Obstet Gynecol Sci.  2023 Sep;66(5):337-346. 10.5468/ogs.23022.

How to screen the cervix and reduce the risk of spontaneous preterm birth in asymptomatic women without a prior preterm birth

Affiliations
  • 1Department of Obstetrics and Gynecology, The Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Korea

Abstract

Preterm birth (PTB) is a leading cause of perinatal morbidity and mortality globally. PTB rates have increased in South Korea despite reduction in birth rates. A history of PTB is a strong predictor of subsequent PTB and screening of cervical length between 16 0/7 weeks and 24 0/7 weeks of gestation is recommended in women with a singleton pregnancy and a prior spontaneous PTB. However, the prediction and prevention of spontaneous PTBs in women without a prior PTB remain a matter of debate. The scope of this review article comprises cervical screening and prevention strategies for PTB in asymptomatic women without a prior PTB, based on recent evidence and guidelines.

Keyword

Preterm birth; Cervix; Length; Ultrasonography

Reference

References

1. Chawanpaiboon S, Vogel JP, Moller AB, Lumbiganon P, Petzold M, Hogan D, et al. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob Health. 2019; 7:e37–46.
2. Blencowe H, Cousens S, Chou D, Oestergaard M, Say L, Moller AB, et al. Born too soon: the global epidemiology of 15 million preterm births. Reprod Health. 2013; 10(Suppl 1):S2.
3. Korean Statistical Information Service. Live births by sex, period of pregnancy of provinces [Internet]. Daejeon (KR): Korean Statistical Information Service;c2022. [cited 2022 Oct 19]. Available from: http://kosis.kr/eng/statisticsList/statisticsListIndex.do .
4. Lee JH, Noh OK, Chang YS. Neonatal outcomes of very low birth weight infants in Korean neonatal network from 2013 to 2016. J Korean Med Sci. 2019; 34:e40.
5. Serenius F, Källén K, Blennow M, Ewald U, Fellman V, Holmström G, et al. Neurodevelopmental outcome in extremely preterm infants at 2.5 years after active perinatal care in Sweden. JAMA. 2013; 309:1810–20.
6. Moster D, Lie RT, Markestad T. Long-term medical and social consequences of preterm birth. N Engl J Med. 2008; 359:262–73.
7. Jin JH, Lee SA, Yoon SW. Medical utilization and costs in preterm infants in the first 6 years of life after discharge from neonatal intensive care unit: a nationwide population-based study in Korea. J Korean Med Sci. 2022; 37:e93.
8. Chan RL. Biochemical markers of spontaneous preterm birth in asymptomatic women. BioMed Res Int. 2014; 2014:164081.
9. Romero R, Dey SK, Fisher SJ. Preterm labor: one syndrome, many causes. Science. 2014; 345:760–5.
10. Park S, You YA, Yun H, Choi SJ, Hwang HS, Choi SK, et al. Cervicovaginal fluid cytokines as predictive markers of preterm birth in symptomatic women. Obstet Gynecol Sci. 2020; 63:455–63.
11. Romero R. Spontaneous preterm labor can be predicted and prevented. Ultrasound Obstet Gynecol. 2021; 57:19–21.
12. McDonald IA. Incompetence of the cervix. Aust N Z J Obstet Gynaecol. 1978; 18:34–7.
13. Lidegaard O. Cervical incompetence and cerclage in Denmark 1980–1990. A register based epidemiological survey. Acta Obstet Gynecol Scand. 1994; 73:35–8.
14. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins-Obstetrics.. Prediction and prevention of spontaneous preterm birth: ACOG practice bulletin, number 234. Obstet Gynecol. 2021; 138:e65–90.
15. World Health Organization. Born too soon: the Global Action Report on preterm birth [Internet]. Geneva (CH): World Health Organization;c2023. [cited 2023 Jan 5]. Available from: https://www.who.int/publications/i/item/9789241503433 .
16. Iams JD, Goldenberg RL, Meis PJ, Mercer BM, Moawad A, Das A, et al. The length of the cervix and the risk of spontaneous premature delivery. National institute of child health and human development maternal fetal medicine unit network. N Engl J Med. 1996; 334:567–72.
17. Honest H, Bachmann LM, Sundaram R, Gupta JK, Kleijnen J, Khan KS. The accuracy of risk scores in predicting preterm birth--a systematic review. J Obstet Gynaecol. 2004; 24:343–59.
