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Second-trimester transvaginal ultrasound measurement of cervical length for prediction of preterm birth : a blinded prospective multicentre diagnostic accuracy study

Kuusela, P. ; Jacobsson, B. ; Hagberg, H. ; Fadl, H. ; Lindgren, P. ; Wesström, J. ; Wennerholm, Ulla-Britt and Valentin, L. LU (2021) In BJOG: An International Journal of Obstetrics and Gynaecology 128(2). p.195-206
Abstract

Objective: To estimate the diagnostic performance of sonographic cervical length for the prediction of preterm birth (PTB). Design: Prospective observational multicentre study. Setting: Seven Swedish ultrasound centres. Sample: A cohort of 11 456 asymptomatic women with a singleton pregnancy. Methods: Cervical length was measured with transvaginal ultrasound at 18–20 weeks of gestation (C×1) and at 21–23 weeks of gestation (C×2, optional). Staff and participants were blinded to results. Main outcome measures: Area under receiver operating characteristic curve (AUC), sensitivity, specificity, positive and negative predictive values (PPV and NPV), positive and negative likelihood ratios (LR+ and LR−), number of false-positive results per... (More)

Objective: To estimate the diagnostic performance of sonographic cervical length for the prediction of preterm birth (PTB). Design: Prospective observational multicentre study. Setting: Seven Swedish ultrasound centres. Sample: A cohort of 11 456 asymptomatic women with a singleton pregnancy. Methods: Cervical length was measured with transvaginal ultrasound at 18–20 weeks of gestation (C×1) and at 21–23 weeks of gestation (C×2, optional). Staff and participants were blinded to results. Main outcome measures: Area under receiver operating characteristic curve (AUC), sensitivity, specificity, positive and negative predictive values (PPV and NPV), positive and negative likelihood ratios (LR+ and LR−), number of false-positive results per true-positive result (FP/TP), number needed to screen to detect one PTB (NNS) and prevalence of ‘short’ cervix. Results: Spontaneous PTB (sPTB) at <33 weeks of gestation occurred in 56/11 072 (0.5%) women in the C×1 population (89% white) and in 26/6288 (0.4%) in the C×2 population (92% white). The discriminative ability of shortest endocervical length was better the earlier the sPTB occurred and was better at C×2 than at C×1 (AUC to predict sPTB at <33 weeks of gestation 0.76 versus 0.65, difference in AUC 0.11, 95% CI 0.01–0.23). At C×2, the shortest endocervical length of ≤25 mm (prevalence 4.4%) predicted sPTB at <33 weeks of gestation with sensitivity 38.5% (10/26), specificity 95.8% (5998/6262), PPV 3.6% (10/274), NPV 99.7% (5988/6014), LR+ 9.1, LR− 0.64, FP/TP 26 and NNS 629. Conclusions: Second-trimester sonographic cervical length can identify women at high risk of sPTB. In a population of mainly white women with a low prevalence of sPTB its diagnostic performance is at best moderate. Tweetable abstract: Cervical length screening to predict preterm birth in a white low-risk population has moderate performance.

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cervical length measurement, diagnostic screening programmes, pregnancy, preterm birth, second trimester
in
BJOG: An International Journal of Obstetrics and Gynaecology
volume
128
issue
2
pages
195 - 206
publisher
Wiley-Blackwell
external identifiers
  • pmid:32964581
  • scopus:85092674504
ISSN
1470-0328
DOI
10.1111/1471-0528.16519
language
English
LU publication?
yes
id
00bfdb9a-b847-48f5-8b84-2560ec3fb35b
date added to LUP
2020-11-11 13:19:26
date last changed
2021-06-23 03:45:56
@article{00bfdb9a-b847-48f5-8b84-2560ec3fb35b,
  abstract     = {<p>Objective: To estimate the diagnostic performance of sonographic cervical length for the prediction of preterm birth (PTB). Design: Prospective observational multicentre study. Setting: Seven Swedish ultrasound centres. Sample: A cohort of 11 456 asymptomatic women with a singleton pregnancy. Methods: Cervical length was measured with transvaginal ultrasound at 18–20 weeks of gestation (C×1) and at 21–23 weeks of gestation (C×2, optional). Staff and participants were blinded to results. Main outcome measures: Area under receiver operating characteristic curve (AUC), sensitivity, specificity, positive and negative predictive values (PPV and NPV), positive and negative likelihood ratios (LR+ and LR−), number of false-positive results per true-positive result (FP/TP), number needed to screen to detect one PTB (NNS) and prevalence of ‘short’ cervix. Results: Spontaneous PTB (sPTB) at &lt;33 weeks of gestation occurred in 56/11 072 (0.5%) women in the C×1 population (89% white) and in 26/6288 (0.4%) in the C×2 population (92% white). The discriminative ability of shortest endocervical length was better the earlier the sPTB occurred and was better at C×2 than at C×1 (AUC to predict sPTB at &lt;33 weeks of gestation 0.76 versus 0.65, difference in AUC 0.11, 95% CI 0.01–0.23). At C×2, the shortest endocervical length of ≤25 mm (prevalence 4.4%) predicted sPTB at &lt;33 weeks of gestation with sensitivity 38.5% (10/26), specificity 95.8% (5998/6262), PPV 3.6% (10/274), NPV 99.7% (5988/6014), LR+ 9.1, LR− 0.64, FP/TP 26 and NNS 629. Conclusions: Second-trimester sonographic cervical length can identify women at high risk of sPTB. In a population of mainly white women with a low prevalence of sPTB its diagnostic performance is at best moderate. Tweetable abstract: Cervical length screening to predict preterm birth in a white low-risk population has moderate performance.</p>},
  author       = {Kuusela, P. and Jacobsson, B. and Hagberg, H. and Fadl, H. and Lindgren, P. and Wesström, J. and Wennerholm, Ulla-Britt and Valentin, L.},
  issn         = {1470-0328},
  language     = {eng},
  number       = {2},
  pages        = {195--206},
  publisher    = {Wiley-Blackwell},
  series       = {BJOG: An International Journal of Obstetrics and Gynaecology},
  title        = {Second-trimester transvaginal ultrasound measurement of cervical length for prediction of preterm birth : a blinded prospective multicentre diagnostic accuracy study},
  url          = {http://dx.doi.org/10.1111/1471-0528.16519},
  doi          = {10.1111/1471-0528.16519},
  volume       = {128},
  year         = {2021},
}