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Cervical length screening among low-risk women; relationship of body mass index on cervical length and risk of preterm birth

Basri NI, Dasrilsyah RA, Jamil AAM, Leong CSY

BMC Pregnancy Childbirth, 2024 May 15;24(1):363.
PMID: 38750414 DOI: 10.1186/s12884-024-06552-6

BACKGROUND: Preterm birth (PTB) contributes to nearly 11% of all deliveries in the world. The majority of spontaneous preterm birth (sPTB) remains unexplained. Risk factors include abnormal body mass index (BMI), short cervical length, comorbidities and many more. However, there is limited study on the association between body mass index, cervical length and preterm birth in Malaysia among low-risk women. Hence, we aim to examine the relationship between body mass index, cervical length and the risk of spontaneous preterm birth.
METHOD: In this prospective cohort study, pregnant women between 16 and 24 weeks who fulfilled the criteria were recruited. Women with history of preterm birth were excluded. Demographic and clinical data (age, BMI, ethnicity, education level and parity) were obtained. Cervical length was measured using transvaginal scan. Patients were then followed up till delivery to determine their delivery gestation and outcome of delivery.
RESULTS: Out of 153 women who participated in this study, 146 women had cervical length of more than 30 mm, six had cervical length between 25 mm and 30 mm and one had cervical length of 24 mm. There were nine (9) cases of sPTB, with all of them being late preterm with normal midtrimester cervical length. Almost half of them (44%) were overweight/obese. A significant association was found between age, cervical length, and parity compared to BMI. Nevertheless, no significant association was seen between the BMI and risk of sPTB.
CONCLUSION: This study demonstrates a higher BMI is associated with longer cervical length, but it is not necessarily protective against sPTB. Hence, we concluded there is a limited role in cervical length screening among low-risk women regardless of their BMI in predicting sPTB.

Matched MeSH terms: Cervical Length Measurement*
Role of phIGFBP-1 and ultrasound cervical length in predicting pre-term labour

Azlin MI, Bang HK, An LJ, Mohamad SN, Mansor NA, Yee BS, et al.

J Obstet Gynaecol, 2010;30(5):456-9.
PMID: 20604646 DOI: 10.3109/01443615.2010.489162

This prospective observational study was to evaluate the efficacy of combining phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) and transvaginal ultrasound cervical length (CL) compared with either indicator alone in predicting pre-term labour (PTL). Women with singleton pregnancy between 24 and 36 weeks' gestation with evidence of PTL were subjected to phIGFBP-1 and CL tests. Of the 51 women, five were tested positive (phIGFBP-1 positive and CL <2.5 cm) for combination of phIGFBP-1 and CL (four delivered within 1 week), whereas 46 tested negative, of which, only one delivered. A much higher negative predictivity (NP), positive predictivity (PP) and specificity (SP) in the combination test was seen compared with phIGFBP-1 or CL alone (NP: 97.8% vs 97.7% vs 97.1%; PP: 80.0% vs 51.1% and CL 23.5%; SP: 97.8% vs 93.5% vs 71.1%, respectively). The cervical os dilatation of 2 cm with combined positive test (p = 0.001) indicated a higher likelihood of PTL.

Matched MeSH terms: Cervical Length Measurement*
Fulltext Insulin-like growth factor binding protein 1, Bishop score, and sonographic cervical length: tolerability and prediction of vaginal birth and vaginal birth within 24 hours following labour induction in nulliparous women

