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Second Trimester Cervical Length and Its Association with Vaginal Birth after Cesarean Delivery
Sara S Nicholas1, Kelly M Orzechowski2, Vincenzo Berghella3
1Department of Obstetrics and Gynecology, Main Line Health Systems, Wynnewood, Pennsylvania.
Objective:
This study aims to evaluate the relationship between cervical length (CL) and trial of labor after cesarean (TOLAC) delivery.
Study Design:
This retrospective cohort study evaluated second trimester CL and likelihood of successful TOLAC. Women undergoing TOLAC from January 2009 to December 2011 who underwent transvaginal ultrasound CL between 18(0/7) to 23(6/7) weeks gestation were included. The threshold for CL was assessed using a receiver operating characteristics curve, with ≥ 45 mm determined to be the optimal threshold. Women with CL < 45 mm were compared with women with CL ≥ 45 mm with respect to TOLAC. Multivariate analysis was used to assess the association of CL with TOLAC.
Results:
A total of 45 patients met inclusion criteria, 14 (31%) with a long CL (≥ 45 mm) and 31 (69%) with CL < 45 mm. Groups did not differ in demographics or factors predictive of vaginal birth after cesarean (VBAC) delivery. More women with CL < 45 mm had successful VBAC (81%) than women with long CL (43%, relative risk 1.9, p = 0.03). Prior vaginal delivery and CL < 45 mm were both significant predictors of VBAC (odds ratio 1.8 and 2.0, respectively).
Conclusion:
CL < 45 mm is associated with VBAC.
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