Reference range of the weekly uterine cervical length at 8 to 38 weeks of gestation in the center of Iran

Jafari-Dehkordi, Esmat; Adibi, Atoosa; Sirus, Mehri

Reference range of the weekly uterine cervical length at 8 to 38 weeks of gestation in the center of Iran

Authors

Department of Radiology, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: There is an inverse relation between the uterine cervical length during pregnancy and the frequency of preterm delivery. The purpose of this study was to construct a chart and evaluate the cervical length at 8 to 38 weeks of normal gestation in the center of Iran.
Materials and Methods: Uterine cervical length was measured on 930 asymptomatic pregnant women by abdominal ultrasonographic technique. For statistical evaluation, regression analysis and calculation of percentiles were performed.
Results: Our data show a significant decrease in uterine cervical length with increasing gestational age. The mean uterine cervical length exhibits minimal changes from 10 to 24 weeks for most women in this study, although the shortening is more prominent at 33 to 38 weeks' gestation. The mean shortening of the uterine cervical length between the second and the ninth months was 14.82% (P < 0.05). Also, the cervical length means in trimesters 1, 2 and 3 were 39.30 ± 4.33, 38.28 ± 5.13 and 36.58 ± 4.58 mm, respectively. The third trimester showed a significant reduction (P < 0.05) in cervical length compared to the first and second trimesters (6.92% and 4.44%, respectively). New charts with the 5 ^th , 10 ^th , 50 ^th , 90 ^th , and 95 ^th percentile are presented.
Conclusion: Our study provides a new chart and reference values for normal uterine cervical length throughout gestation based on a large sample in the center of Iran. There was a progressive decrease in mean uterine cervical length with increasing gestational age in the population of this study. Our established charts for uterine cervical length throughout gestation might be more useful than a single cut-off value for more efficient prevention and management of preterm birth.

Keywords

References

1.	Slager J, Lynne S. Assessment of cervical length and the relationship between short cervix and preterm birth. J Midwifery Womens Health 2012;57(Suppl 1):S4-11.
2.	Vaisbuch E, Romero R, Mazaki-Tovi S, Erez O, Kusanovic JP, Mittal P, et al. The risk of impending preterm delivery in asymptomatic patients with a nonmeasurable cervical length in the second trimester. Am J Obstet Gynecol 2010;203:446.e1-9.
3.	Pandis GK, Papageorghiou AT, Ramanathan VG, Thompson MO, Nicolaides KH . Preinduction sonographic measurement of cervical length in the prediction of successful induction of labor. Ultrasound Obstet Gynecol 2001;18:623-8.
4.	Roman H, Verspyck E, Vercoustre L, Degre S, Col JY, Firmin JM, et al. Does ultrasound examination when the cervix is unfavorable improve the prediction of failed labor induction? Ultrasound Obstet Gynecol 2004;23:357-62.
5.	Berghella V, Tolosa JE, Kuhlman K, Weiner S, Bolognese RJ, Wapner RJ . Cervical ultrasonography compared with manual examination as a predictor of preterm delivery. Am J Obstet Gynecol 1997;177:723-30.
6.	Carvalho MH, Bittar RE, Brizot ML, Maganha PP, Borges da Fonseca ES, Zugaib M. Cervical length at 11-14 weeks' and 22-24 weeks' gestation evaluated by transvaginal sonography, and gestational age at delivery. Ultrasound Obstet Gynecol 2003;21:135-9.
7.	Saul LL, Kurtzman JT, Hagemann C, Ghamsary M, Wing DA . Is transabdominal sonography of the cervix after voiding a reliable method of cervical length assessment? J Ultrasound Med 2008;27:1305-11.
8.	Silva SV, Damiao R, Fonseca EB, Garcia S, Lippi UG . Reference ranges for cervical length by transvaginal scan in singleton pregnancies. J Matern Fetal Neonatal Med 2010;23:379-82.
9.	Hoesli I, Tercanli S, Holzgreve W. Cervical length assessment by ultrasound as a predictor of preterm labour−is there a role for routine screening? Bjog 2003;110(Suppl 20):61-5.
10.	Salomon LJ, Diaz-Garcia C, Bernard JP, Ville Y . Reference range for cervical length throughout pregnancy: Non-parametric LMS-based model applied to a large sample. Ultrasound Obstet Gynecol 2009;33:459-64.
11.	To MS, Skentou C, Liao AW, Cacho A, Nicolaides KH. Cervical length and funneling at 23 weeks of gestation in the prediction of spontaneous early preterm delivery. Ultrasound Obstet Gynecol 2001;18:200-3.
12.	Crane JM, Hutchens D. Transvaginal sonographic measurement of cervical length to predict preterm birth in asymptomatic women at increased risk: A systematic review. Ultrasound Obstet Gynecol 2008;31:579-87.
13.	Demirci O, Unal A, Demirci E, Sozen H, Akdemir Y, Boybek E, et al. Sonographic measurement of cervical length and risk of preterm delivery. J Obstet Gynaecol Res 2011;37:809-14.
14.	Guzman ER, Mellon C, Vintzileos AM, Ananth CV, Walters C, Gipson K. Longitudinal assessment of endocervical canal length between 15 and 24 weeks' gestation in women at risk for pregnancy loss or preterm birth. Obstet Gynecol 1998;92:31-7.
15.	Hernandez-Andrade E, Romero R, Ahn H, Hussein Y, Yeo L, Korzeniewski SJ, et al. Transabdominal evaluation of uterine cervical length during pregnancy fails to identify a substantial number of women with a short cervix. J Matern Fetal Neonatal Med 2012;25:1682-9.
16.	Souka AP, Papastefanou I, Michalitsi V, Salambasis K, Chrelias C, Salamalekis G, et al. Cervical length changes from the first to second trimester of pregnancy, and prediction of preterm birth by first-trimester sonographic cervical measurement. J Ultrasound Med 2011;30:997-1002.
17.	Scheerer L, Bartolucci L. Ultrasound evaluation of the cervix. In: Callen PW, editor. Ultrasonography in obstetrics and gynecology. 4 ^th ed. Philadelphia, PA: WB Saunders; 2000.
18.	Guyer B, Hoyert DL, Martin JA, Ventura SJ, MacDorman MF, Strobino DM . Annual summary of vital statistics−1998. Pediatrics 1999;104:1229-46.
19.	Andersen HF, Nugent CE, Wanty SD, Hayashi RH . Prediction of risk for preterm delivery by ultrasonographic measurement of cervical length. Am J Obstet Gynecol 1990;163:859-67.
20.	Di Tommaso M, Berghella V. Cervical length for the prediction and prevention of preterm birth. Expert Rev Obstet Gynecol 2013;8:345-55.
21.	Hibbard JU, Tart M, Moawad AH. Cervical length at 16-22 weeks' gestation and risk for preterm delivery. Obstet Gynecol 2000;96:972-8.
22.	Iams JD, Goldenberg RL, Meis PJ, Mercer BM, Moawad A, Das A, et al. The length of the cervix and the risk of spontaneous premature delivery. National Institute of Child Health and Human Development Maternal Fetal Medicine Unit Network. N Engl J Med 1996;334:567-72.
23.	Ozdemir I, Demirci F, Yucel O, Erkorkmaz U . Ultrasonographic cervical length measurement at 10-14 and 20-24 weeks gestation and the risk of preterm delivery. Eur J Obstet Gynecol Reprod Biol 2007;130:176-9.
24.	Norman JE. Preterm labour. Cervical function and prematurity. Best Pract Res Clin Obstet Gynaecol 2007;21:791-806.

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