Does Hospitalization Prevent Preterm Delivery in the Patient with a Short Cervix?

Abstract

This study considers whether admission to the hospital of a patient diagnosed with a short cervix delayed delivery, prevented preterm delivery, and/or decreased the rate of change in the cervical length (CL) on follow-up measurements. The design was a retrospective cohort study of women carrying singleton pregnancies with cervical lengths <or= 25 mm at gestational ages 16 to 28 weeks managed expectantly from July 2002 through July 2005. Eighty-two patients met criteria for inclusion, 26 (32%) of whom were hospitalized. On univariate analysis, hospitalization correlated with delivery < 34 weeks ( p=0.027), an earlier gestational age (GA) at delivery ( p=0.046), and a shorter time from diagnosis to delivery ( p< .001). Multivariate regression analysis of significant factors (age, prior preterm births, initial CL, GA at diagnosis, and hospitalization) showed a correlation between hospitalization and increased rate of cervical shortening ( p=0.005), and a trend toward hospitalization as an independent risk factor for delivery less than 34 weeks ( p=0.066), an earlier GA at delivery ( p=0.058), and a shorter time from diagnosis to delivery ( p=0.078). There also was no benefit seen from hospitalization when the initial CL was < 15 mm, although we were underpowered for this analysis. Admission to the hospital was not associated with a decreased rate of preterm delivery and there was a trend toward hospitalization as an independent risk factor for delivery at < 34 weeks, an earlier GA at delivery, and a shorter time from diagnosis to delivery. Hospitalization was independently associated with an increased rate of cervical shortening.