Risk Factors for Early Preterm Birth in Women With Short Cervix Treated With Vaginal Progesterone [26C]. (May 2017)

• Record Type: Journal Article
• Authors: Boelig, Rupsa; Villani, Michela; Jiang, Eva; Orzechowski, Kelly; Berghella, Vincenzo
• Is Part Of: Obstetrics and gynecology. Volume 129 (2017)Supplement 1
• Publication Date: 2017-05
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/01.AOG.0000514320.45998.f6
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : INTRODUCTION: The purpose is to identify risk factors for early preterm birth (PTB), defined as less than 34 weeks, in otherwise low risk women who have a short cervix (less than or equal to 20mm) and prescribed vaginal progesterone. METHODS: Retrospective cohort study from 1/2012-12/2014 of singleton gestations without a history of prior spontaneous preterm birth who underwent cervical length (CL) screening between 18 0/7-23 6/7 weeks. Women with a short cervix who took vaginal progesterone were included. RESULTS: 3, 678 women were screened, 38 women (1.0%) were diagnosed with a short cervix, 31 accepted and were started on vaginal progesterone. Of the 31 women included, 11 women (36%) had an early PTB. Among women who had an early PTB, demographic characteristics and obstetric history were similar, however mean CL was significantly lower (11.9 ±4.0 vs 16.5 ±4.1, p=0.005) and the percent of women with a CL less than 15mm was significantly higher (82% vs 15%, p < 0.001) compared to those who delivered after 34 weeks. ROC curve demonstrated that CL was predictive of a PTB < 34 weeks with an area under the curve of 0.81 (p=0.005). CL less than 15mm was associated with an increased risk of PTB < 34 weeks with an odds ratio of 25.5 (95%CI 3.6-181.6). CONCLUSION: A cervical length less than 15mm is highly predictive of an early PTB in women with a short cervix, despite vaginal progesterone therapy. Further studies should be done in this subgroup of women to see if they would benefit from additional interventions.