Midpregnancy Cervical Length in Nulliparous Women and its Association with Postterm Delivery and Intrapartum Cesarean Delivery

A. J. van der Ven; M. A. van Os; C. E. Kleinrouweler; C. J. M. Verhoeven; E. de Miranda; P. M. Bossuyt; C. J. M. de Groot; M. C. Haak; E. Pajkrt; B. W. J. Mol; B. M. Kazemier

doi:10.1055/s-0035-1556067

American Journal of Perinatology, Table of Contents

Am J Perinatol 2016; 33(01): 040-046
DOI: 10.1055/s-0035-1556067

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Midpregnancy Cervical Length in Nulliparous Women and its Association with Postterm Delivery and Intrapartum Cesarean Delivery

A. J. van der Ven

¹Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands

,

M. A. van Os

²Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands

,

C. E. Kleinrouweler

¹Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands

,

C. J. M. Verhoeven

³Department of Obstetrics and Gynaecology, Máxima Medical Center, Veldhoven, The Netherlands

⁴Department of Midwifery Science, AVAG/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands

,

E. de Miranda

¹Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands

,

P. M. Bossuyt

⁵Department of Clinical Epidemiology, Biostatistics and Bioinformatics (KEBB), Academic Medical Center, Amsterdam, The Netherlands

,

C. J. M. de Groot

²Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands

,

M. C. Haak

⁶Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands

,

E. Pajkrt

¹Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands

,

B. W. J. Mol

⁷The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Australia

,

B. M. Kazemier

¹Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands

› Author Affiliations

Abstract

Objective To evaluate the association between midpregnancy cervical length and postterm delivery and cesarean delivery during labor.

Study Design In a multicenter cohort study, cervical length was measured in low-risk singleton pregnancies between 16 and 22 weeks of gestation. From this cohort, we identified nulliparous women who delivered beyond 34 weeks and calculated cervical length quartiles. We performed logistic regression to compare the risk of postterm delivery and intrapartum cesarean delivery to cervical length quartiles, using the lowest quartile as a reference. We adjusted for induction of labor, maternal age, ethnicity, cephalic position, preexisting hypertension, and gestational age at delivery.

Results We studied 5,321 nulliparous women. Women with cervical length in the 3rd and 4th quartile were more likely to deliver at 42⁺⁰ to 42⁺⁶ weeks (adjusted odds ratio [aOR] 2.02, 95% confidence interval [CI] 1.07–3.79 and aOR 1.97, 95% CI 1.06–3.67, respectively). The frequency of intrapartum cesarean delivery increased with cervical length quartile from 9.4% in the 1st to 14.9% in the 4th quartile (p = 0.01). This increase was only present in intrapartum cesarean delivery because of failure to progress and not because of fetal distress.

Conclusion The longer the cervix at midtrimester the higher the risk of both postterm delivery and intrapartum cesarean delivery.

Keywords

cervical length - postterm delivery - cesarean section - cohort study

Full Text

References

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