The association of a cervical length of <25 mm in high-risk pregnancies on neonatal morbidity and mortality in preterm infants
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- Oncel, M.Y., Arayici, S., Celen, S. et al. Arch Gynecol Obstet (2013) 287: 893. doi:10.1007/s00404-012-2678-7
To evaluate and compare the effects of a short cervix (<25 mm) on neonatal morbidity and mortality as opposed to a normal cervical length (≥25 mm). The predictive value of a short cervix on neonatal outcome is also investigated.
Preterm infants who were admitted to the neonatal intensive care unit and whose mothers had undergone a pre-delivery evaluation for cervical length (CL) and cervical cultures were included in the study. Infants were stratified into two groups based on CL measurements (Group 1, CL < 25 mm; Group 2, CL ≥ 25 mm).
A total of 203 infants were included in the final analysis. Group 1 consisted of 105 neonates while Group 2 had 98 newborns. Cervical culture positivity rate was 46.7 % (n = 49) in Group 1 compared to 19.4 % (n = 19) in Group 2 (p = 0.0001). Frequencies of early onset neonatal sepsis (EOS) in Group 1 and Group 2 were 31.5 and 18.4 %, respectively (p = 0.032), whereas respective frequencies of proven sepsis in the two groups were 18.1 and 8.2 % (p = 0.037). A CL < 25 mm was found to increase the risk of cervical culture positivity, EOS and proven EOS by odds ratios of 3.63, 2.03 and 2.48, respectively.
This is the first clinical study to demonstrate a significant link between CL and each of cervical culture positivity, EOS and neonatal morbidity and mortality. Preterm infants born to high-risk mothers with short CL should be monitored closely for the risk of EOS.