The association of a cervical length of <25 mm in high-risk pregnancies on neonatal morbidity and mortality in preterm infants
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.
KeywordsCervical length Cervical culture Neonatal sepsis Neonatal morbidity Neonatal mortality
- 1.Spong C (2007) Prediction and prevention of recurrent spontaneous preterm birth. Obstet Gynecol 110:415Google Scholar
- 2.Owen J, Yost N, Berghella V, Thom E, Swain M, Dildy GA 3rd, Miodovnik M, Langer O, Sibai B, McNellis D, for the National Institute for Child Health and Human Development Maternal Fetal Medicine Unit Network (2001) Mid-trimester endovaginal sonography in women at high risk for spontaneous preterm birth. JAMA 286:1340–1348PubMedCrossRefGoogle Scholar
- 8.Rizzo G, Capponi A, Angelini E, Vlachopoulou A, Grassi C, Romanini C (1998) The value of transvaginal ultrasonographic examination of the uterine cervix in predicting preterm delivery in patients with preterm premature rupture of membranes. Ultrasound Obstet Gynecol 11:23–29PubMedCrossRefGoogle Scholar
- 10.Owen J, Szychowski JM, Hankins G, Iams JD, Sheffield JS, Perez-Delboy A, Berghella V, Wing DA, Guzman ER, Vaginal Ultrasound Trial Consortium (2010) Does midtrimester cervical length ≥25 mm predict preterm birth in high-risk women? Am J Obstet Gynecol 203:393.e1–e5Google Scholar
- 15.Kiefer DG, Keeler SM, Rust OA, Wayock CP, Vintzileos AM, Hanna N (2009) Is midtrimester short cervix a sign of intraamniotic inflammation? Am J Obstet Gynecol 200:374.e1–e5Google Scholar
- 16.Rizzo G, Capponi A, Vlachopoulou A, Angelini E, Grassi C, Romanini C (1998) Ultrasonographic assessment of the uterine cervix and interleukin-8 concentrations in cervical secretions predict intrauterine infection in patients with preterm labor and intact membranes. Ultrasound Obstet Gynecol 12:86–92PubMedCrossRefGoogle Scholar
- 19.Gomez R, Galasso M, Romero R, Mazor M, Sorokin Y, Goncalves L, Treadwell M (1994) Ultrasonographic examination of the uterine cervix is better than cervical digital examination as a predictor of the likelihood of premature delivery in patients with preterm labor and intact membranes. Am J Obstet Gynecol 24:554–557Google Scholar
- 21.Gomez R, Romero R, Nien JK, Chaiworapongsa T, Medina L, Kim YM, Yoon BH, Carstens M, Espinoza J, Iams JD, Gonzalez R (2005) A short cervix in women with preterm labor and intact membranes: a risk factor for microbial invasion of the amniotic cavity. Am J Obstet Gynecol 192:678–689PubMedCrossRefGoogle Scholar
- 23.Iams JD, for the NICHD MFMU Network. Maternal Fetal Medicine Unit Network (1997) The Preterm prediction study: cervical length and perinatal infection. Am J Obstet Gynecol 176:S6Google Scholar
- 27.Oncel MY, Dilmen U, Erdeve O, Ozdemir R, Calisici E, Yurttutan S, Canpolat FE, Oguz SS, Uras N (2012) Proadrenomedullin as a prognostic marker in neonatal sepsis. Pediatr Res doi:10.1038/pr.2012.106. [Epub ahead of print]
- 28.Cahill AG, Odibo AO, Caughey AB, Stamilio DM, Hassan SS, Macones GA, Romero R (2010) Universal cervical length screening and treatment with vaginal progesterone to prevent preterm birth: a decision and economic analysis. Am J Obstet Gynecol 202:548.e1–e8Google Scholar