18. Jarde A, Lutsiv O, Park CK, Beyene J, Dodd JM, Barrett J, et al. Effectiveness of progesterone, cerclage and pessary for preventing preterm birth in singleton pregnancies: a systematic review and network meta-analysis. BJOG. 2017; 124:1176–89.
19. Care A, Nevitt SJ, Medley N, Donegan S, Good L, Hampson L, et al. Interventions to prevent spontaneous preterm birth in women with singleton pregnancy who are at high risk: systematic review and network meta-analysis. BMJ. 2022; 376:e064547.
20. McIntosh J, Feltovich H, Berghella V, Manuck T. The role of routine cervical length screening in selected high- and low-risk women for preterm birth prevention. Am J Obstet Gynecol. 2016; 215:B2–7.
21. Lim K, Butt K, Crane JM. No. 257-ultrasonographic cervical length assessment in predicting preterm birth in singleton pregnancies. J Obstet Gynaecol Can. 2018; 40:e151–64.
22. Salomon LJ, Alfirevic Z, Berghella V, Bilardo CM, Chalouhi GE, Da Silva Costa F, et al. ISUOG practice guidelines (updated): performance of the routine mid-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol. 2022; 59:840–56.
23. Coutinho CM, Sotiriadis A, Odibo A, Khalil A, D’Antonio F, Feltovich H, et al. ISUOG practice guidelines: role of ultrasound in the prediction of spontaneous preterm birth. Ultrasound Obstet Gynecol. 2022; 60:435–56.
24. Seol HJ, Sung JH, Seong WJ, Kim HM, Park HS, Kwon H, et al. Standardization of measurement of cervical elastography, its reproducibility, and analysis of baseline clinical factors affecting elastographic parameters. Obstet Gynecol Sci. 2020; 63:42–54.
25. Kagan KO, Sonek J. How to measure cervical length. Ultrasound Obstet Gynecol. 2015; 45:358–62.
26. Hughes K, Kane SC, Araujo E Júnior, Da Silva Costa F, Sheehan PM. Cervical length as a predictor for spontaneous preterm birth in high-risk singleton pregnancy: current knowledge. Ultrasound Obstet Gynecol. 2016; 48:7–15.
27. Bortoletto TG, Silva TV, Borovac-Pinheiro A, Pereira CM, Silva AD, França MS, et al. Cervical length varies considering different populations and gestational outcomes: results from a systematic review and meta-analysis. PLoS One. 2021; 16:e0245746.
28. Krief D, Foulon A, Tondreau A, Diouf M, Sergent F, Gondry J, et al. Transperineal ultrasound in routine uterine cervix measurement. Arch Gynecol Obstet. 2023; 307:387–93.
29. Gauthier T, Marin B, Garuchet-Bigot A, Kanoun D, Catalan C, Caly H, et al. Transperineal versus transvaginal ultrasound cervical length measurement and preterm labor. Arch Gynecol Obstet. 2014; 290:465–9.
30. Feldmann A, Langlois C, Dewailly M, Martinez EF, Boulanger L, Kerdraon O, et al. Shear wave elastography (SWE): an analysis of breast lesion characterization in 83 breast lesions. Ultrasound Med Biol. 2015; 41:2594–604.
31. Dong FJ, Li M, Jiao Y, Xu JF, Xiong Y, Zhang L, et al. Acoustic radiation force impulse imaging for detecting thyroid nodules: a systematic review and pooled meta-analysis. Med Ultrason. 2015; 17:192–9.
32. Mella MT, Berghella V. Prediction of preterm birth: cervical sonography. Semin Perinatol. 2009; 33:317–24.
33. Vintzileos AM, Visser GH. Interventions for women with mid-trimester short cervix: which ones work? Ultrasound Obstet Gynecol. 2017; 49:295–300.
34. Park HS, Kwon H, Kwak DW, Kim MY, Seol HJ, Hong JS, et al. Addition of cervical elastography may increase preterm delivery prediction performance in pregnant women with short cervix: a prospective study. J Korean Med Sci. 2019; 34:e68.
35. Cha HH, Seong WJ, Kim HM, Seol HJ, Sung JH, Park HS, et al. Midtrimester cervical elastography in pregnant women with a history of loop electrosurgical excision procedure (LEEP). Sci Rep. 2022; 12:9191.
36. Jung YJ, Kwon H, Shin J, Park Y, Heo SJ, Park HS, et al. The feasibility of cervical elastography in predicting preterm delivery in singleton pregnancy with short cervix following progesterone treatment. Int J Environ Res Public Health. 2021; 18:2026.
37. Patberg ET, Wells M, Vahanian SA, Zavala J, Bhattacharya S, Richmond D, et al. Use of cervical elastography at 18 to 22 weeks’ gestation in the prediction of spontaneous preterm birth. Am J Obstet Gynecol. 2021; 225:525e1–9.
