Repeat Measurement of Cervical Length in Women with Threatened Preterm Labor

Abstract

Objective: To examine the value of a repeat measurement some days after the first cervical length measurement done at the time of preterm contractions. Study Design: Retrospective study involving women with singleton pregnancies who presented with preterm contractions at 24 to 33 + 6 weeks of gestation. The cervical length was measured at the time of presentation and some days afterwards. Results: The study population consisted of 17 cases with a preterm delivery within 14 days and 288 uneventful pregnancies. Univariate logistic regression analysis indicated a significant correlation between delivery within 14 days and both, the first and second cervical length measurements as well as the difference between the two measurements. Up to a false positive rate of 20 %, ROC curve analysis showed an improved detection rate for preterm delivery by inluding both measurements. At a false positive rate of 10 % – which corresponds to a first and second cervical length of 10 and 9 mm – the detection rate was 17.6 % with the first cervical length measurement, 47.0 % with the second and 52.9 % if the difference between both measurements was added. Conclusion: Our results indicate that in women with symptoms of preterm labor it is worth to repeat the measurement some days later and to take into account the difference between both measurements.

Zusammenfassung

Ziel: Ziel der Studie war es, bei Patientinnen mit vorzeitiger Wehentätigkeit den Nutzen einer wiederholten Messung der Zervixlänge zu prüfen. Design der Studie: Retrospektive Studie bei Frauen mit Einlingsschwangerschaften, die sich zwischen der 24 + 0 und 33 + 6 SSW wegen vorzeitiger Wehentätigkeit vorstellten. Die Zervixlänge wurde bei der Erstvorstellung sowie einige Tage danach gemessen. Ergebnisse: Untersucht wurden 17 Patientinnen, die innerhalb von 14 Tagen nach Vorstellung vorzeitig entbanden, sowie 288 Frauen mit komplikationslosen Schwangerschaften. Bei der univariaten logistischen Regressionsanalyse zeigte sich eine signifikante Korrelation zwischen vorzeitiger Entbindung innerhalb von 14 Tagen und beiden Zervixlängenmessungen sowie deren Unterschied. Die ROC-Kurvenanalyse wies bis zu einer Falsch-Positiv-Rate von 20 % eine deutlich höhere Detektionsrate für vorzeitige Entbindungen durch die Kombination der Parameter auf. Bei einer Falsch-Positiv-Rate von 10 % – die einer Zervixlänge von jeweils 10 bzw. 9 mm bei der Erst- bzw. Zweitmessung entspricht – lag die Detektionsrate bei der ersten Messung der Zervixlänge bei 17,6 %, bei der Zweitmessung bei 47,0 % und, wenn der Unterschied zwischen den beiden Messwerten mitgerechnet wurde, bei 52,9 %. Schlussfolgerung: Unsere Ergebnisse zeigen, dass es bei Frauen mit vorzeitigen Wehen nützlich sein kann, die Messung der Zervixlänge einige Tage nach der Erstmessung zu wiederholen und auf den Unterschied beider Messwerte zu achten.

Key words

labor - cervical length - ultrasonography - preterm delivery

Schlüsselwörter

Wehen - Zervixlänge - Sonografie - Frühgeburt

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