Prior Uterine Evacuation and Risk of Short Cervix and Spontaneous Preterm Birth [24D

Abstract

INTRODUCTION: Prior pregnancy termination has been associated with an increased risk of spontaneous preterm birth (sPTB). However there is little data on the association between prior uterine dilation and evacuation (D&E) and the risk of a short second trimester cervical length (CL) and subsequent sPTB in otherwise low risk women. METHODS: Retrospective cohort of singletons with no prior sPTB who underwent CL screening between 18 0/7–23 6/7 weeks from 1/2012–3/2014. Demographic, obstetric, and delivery outcome data were collected. Risk for short CL (≤20 mm) in women with and without a prior D&E were compared with odds ratio adjusted (aOR) for confounders. Among women with a short CL, the risk of sPTB for those with and without a prior D&E was also assessed. RESULTS: 2215 women were included, of those 26 (1.2%) women with a short CL and 596 (27%) had a prior D&E. Women with a short CL were more likely to be African American (69% vs 49%, P=.029). Women with a prior D&E were more likely to have a short CL (2.2% vs 0.7%, P<.01, aOR 2.8 [1.21–6.62]). Women with a short CL and prior D&E were more likely to have a sPTB (85% vs 40%, P=.039; aOR 23.9 [1.05–543.7]) than those with a short CL and no prior D&E. CONCLUSION: Women with prior D&E are at increased risk of a short CL. Furthermore, with a short CL they are at significantly higher risk of sPTB than those with a short CL without prior D&E.