First trimester cervical length is associated with mid-trimester loss
Ioannis Papastefanou1,2, Ioannis Kavalakis3, Athanasios Pilalis1,2
1a Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology , Athens Medical School, National and Kapodistrian University of Athens, 'Attikon' University Hospital , Athens , Greece .
Summary
First trimester cervical length (CL) measurement can predict second trimester miscarriage. Shorter CL in early pregnancy is associated with a higher risk of late miscarriage, aiding in early risk assessment.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Diagnostic Ultrasound
Background:
- Second trimester miscarriage poses significant risks to maternal health.
- Accurate prediction of miscarriage allows for timely intervention and improved outcomes.
- Early identification of at-risk pregnancies is crucial for effective prenatal care.
Purpose of the Study:
- To evaluate the predictive value of first trimester cervical length (CL) measurement for second trimester miscarriage (16-24 weeks).
- To determine if transvaginal ultrasound assessment of CL in early pregnancy can identify women at risk for late pregnancy loss.
Main Methods:
- A prospective study involving routine obstetric population.
- Transvaginal ultrasound was used to measure endocervical canal length between 11-14 weeks gestation.
- Statistical analysis, including Mann-Whitney U test and logistic regression, was performed to assess CL's predictive accuracy.
Main Results:
- A total of 2836 singleton pregnancies were analyzed.
- Women experiencing second trimester miscarriage (16-24 weeks) had significantly shorter cervical lengths (median 28mm) compared to those delivering after 34 weeks (median 32mm).
- First trimester CL was a significant predictor of late miscarriage (AUC=0.7838, p<0.001), with a 63.64% detection rate at a 20% screen positive rate.
Conclusions:
- First trimester cervical length is significantly shorter in women who subsequently experience a second trimester miscarriage.
- In low-risk singleton pregnancies, early CL measurement is a valuable tool for predicting mid-trimester pregnancy loss.
- This finding supports the use of first trimester ultrasound for enhanced miscarriage risk stratification.
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