Cervical Length at Mid-Pregnancy and the Risk of Primary Cesarean Delivery  

Oleh:

Smith, Gordon C. S. ; Celik, Ebru ; To, Meekai ; Khouri, Olga ; Nicolaides, Kypros H. ; and Others

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The New England Journal of Medicine (keterangan: ada di Proquest) vol. 358 no. 13 (Mar. 2008), page 1346.

Ketersediaan

Perpustakaan FK Nomor Panggil: N08.K.2008.02 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

Background Physiological and biochemical studies suggest that normal parturition at term is dependent on programmed development of the uterus in early pregnancy. It is recognized that a short cervix in mid-pregnancy is associated with an increased risk of spontaneous preterm birth. We hypothesized that a long cervix in mid-pregnancy would be associated with an increased risk of cesarean delivery during labor at term. Methods We studied 27,472 primiparous women who had a cervical length of 16 mm or more at a median of 23 weeks of gestation and who ultimately delivered a live infant in labor at term. Results The rate of cesarean delivery at term was lowest (16.0%) among women with a mid-pregnancy cervical length in the lowest quartile (16 to 30 mm) and was significantly greater in the second quartile (18.4%, 31 to 35 mm), third quartile (21.7%, 36 to 39 mm), and fourth quartile (25.7%, 40 to 67 mm) (P<0.001 for trend). The odds ratio for cesarean delivery among women in the fourth quartile, as compared with the first quartile, was 1.81 (95% confidence interval [CI], 1.66 to 1.97), and the odds ratio adjusted for maternal age, body-mass index, smoking status, race or ethnic group, gestational age at birth, spontaneous or induced labor, birth-weight percentile, and hospital of delivery was 1.68 (95% CI, 1.53 to 1.84; P<0.001). The increased risk of cesarean delivery was attributable to procedures performed for poor progress in labor. Conclusions The cervical length at mid-pregnancy is an independent predictor of the risk of cesarean delivery at term in primiparous women.

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