Women’s Obstetric History and Midtrimester Cervical Length Measurements by 2D/3D and Doppler Ultrasound

Marinelli, Juliana Valente Codato; Amorim Filho, Antonio Gomes de; Barros, Monica Fairbanks de; Rodrigues, Agatha Sacramento; Francisco, Rossana Pulcineli Vieira; Carvalho, Mario Henrique Burlacchini de

doi:10.1055/s-0040-1713010

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Revista Brasileira de Ginecologia e Obstetrícia

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Original Article • Rev. Bras. Ginecol. Obstet. 42 (09) • Sept 2020 • https://doi.org/10.1055/s-0040-1713010 copy

Women’s Obstetric History and Midtrimester Cervical Length Measurements by 2D/3D and Doppler Ultrasound

História obstétrica e medida do comprimento do colo uterino de mulheres no segundo trimestre gestacional por ultrassonografia bi/tridimensional e Doppler

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

The aim of the present study was to compare the obstetric history and both two- and tri-dimensional ultrasound parameters according to different cervical lengths.

Methods

The present cross-sectional study analyzed 248 midtrimester pregnant women according to cervical length and compared the data with the obstetric history and 2D/3D ultrasound parameters. Patients were divided into 3 groups according to cervical length: The Short Cervix group for cervical lengths ≥ 15mm and< 25mm(n= 68), the Very Short Cervix group for cervical lengths< 15mm (n = 18) and the Control group, composed of 162 pregnant women with uterine cervical lengths ≥ 25mm.

Results

When analyzing the obstetric history of only non-nulliparous patients, a significant association between the presence of a short cervix in the current pregnancy and at least one previous preterm birth was reported (p = 0.021). Cervical length and volume were positively correlated (Pearson coefficient = 0.587, p < 0.0001). The flow index (FI) parameter of cervical vascularization was significantly different between the Control and Very Short Cervix groups. However, after linear regression, in the presence of volume information, we found no association between the groups and FI. Uterine artery Doppler was also not related to cervical shortening.

Conclusion

The present study showed a significant association between the presence of a short cervix in the current pregnancy and at least one previous preterm birth. None of the vascularization indexes correlate with cervical length as an independent parameter. Uterine artery Doppler findings do not correlate with cervical length.

Keywords:
cervix uteri; cervical length measurement; pregnancy trimester, second; reproductive history; pregnancy, high-risk

Demographic characteristics			Control	Short Cervix	Very Short Cervix	p-value
			(≥ 25 mm)	(≥ 15 mm and < 25 mm)	(< 15 mm)
			n = 162	n = 68	n = 18
Maternal age (years)		Median (minimum–maximum)	31 (14–47)	29.50 (13–41)	30.50 (15–40)	0.025^* * Kruskal-Wallis Test.
Weight (kg)		Median (minimum–maximum)	69.30 (43–130.20)	66 (49–103)	68.20 (56–107.80)	0.464^* * Kruskal-Wallis Test.
Height (cm)		Median (minimum–maximum)	161 (145–178)	162.50 (152–181)	164 (150–170)	0.114^* * Kruskal-Wallis Test.
BMI (kg/m²)		Median (minimum–maximum)	26.84 (17.55–48.93)	25.97 (18–39.13)	25.53 (20.57–39.12)	0.199^* * Kruskal-Wallis Test.
Race	Caucasian	n (%)	76 (46.9%)	37 (54.4%)	9 (50%)	0.037**
	Mixed		62 (38.3%)	23 (33.8%)	2 (11.1%)
	Black		24 (14.8%)	8 (11.8%)	7 (38.9%)
Smoking		n (%)	5 (3.1%)	3 (4.4%)	0 (0%)	0.836^ Fisher Exact Test.
Gestational age at inclusion (weeks)		Median (minimum–maximum))	22.14 (20–23.86)	22.71 (20.29–23.86)	22.08 (20.14–23.86)	0.042^* * Kruskal-Wallis Test.

Obstetric history	GROUP			p-value^* * Pearson chi-square test.
	Control	Short Cervix	Very Short Cervix
	(≥ 25 mm)	(≥ 15 mm and < 25 mm)	(< 15 mm)
	n = 162	n = 68	n = 18
First pregnancy	59 (36.4%)	29 (42.6%)	8 (44.4%)	0.593
Previous delivery ^ At least one previous episode.	90 (55.60%)	29 (42.6%)	8 (44.4%)	0.169
Abortion^ At least one previous episode.	45 (27.8%)	24 (35.3%)	6 (33.3%)	0.508
Curettage^ At least one previous episode.	27 (16.7%)	18 (26.5%)	5 (27.8%)	0.178
Bleeding^* ***** At least 1 episode in the current pregnancy.	45 (27.8%)	16 (23.5%)	6 (33.3%)	0.661

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[1] Address for correspondence Mario Henrique Burlacchini de Carvalho, PhD, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Enéas Carvalho de Aguiar, 255, 05403-000, Sao Paulo, SP, Brazil (e-mail: mario.burlacchini@hc.fm.usp.br).

Parameters	Group^ Group: Control (n = 162), Short Cervix (n = 68) Very Short Cervix (n = 18).	Median	*p-value^ * Kruskal-Wallis Test.**
Parameters		min–max	*p-value^ * Kruskal-Wallis Test.**
Volume (cm3)	Control	43. 8 (23.10–100.87)	< 0.001
	Short Cervix	30.87 (7.58–69.04)
	Very Short Cervix	19.57 (5.42–47.23)
Vascularization Index (VI)	Control	4.87 (0.51–19.87)	0.656
	Short Cervix	4.10 (0.43–24.23)
	Very Short Cervix	5.89 (0.41–11.67)
Vascularization Index (FI)	Control	38.92 (29.02–69.39)	0.027
	Short Cervix	39.32 (28.45–52.44)
	Very Short Cervix	35.16 (28.71–49.24)
Vascularization Index (VFI)	Control	2.51 (0.15–7.51)	0.457
	Short Cervix	2.02 (0.13–21.13)
	Very Short Cervix	2.17 (0.12–5.31)
Right Uterine Artery (RI)	Control	0.59 (0.38–0.82)	0.075
	Short Cervix	0.59 (0.38–0.90)
	Very Short Cervix	0.68 (0.41–1.46)
Right Uterine Artery (S/D)	Control	2.46 (1.61–5.60)	0.197
	Short Cervix	2.53 (1.61–9.85)
	Very Short Cervix	3.09 (1.71–6.82)
Right Uterine Artery (PI)	Control	0.97 (0.43–2.39)	0.575
	Short Cervix	0.98 (0.48–3.26)
	Very Short Cervix	1.05 (0.47–2.77)
Left Uterine Artery (RI)	Control	0.62 (0.39–0.93)	0.356
	Short Cervix	0.63 (0.41–0.90)
	Very Short Cervix	0.59 (0.43–0.83)
Left Uterine Artery (S/D)	Control	2.61 (1.64–4.99)	0.247
	Short Cervix	2.63 (1.69–9.79)
	Very Short Cervix	2.42 (1.74–5.88)
Left Uterine Artery (PI)	Control	1.01 (0.51–2.14)	0.194
	Short Cervix	1.04 (0.55–3.94)
	Very Short Cervix	0.97 (0.61–2.45)