlier gestational age at delivery than the 123 women without funneling (31.7+/-7.9 weeks compared with 36.9+/-4.4 weeks; P<.001). In the 60 women with funneling on at least one evaluation, the progression over time of internal os cervical anatomy from a “T” to a “V” to a “U” shape was associated with earlier gestational age at delivery, whereas resolution of “V” shape funnels was associated with term delivery. Women with a shortened cervical length less than 25 mm (n=60) had a similar gestational age at birth with or without funneling (30.6+/-8.0 weeks compared with 31.9+/-6.6 weeks; P=.59). After controlling for the shortest observed cervical length, largest funnel percent was not a significant independent risk factor. CONCLUSION: The natural history of second-trimester funneling has significant variability and a significant association with earlier gestational age at delivery. As an independent finding, funneling does not add appreciably to the risk of early gestational age at delivery associated with a shortened cervical length. LEVEL OF EVIDENCE: II.
Mesh Headings (Keywords): Adult, Cervix Uteri, Female, Gestational Age, Humans, Pregnancy, Pregnancy Trimester, Second, Premature Birth, Risk Factors, Uterine Prolapse
Check for Full Text / PubMed Unique Identifier (PMID): 17400847
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