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The risk of preterm birth in women with history of short cervix delivering at term in the previous pregnancy: a retrospective cohort study

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To investigate whether women with a short cervical length (CL), but delivered at term in the first pregnancy might have increased risks of having short cervix and spontaneous preterm birth (sPTB) in the subsequent pregnancies.

Methods

This is a retrospective cohort study including singleton gestations who were delivered between Jan 2011 and Dec 2018, who had had one childbirth experience and who had transvaginal sonographic CL assessment performed at mid-trimester (18 ~ 30 weeks) in both pregnancy. The women were divided into four group according to the history of preterm birth and a short cervix (< 25 mm before 30 weeks of gestation): (1) the Preterm-short cervix group, (2) the Preterm-no shortening group, (3) the Term-short cervix group, and (4) the Term-no shortening group. We compared the risk of having short cervix and sPTB during the second pregnancy of women. Secondary outcomes were threatened preterm labor, need for tocolytics, and cerclage placement.

Results

A total of 804 women met our inclusion criteria. The rate of having short cervix (< 25 mm before 28 weeks of gestation) during the second pregnancy in women in the Term-short cervix group (43.2%) was significantly higher than those in women in the Term-no shortening group (6.6%), and in the Preterm-no shortening group (8.8%) (all p < 0.001 with Bonferroni correction), but not higher than those in women with the Preterm-short cervix group (30.8%, p > 0.05 with Bonferroni correction). When compared with women in the Preterm-no shortening group, women in the Term-short cervix group were also at an increased risk of need for need of tocolytics (60.2% vs. 26.5%) and cerclage placement (15.9% vs. 6.1%, all p < 0.001). Women in the Term-short cervix group had an increased risk of sPTB (< 37 weeks) during the second pregnancy, as compared to those in the Term-no shortening group (adjusted odds ratio 5.098, 95% CI 2.107–11.874).

Conclusion

Women with a history of short cervix in their first pregnancy, but who delivered at term, were at increased risk of having a short cervix and sPTB in their second pregnancy, as compared to women with a history of term delivery without cervical shortening. Thus, short cervix of the previous pregnancy might be a predictive factors for preterm birth in the subsequent pregnancy.

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Availability of data and materials

All data and code supporting the conclusion of the article are available from the corresponding author on reasonable request.

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Funding

This study was supported by Research Fund of Seoul St. Mary’s Hospital, The Catholic University of Korea.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Jeong Ha Wie, Ji Sun Lee & Ji Young Kwon

  2. Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea

    Hye Sung Hwang, Hyun Sun Ko & In Yang Park

Authors
  1. Jeong Ha Wie
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  2. Ji Sun Lee
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  3. Hye Sung Hwang
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Contributions

JHW: Project development, data collection, manuscript writing, data analysis. JSL: Data collection. HSH: Data collection and Manuscript editing. JYK: Project development, supervision. HSK: Project development. IYP: Project development, manuscript editing. Supervision.

Corresponding author

Correspondence to In Yang Park.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

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The Institutional Review Board of the Catholic University of Korea approved the present study.

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Wie, J.H., Lee, J.S., Hwang, H.S. et al. The risk of preterm birth in women with history of short cervix delivering at term in the previous pregnancy: a retrospective cohort study. Arch Gynecol Obstet 305, 1151–1158 (2022). https://doi.org/10.1007/s00404-021-06202-8

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  • DOI: https://doi.org/10.1007/s00404-021-06202-8

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