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.
(Less)
- author
- Kuusela, P.
; Jacobsson, B.
; Hagberg, H.
; Fadl, H.
; Lindgren, P.
; Wesström, J.
; Wennerholm, Ulla-Britt
and Valentin, L.
LU
- organization
- publishing date
- 2021
- 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
- 2024-04-17 18:32:35
@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 <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.</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}},
keywords = {{Cervical length measurement; diagnostic screening programmes; pregnancy; preterm birth; second trimester}},
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}},
}