38. Feng Q, Chaemsaithong P, Duan H, Ju X, Appiah K, Shen L, et al. Screening for spontaneous preterm birth by cervical length and shear-wave elastography in the first trimester of pregnancy. Am J Obstet Gynecol. 2022; 227:500e1–14.
39. Hernandez-Andrade E, Maymon E, Luewan S, Bhatti G, Mehrmohammadi M, Erez O, et al. A soft cervix, categorized by shear-wave elastography, in women with short or with normal cervical length at 18–24 weeks is associated with a higher prevalence of spontaneous preterm delivery. J Perinat Med. 2018; 46:489–501.
40. Woo J, Ge W, Mancheri J, Hyett J, Mogra R. Shear wave elastography: the relationship of the cervical stiffness with gestational age and cervical length- a feasibility study. J Matern Fetal Neonatal Med. 2022; 35:9684–93.
41. EPPPIC Group. Evaluating progestogens for preventing preterm birth international collaborative (EPPPIC): meta-analysis of individual participant data from randomised controlled trials. Lancet. 2021; 397:1183–94.
42. Alfirevic Z, Stampalija T, Medley N. Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy. Cochrane Database Syst Rev. 2017; 6:CD008991.
43. Berghella V, Ciardulli A, Rust OA, To M, Otsuki K, Althuisius S, et al. Cerclage for sonographic short cervix in singleton gestations without prior spontaneous preterm birth: systematic review and meta-analysis of randomized controlled trials using individual patient-level data. Ultrasound Obstet Gynecol. 2017; 50:569–77.
44. Enakpene CA, DiGiovanni L, Jones TN, Marshalla M, Mastrogiannis D, Della Torre M. Cervical cerclage for singleton pregnant patients on vaginal progesterone with progressive cervical shortening. Am J Obstet Gynecol. 2018; 219:397e1–10.
45. Makrydimas G, Barmpalia Z, Sotiriadis A. Cervical cerclage for women with shortening cervix while on progesterone. Am J Obstet Gynecol. 2019; 220:209–10.
46. Grobman WA, Gilbert SA, Iams JD, Spong CY, Saade G, Mercer BM, et al. Activity restriction among women with a short cervix. Obstet Gynecol. 2013; 121:1181–6.
47. Giraldo-Isaza MA, Fried GP, Hegarty SE, Suescum-Diaz MA, Cohen AW, Berghella V. Comparison of 2 stitches vs 1 stitch for transvaginal cervical cerclage for preterm birth prevention. Am J Obstet Gynecol. 2013; 208:209e1–9.
48. Abdel-Aleem H, Shaaban OM, Abdel-Aleem MA, Aboelfadle Mohamed A. Cervical pessary for preventing preterm birth in singleton pregnancies. Cochrane Database Syst Rev. 2022; 12:CD014508.
49. Morrison J. Twin gestation and premature birth. J Perinatol. 2005; 25:1–3.
50. Jee J, Hong SJ, Ha S, Kim HY, Ahn KH, Hong SC, et al. Pregnancy outcomes in twin pregnancies over 10 years. Obstet Gynecol Sci. 2022; 66:20–5.
51. Stock S, Norman J. Preterm and term labour in multiple pregnancies. Semin Fetal Neonatal Med. 2010; 15:336–41.
52. Conde-Agudelo A, Romero R, Hassan SS, Yeo L. Transvaginal sonographic cervical length for the prediction of spontaneous preterm birth in twin pregnancies: a systematic review and metaanalysis. Am J Obstet Gynecol. 2010; 203:128:e1–12.
53. Roman A, Ramirez A, Fox NS. Prevention of preterm birth in twin pregnancies. Am J Obstet Gynecol MFM. 2022; 4:100551.
54. Kindinger LM, Poon LC, Cacciatore S, MacIntyre DA, Fox NS, Schuit E, et al. The effect of gestational age and cervical length measurements in the prediction of spontaneous preterm birth in twin pregnancies: an individual patient level meta-analysis. BJOG. 2016; 123:877–84.
55. Committee on Practice Bulletins-Obstetrics and the American Institute of Ultrasound in Medicine. Practice bulletin no. 175: ultrasound in pregnancy. Obstet Gynecol. 2016; 128:e241–56.
56. Khalil A, Rodgers M, Baschat A, Bhide A, Gratacos E, Hecher K, et al. ISUOG practice guidelines: role of ultrasound in twin pregnancy. Ultrasound Obstet Gynecol. 2016; 47:247–63.
57. Crowther CA, Han S. Hospitalisation and bed rest for multiple pregnancy. Cochrane Database Syst Rev. 2010; 12010:CD000110.
58. Yamasmit W, Chaithongwongwatthana S, Tolosa JE, Limpongsanurak S, Pereira L, Lumbiganon P. Prophylactic oral betamimetics for reducing preterm birth in women with a twin pregnancy. Cochrane Database Syst Rev. 2015; 2015:CD004733.
59. Dodd JM, Grivell RM, OBrien CM, Dowswell T, Deussen AR. Prenatal administration of progestogens for preventing spontaneous preterm birth in women with a multiple pregnancy. Cochrane Database Syst Rev. 2017; 10:CD012024.
