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Am J Perinatol 2018; 35(09): 840-843
DOI: 10.1055/s-0037-1621734
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Is Uterocervical Angle Associated with Gestational Latency after Physical Exam Indicated Cerclage?

Kate Swanson
1   Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
William A. Grobman
2   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Emily S. Miller
2   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
› Institutsangaben Funding This study was funded by the Northwestern University Clinical and Translational Sciences Institute UL1TR001422 and K12 HD050121–09 (E.S.M.).
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Publikationsverlauf

01. August 2017

14. Dezember 2017

Publikationsdatum:
24. Januar 2018 (online)

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Abstract

Objective Prediction of gestational latency after placement of physical exam indicated cerclage (PEIC) is limited. Uterocervical angle (UCA) has been associated with spontaneous preterm delivery in the general population. Our objective was to examine whether UCA is associated with gestational latency in women with PEIC.

Study Design This retrospective cohort included women with a singleton gestation who had PEIC placed at a single tertiary care center between January 2010 and September 2015. Ultrasound images of the cervix obtained prior to placement of PEIC were reviewed. Spearman's correlation coefficient for the relationship between UCA and gestational latency was estimated. UCA was dichotomized at 95° and 105°. Survival analyses were performed and Cox proportional hazard ratios were calculated.

Results Sixty women met the inclusion criteria. Median gestational latency was 93 days (IQR 39–121 d). There was no significant correlation between UCA and gestational latency (Spearman's rho 0.08, p = 0.54). Survival analyses demonstrated no significant difference in gestational latency stratified by UCA ≥ 95° (HR 1.19, 95% CI 0.70–2.04) or UCA ≥ 105° (HR 0.95, 95% CI 0.56–1.63). Findings persisted after adjusting for potential confounders (aHR 1.29, 95% CI 0.74–2.23 for UCA ≥ 95° and aHR 1.04, 95% CI 0.60–1.82).

Conclusion UCA is not associated with gestational latency in women with PEIC.

Keywords

physical exam indicated cerclage - uterocervical angle - transvaginal ultrasound - gestational latency
 

  • References

  • 1 American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No.142: Cerclage for the management of cervical insufficiency. Obstet Gynecol 2014; 123 (2 Pt 1): 372-379
    CrossrefPubMedGoogle Scholar
  • 2 Curti A, Simonazzi G, Farina A, Mehmeti H, Facchinetti F, Rizzo N. Exam-indicated cerclage in patients with fetal membranes at or beyond external os: a retrospective evaluation. J Obstet Gynaecol Res 2012; 38 (12) 1352-1357
    CrossrefPubMedGoogle Scholar
  • 3 Olatunbosun OA, al-Nuaim L, Turnell RW. Emergency cerclage compared with bed rest for advanced cervical dilatation in pregnancy. Int Surg 1995; 80 (02) 170-174
    PubMedGoogle Scholar
  • 4 Daskalakis G, Papantoniou N, Mesogitis S, Antsaklis A. Management of cervical insufficiency and bulging fetal membranes. Obstet Gynecol 2006; 107 (2 Pt 1): 221-226
    CrossrefPubMedGoogle Scholar
  • 5 Ehsanipoor RM, Seligman NS, Saccone G. , et al. Physical examination-indicated cerclage: a systematic review and meta-analysis. Obstet Gynecol 2015; 126 (01) 125-135
    CrossrefPubMedGoogle Scholar
  • 6 Aoki S, Ohnuma E, Kurasawa K, Okuda M, Takahashi T, Hirahara F. Emergency cerclage versus expectant management for prolapsed fetal membranes: a retrospective, comparative study. J Obstet Gynaecol Res 2014; 40 (02) 381-386
    CrossrefPubMedGoogle Scholar
  • 7 Dziadosz M, Bennett TA, Dolin C. , et al. Uterocervical angle: a novel ultrasound screening tool to predict spontaneous preterm birth. Am J Obstet Gynecol 2016; 215 (03) 376.e1-376.e7
    CrossrefPubMedGoogle Scholar
  • 8 Knight JC, Tenbrink E, Sheng J, Patil AS. Anterior uterocervical angle measurement improves prediction of cerclage failure. J Perinatol 2017; 37 (04) 375-379
    CrossrefPubMedGoogle Scholar
  • 9 Iams JD, Goldenberg RL, Meis PJ. , et al; National Institute of Child Health and Human Development Maternal Fetal Medicine Unit Network. The length of the cervix and the risk of spontaneous premature delivery. N Engl J Med 1996; 334 (09) 567-572
    CrossrefPubMedGoogle Scholar