Gestational age at previous preterm birth does not affect cerclage efficacy - 19/08/11

Doi : 10.1016/j.ajog.2010.05.018

Deborah A. Wing, MD ^a, Jeff Szychowski, PhD ^b, John Owen, MD ^c, Gary Hankins, MD ^d, Jay D. Iams, MD ^e, Jeanne S. Sheffield, MD ^f, Annette Perez-Delboy, MD ^g, Vincenzo Berghella, MD ^h, Edwin R. Guzman, MD ⁱ
Vaginal Ultrasound Trial Consortium
^a Department of Obstetrics and Gynecology, University of California, Irvine, Irvine, CA
^b Department of Biostatistics and the Division of Maternal-Fetal Medicine, University of Alabama, Birmingham, AL
^c Department of Obstetrics and Gynecology, University of Alabama, Birmingham, AL
^d Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX
^e Department of Obstetrics and Gynecology, The Ohio State University Medical Center, Columbus, OH
^f Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
^g Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY
^h Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA
ⁱ Department of Obstetrics and Gynecology, Saint Peter's University Hospital, New Brunswick, NJ

Résumé

Objective

The purpose of this study was to evaluate the effect of earliest previous spontaneous preterm birth (SPTB) gestational age on cervical length, pregnancy duration, and ultrasound-indicated cerclage efficacy in a subsequent gestation.

Study Design

Planned secondary analysis of the National Institute of Child Health and Human Development–trial of cerclage for cervical length of <25 mm. Women with at least 1 previous SPTB between 17-33 weeks 6 days of gestation underwent serial vaginal ultrasound screening between 16 and 23 weeks 6 days of gestation; cervical length at qualifying randomization evaluation was used.

Results

We observed a significant correlation (P = .0008) between previous SPTB gestational age and qualifying cervical length. In a linear regression model that was controlled for cervical length and cerclage, neither previous SPTB gestational age nor the interaction between cerclage and previous birth gestational age was significant predictor of subsequent birth gestational age.

Conclusion

Although there is an association between previous SPTB gestational age and cervical length in women with a mid-trimester cervical length of <25 mm, there does not appear to be a disproportionate benefit of cerclage in women with earlier previous SPTB.

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Key words : cerclage, cervical length, earliest gestational age, spontaneous preterm birth

Plan

Materials and Methods

Results

Comment

	Reprints not available from the authors.
	Supported by the Eunice Kennedy Shriver National Institute of Child Health and Development (Grant no. U01 HD039939).
	Other members of the Vaginal Ultrasound Trial Consortium are Susan Ramin, MD; Mark Tomlinson, MD; Eric Knudtson, MD; Robert Egerman, MD; Richard Silver, MD; Helen How, MD; and Mike Gordon, MD.
	Cite this article as: Wing DA, Szychowski J, Owen J, et al. Gestational age at previous preterm birth does not affect cerclage efficacy. Am J Obstet Gynecol 2010;203:377.e1-4.

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Vol 203 - N° 4

P. 377.e1-377.e4 - octobre 2010 Retour au numéro

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Gestational age at previous preterm birth does not affect cerclage efficacy - 19/08/11

Résumé

Objective

Study Design

Results

Conclusion

Plan

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