Vallikkannu N, Lam WK, Omar SZ, Tan PC

BJOG, 2017 Jul;124(8):1274-1283.
PMID: 27348806 DOI: 10.1111/1471-0528.14175

OBJECTIVE: To evaluate the tolerability of cervical insulin-like growth factor binding protein 1 (IGFBP-1) and its value as a predictor of successful labour induction, compared with Bishop score and transvaginal ultrasound (TVUS) cervical length.
DESIGN: A prospective study.
SETTING: A tertiary hospital in Malaysia.
POPULATION: A cohort of 193 term nulliparous women with intact membranes.
METHODS: Prior to labour induction, cervical fluid was obtained via a vaginal speculum and tested for IGFBP-1, followed by TVUS and finally Bishop score. After each assessment the procedure-related pain was scored from 0 to 10. Cut-off values for Bishop score and cervical length were obtained from the receiver operating characteristic (ROC) curve. Multivariable logistic regression analysis was performed.
MAIN OUTCOMES MEASURES: Vaginal delivery and vaginal delivery within 24 hours of starting induction.
RESULTS: Bedside IGFBP-1 testing is better tolerated than Bishop score, but is less well tolerated than TVUS [median (interquartile range) of pain scores: 5 (4-5) versus 6 (5-7) versus 3 (2-3), respectively; P < 0.001]. IGFBP-1 independently predicted vaginal delivery (adjusted odds ratio, AOR 5.5; 95% confidence interval, 95% CI 2.3-12.9) and vaginal delivery within 24 hours of induction (AOR 4.9; 95% CI 2.1-11.6) after controlling for Bishop score (≥4 or ≥5), cervical length (≤29 or ≤27 mm), and other significant characteristics for which the Bishop score and TVUS were not predictive of vaginal delivery after adjustment. IGFBP-1 has 81% sensitivity, 59% specificity, positive and negative predictive values of 82 and 58%, respectively, and positive and negative likelihood ratios of 2.0 and 0.3 for vaginal delivery, respectively.
CONCLUSION: IGFBP-1 better predicted vaginal delivery than BS or TVUS, and may help guide decision making regarding labour induction in nulliparous women.
TWEETABLE ABSTRACT: IGFBP-1: a stronger independent predictor of labour induction success than Bishop score or cervical sonography.

Matched MeSH terms: Cervical Length Measurement/statistics & numerical data*
Fulltext Use of the Arabin pessary in women at high risk for preterm birth: long-term experience at a single tertiary center in Malaysia

Rahman RA, Atan IK, Ali A, Kalok AM, Ismail NAM, Mahdy ZA, et al.

BMC Pregnancy Childbirth, 2021 May 10;21(1):368.
PMID: 33971828 DOI: 10.1186/s12884-021-03838-x

BACKGROUND: Spontaneous preterm birth is a global issue that contributed to perinatal morbidities and mortalities worldwide. The study aimed to describe the experience at UKM Medical Center in managing women at high risk for spontaneous preterm birth using the Arabin pessary.
METHODS: This is a retrospective observational study involving 58 pregnancies from 1st January 2013 to 31st December 2019. Inclusion criteria were previous mid-trimester miscarriage and/or preterm birth, previous cervical surgery or short cervical length on routine sonogram. The demographic data, characteristics of each pregnancy and details of outcomes and management were described.
RESULTS: The majority of women were Malay with mean age and body mass index of 32.9 ± 4.2 years and 27.1 ± 6.3 kg/m2 respectively. The most frequent indications for Arabin pessary insertion were previous mid-trimester miscarriage (46.4%) and early preterm birth (17.2%). A total of 73.4% of these women had the pessary inserted electively at a mean cervical length of 31.6 ± 9.1 mm at median gestation of 15.0 weeks. They were managed as outpatient (56.9%), inpatient (24.1%) or mixed (19.0%) with combination of progestogen (81.0%) and 53.4% received antenatal corticosteroids. Spontaneous preterm birth at or more than 34 weeks gestation occurred in 74.1% with birthweight at or more than 2000 g (82.4%). Despite cervical funneling in 12 women (20.7%), 66.7% delivered at or later than 34 weeks gestation and 2 (16.7%) resulted in miscarriage.
CONCLUSIONS: Insertion of the Arabin pessary is beneficial to prevent spontaneous preterm birth in pregnant women who are at high risk. In particular, early insertion and close monitoring allows the best possible outcomes.
TRIAL REGISTRATION: This study was retrospectively registered with ClinicalTrials.gov ( NCT04638023 ) on 20/11/2020.

Matched MeSH terms: Cervical Length Measurement