Validating staging criteria for sonographic and physical examination for cervical changes at

Abstract

BackgroundPreterm birth represents a significant clinical challenge, and the ability to predict it effectively is a priority in obstetrics. The cervix undergoes specific changes during pregnancy, and staging these changes may offer a valuable predictive model for preterm birth, particularly in women with a mid-trimester short cervical length. ObjectiveThe study aims to validate a proposed staging model for asymptomatic women with mid-trimester short cervical length and evaluate its potential in predicting preterm birth. The integration of cervical examination and inspection with cervical length measurement was a novel approach to be assessed. Study DesignA multi-center retrospective cohort study included 925 pregnant women with a singleton fetus and a mid-trimester cervical length measurement of 25 mm or less. Cervical conditions were assessed using ultrasound, speculum, and physical examination, and classified according to five cervical staging to correlate with the likelihood of preterm birth. Statistical analyses included Kaplan-Meier Survival Analysis to illustrate the time-to-event characteristics across the five stages, and density plot evaluation to visualize the distribution of gestational ages within the stages. ResultsThe staging model included five stages based on cervical length, appearance, and dilatation. Among the 925 participants, 649 were classified as Stage 1, 245 as Stage 2, 18 as Stage 3, 10 as Stage 4, and 3 as Stage 5. The observed rates of preterm birth before 37 weeks for individuals classified in Stages 1, 2, 3, 4, and 5 were 22.3%, 26.5%, 44.4%, 60%, and 66.7%, respectively (p = 0.005). The overall observed rates of preterm birth before 28, 32, 34, and 37 weeks’ gestation were 5.5%, 9.9%, 12.2%, and 24.1%, respectively (p = 0.005). ConclusionsThis study validates the proposed staging criteria as an effective predictor of preterm birth due to cervical insufficiency. The results demonstrate a significant increase in the preterm birth rate with advancing stage classifications, indicating that the staging effectively stratifies women based on their risk of preterm birth, and highlighting the potential utility for targeted interventions. Implementing these staging criteria can potentially improve the counseling and management of pregnant women at risk for preterm birth.