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Predictors of preterm birth.

Yves Ville1, Patrick Rozenberg2

  • 1Université Paris Descartes, EHU-PACT, Department of Obstetrics and Fetal Medicine, Hôpital Necker Enfants-Malades, 149 rue de Sèvres, 75015, Paris, France.

Best Practice & Research. Clinical Obstetrics & Gynaecology
|October 13, 2018
PubMed
Summary

Transvaginal ultrasound measurement of cervical length (CL) effectively predicts preterm birth (PTB) risk. Early screening and monitoring of CL can guide interventions, reduce complications, and avoid unnecessary hospitalizations.

Keywords:
Cervical lengthFetal fibronectinPredictionPreterm deliveryPreterm laborTransvaginal ultrasound

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Area of Science:

  • Obstetrics
  • Maternal-Fetal Medicine
  • Diagnostic Imaging

Background:

  • Cervical length (CL) measured by transvaginal ultrasound examination (TVUE) is a key predictor of preterm birth (PTB).
  • Identifying women at risk for PTB allows for timely interventions such as corticosteroids or in utero transfer.
  • Early screening improves the effectiveness of tocolysis and reduces healthcare costs.

Purpose of the Study:

  • To evaluate the role of cervical length measurement in predicting preterm birth risk.
  • To assess the utility of CL screening in various obstetric scenarios, including preterm premature rupture of membranes (PPROM) and twin pregnancies.
  • To compare the effectiveness of CL with other methods like fetal fibronectin in managing preterm labor (PTL).

Main Methods:

  • Transvaginal ultrasound examination (TVUE) for cervical length (CL) measurement.
  • Screening asymptomatic women at risk at 2-week intervals from 16 to 24 weeks gestation.
  • Monitoring CL trends, including decreases after 16 weeks and stable CL.
  • Evaluating the predictive value of CL in PPROM, twin pregnancies, and symptomatic women with PTL.

Main Results:

  • CL <10th centile indicates increased PTB risk, particularly with a decrease after 16 weeks.
  • Repeat ultrasounds enhance predictive accuracy; stable CL suggests term delivery.
  • In PPROM, CL predicts latency but not sepsis risk.
  • CL is superior to fetal fibronectin in symptomatic women and reduces unnecessary interventions in twin pregnancies.

Conclusions:

  • Transvaginal ultrasound measurement of cervical length is a reliable tool for predicting preterm birth risk.
  • Routine CL screening can optimize management, potentially avoiding up to 15% of unjustified hospitalizations and treatments for PTL.
  • CL measurement provides valuable prognostic information in PPROM and twin gestations, guiding clinical decision-making.