Affiliations 

  • 1 RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
  • 2 School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  • 3 Department of Maternal Fetal Medicine, Tengku Ampuan Rahimah Hospital, Klang, Malaysia
  • 4 Royal Hospital for Women, Sydney, New South Wales, Australia
Acta Obstet Gynecol Scand, 2018 Jun;97(6):668-676.
PMID: 29450884 DOI: 10.1111/aogs.13310

Abstract

INTRODUCTION: Cesarean section rates continue to increase globally. Prediction of intrapartum cesarean section could lead to preventive measures. Our aim was to assess the association between sonographically measured cervical length at 37 weeks of gestation and cesarean section among women planning a vaginal birth. The population was women with a low-risk pregnancy or with gestational diabetes.

MATERIAL AND METHODS: This was a prospective cohort study conducted in a tertiary referral hospital in Sydney, Australia. In all, 212 women with a low-risk pregnancy or with gestational diabetes were recruited including 158 nulliparous and 54 parous women. Maternal demographic, clinical and ultrasound characteristics were collected at 37 weeks of gestation. Semi-Bayesian logistic regression and Markov chain Monte Carlo simulation were used to assess the relation between cervical length and cesarean section in labor.

RESULTS: Rates of cesarean section were 5% (2/55) for cervical length ≤20 mm, 17% (17/101) for cervical length 20-32 mm, and 27% (13/56) for cervical length >32 mm. These rates were 4, 22 and 33%, respectively, in nulliparous women. In the semi-Bayesian analysis, the odds ratio for cesarean section was 6.2 (95% confidence interval 2.2-43) for cervical length 20-32 mm and 10 (95% confidence interval 4.8-74) for cervical length >32 mm compared with the lowest quartile of cervical length, after adjusting for maternal age, parity, height, prepregnancy body mass index, gestational diabetes, induction of labor, neonatal sex and birthweight centile.

CONCLUSIONS: Cervical length at 37 weeks of gestation is associated with intrapartum cesarean section.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.