Cervical length distribution and other sonographic ancillary findings of singleton nulliparous patients at midgestation - 16/03/21

Doi : 10.1016/j.ajog.2021.02.017

Maged M. Costantine, MD ^a,^⁎ , Lynda Ugwu, PhD ^b, William A. Grobman, MD, MBA ^c, Brian M. Mercer, MD ^d, Alan T.N. Tita, MD, PhD ^e, Dwight J. Rouse, MD ^f, Yoram Sorokin, MD ^g, Ronald J. Wapner, MD ^h, Sean C. Blackwell, MD ⁱ, Jorge E. Tolosa, MD, MSCE ^j, John M. Thorp, MD ^k, Steve N. Caritis, MD ^l
On behalf of the
Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
A. Peaceman, M. Dinsmoor, G. Mallett, J. Senka, F. Johnson, J. Iams, D. Cline, C. Latimer, S. Frantz, S. Fyffe, P. Shubert, L. Gerwig, C. Milluzzi, W. Dalton, J. Russo, S. Myers, T. Waters, T. Dotson, W. Andrews, A. Northen, J. Sheppard, J. Grant, D. Rouse, D. Allard, J. Hunt, J. Tillinghast, M. Bethelemy, D. Gardner, C. Duquette, N. Hauff, G. Norman, M. King, RDMS, D. Allen, RDMS, T. Smith, R. Miller, S. Bousleiman, L. Plante, C. Tocci, A. Ranzini, M. Lake, M. Hoffman, S. Lynch, J. Dashe, K. Leveno, L. Moseley, J. Kingsbery, V. Bludau, R. Benezue, F. Ortiz, P. Givens, B. Rech, C. Moran, P. Reed, K. Hill, M.W. Varner, M.S. Esplin, A. Weaver, S. Alexander, D. Thompson-Garbrecht, J. Miller, R. Acosta, C. Flores, M. Ricon, W. Smith, S. Butcher, S. Segel, L. Pereira, K. Dorman, K. Pena-Centeno, K. Clark, S. Timlin, M.H. Birkland, H. Simhan, P. Cotroneo, R. Zubic, D. Nowinski, E. Thom, S. Gilbert, A. Lozitska, C. Spong, S. Tolivaisa, J.P. VanDorsten

^a Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, TX
^b Department of Obstetrics and Gynecology, George Washington University Biostatistics Center, Washington, DC
^c Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL
^d Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
^e Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
^f Department of Obstetrics and Gynecology, Brown University, Providence, RI
^g Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
^h Department of Obstetrics and Gynecology, Columbia University, New York, NY
ⁱ Department of Obstetrics and Gynecology, The University of Texas Health Science Center at Houston, Children’s Memorial Hermann Hospital, Houston, TX
^j Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR
^k Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC
^l Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA

^∗Corresponding author: Maged M. Costantine, MD.

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Abstract

Background

Short cervix at midgestation, the presence of intraamniotic debris, and cervical funneling are risk factors for preterm birth; however, cervical length measurements and cutoffs are not well documented among pregnant patients of different gestational ages and self-reported races and ethnicities.

Objective

This study aimed to describe the distribution of cervical length and frequency of funneling and debris at midgestation in nulliparous women by gestational age and race/ethnicity.

Study Design

This secondary analysis of screening data from a multicenter treatment trial of singleton nulliparous patients with short cervix was conducted at 14 geographically distributed, university-affiliated medical centers in the United States. Singleton nulliparous patients with no known risk factors for preterm birth were screened for trial participation and asked to undergo a transvaginal ultrasound to measure cervical length by a certified sonographer. The distribution of cervical length and the frequency of funneling and debris were assessed for each gestational age week (16–22 weeks) and stratified by self-reported race and ethnicity, which for this study were categorized as white, black, Hispanic, and other. Patients enrolled in the randomized trial were excluded from this analysis.

Results

A total of 12,407 nulliparous patients were included in this analysis. The racial or ethnic distribution of the study participants was as follows: white, 41.6%; black, 29.6%; Hispanic, 24.2%; and others, 4.6%. The 10th percentile cervical length for the entire cohort was 31.1 mm and, when stratified by race and ethnicity, 31.9 mm for white, 30.2 mm for black, 31.4 mm for Hispanic, and 31.2 mm for patients of other race and ethnicity (P<.001). At each gestational age, the cervical length corresponding to the tenth percentile was shorter in black patients. The 25 mm value commonly used to define a short cervix and thought to represent the 10th percentile ranged from 1.3% to 5.4% across gestational age weeks and 1.0% to 3.8% across race and ethnicity groups. Black patients had the highest rate of funneling (2.6%), whereas Hispanic and black patients had higher rates of intraamniotic debris than white and other patients (P<.001).

Conclusion

Black patients had shorter cervical length and higher rates of debris and funneling than white patients. The racial and ethnic disparities in sonographic midtrimester cervical findings may provide insight into the racial disparity in preterm birth rates in the United States.

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Key words : cervical funneling, ethnicity, intraamniotic debris, preterm birth, race, short cervix

Plan

Results and research and clinical implications

Strengths and limitations

Conclusions

	The other members of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network are listed in the Appendix.
	The authors report no conflict of interest.
	The project described was supported by grants from the Eunice Kennedy ShriverNational Institute of Child Health and Human Development (HD21410, UL1 RR024153; UL1 TR000005; HD27869, HD27915, HD27917, HD34116, HD34208, 5UL1RR025764, U10HD36801, HD40500, HD40512, HD40544, M01 RR00080, UL1 RR024989 (NCRR), HD40545, HD40560, HD40485, HD53097, HD53118). The comments and views of the authors do not necessarily represent the official views of the National Institutes of Health.
	Cite this article as: Costantine MM, Ugwu L, Grobman WA, et al. Cervical length distribution and other sonographic ancillary findings of singleton nulliparous patients at midgestation. Am J Obstet Gynecol 2021;XX:x.ex–x.ex.