60. Rehal A, Benkő Z, De Paco Matallana C, Syngelaki A, Janga D, Cicero S, et al. Early vaginal progesterone versus placebo in twin pregnancies for the prevention of spontaneous preterm birth: a randomized, double-blind trial. Am J Obstet Gynecol. 2021; 224:86:e1–19.
61. Romero R, Conde-Agudelo A, Rehal A, Da Fonseca E, Brizot ML, Rode L, et al. Vaginal progesterone for the prevention of preterm birth and adverse perinatal outcomes in twin gestations with a short cervix: an updated individual patient data meta-analysis. Ultrasound Obstet Gynecol. 2022; 59:263–6.
62. Roman A, Zork N, Haeri S, Schoen CN, Saccone G, Colihan S, et al. Physical examination-indicated cerclage in twin pregnancy: a randomized controlled trial. Am J Obstet Gynecol. 2020; 223:902e1–11.
63. Li C, Shen J, Hua K. Cerclage for women with twin pregnancies: a systematic review and metaanalysis. Am J Obstet Gynecol. 2019; 220:543–57e1.
64. Ridout AE, Ibeto LA, Ross GN, Cook JR, Sykes L, David AL, et al. Cervical length and quantitative fetal fibronectin in the prediction of spontaneous preterm birth in asymptomatic women with congenital uterine anomaly. Am J Obstet Gynecol. 2019; 221:341e1–9.
65. Hughes KM, Kane SC, Haines TP, Sheehan PM. Cervical length surveillance for predicting spontaneous preterm birth in women with uterine anomalies: a cohort study. Acta Obstet Gynecol Scand. 2020; 99:1519–26.
66. Visintine J, Berghella V, Henning D, Baxter J. Cervical length for prediction of preterm birth in women with multiple prior induced abortions. Ultrasound Obstet Gynecol. 2008; 31:198–200.
67. Bjørge T, Skare GB, Bjørge L, Tropé A, Lönnberg S. Adverse pregnancy outcomes after treatment for cervical intraepithelial neoplasia. Obstet Gynecol. 2016; 128:1265–73.
68. Lim KI, Butt K, Nevo O, Crane JM. Guideline no. 401: sonographic cervical length in singleton pregnancies: techniques and clinical applications. J Obstet Gynaecol Can. 2020; 42:1394–413e1.
69. Castanon A, Landy R, Brocklehurst P, Evans H, Peebles D, Singh N, et al. Risk of preterm delivery with increasing depth of excision for cervical intraepithelial neoplasia in England: nested case-control study. BMJ. 2014; 349:g6223.
70. Himes KP, Simhan HN. Time from cervical conization to pregnancy and preterm birth. Obstet Gynecol. 2007; 109:314–9.
71. Miyakoshi K, Itakura A, Abe T, Kondoh E, Terao Y, Tabata T, et al. Risk of preterm birth after the excisional surgery for cervical lesions: a propensity-score matching study in Japan. J Matern Fetal Neonatal Med. 2021; 34:845–51.
72. Zeisler H, Joura EA, Bancher-Todesca D, Hanzal E, Gitsch G. Prophylactic cerclage in pregnancy. Effect in women with a history of conization. J Reprod Med. 1997; 42:390–2.
73. Park HS, Kim HS, Lee SA, Yoon J, Kim EH. Prophylactic cerclage to prevent preterm birth after conization: a cohort study using data from the National Health Insurance Service of Korea. Yonsei Med J. 2021; 62:1083–9.
74. Cho GJ, Ouh YT, Kim LY, Lee TS, Park GU, Ahn KH, et al. Cerclage is associated with the increased risk of preterm birth in women who had cervical conization. BMC Pregnancy Childbirth. 2018; 18:277.
75. Cetingoz E, Cam C, Sakalli M, Karateke A, Celik C, Sancak A. Progesterone effects on preterm birth in high-risk pregnancies: a randomized placebo-controlled trial. Arch Gynecol Obstet. 2011; 283:423–9.
76. Fischer RL, Sveinbjornsson G, Hansen C. Cervical sonography in pregnant women with a prior cone biopsy or loop electrosurgical excision procedure. Ultrasound Obstet Gynecol. 2010; 36:613–7.
77. Park H, Kwon DY, Kim SY, Park J, Kim YM, Sung JH, et al. Association of adherence to guidelines for cervical cerclage with perinatal outcomes and placental inflammation in women with cervical length ≥2.0 cm. Taiwan J Obstet Gynecol. 2021; 60:665–73.
78. Kindinger LM, Kyrgiou M, MacIntyre DA, Cacciatore S, Yulia A, Cook J, et al. Preterm birth prevention post-conization: a model of cervical length screening with targeted cerclage. PLoS One. 2016; 11:e0163793.
Full Text Links
  • OGS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr