Shorten Cervical Length Assessed by Transvaginal Ultrasound at 18-20 Weeks' Associated With Other Risk Factors - Predictive Condition for Miscarriage or Preterm Delivery

Objective: The aim of this study was to detect the predictive factors of miscarriage and preterm delivery. Material and Methods: The prospective study consisting of Transvaginal cervical ultrasound examination of 538 asymptomatic women with singleton pregnancies at 18-20 weeks. The maternal age and weight, parity, smoking habits, social-economic status, physical and sexual activity, obstetrical and cervical surgery history of the patients were also considered. Multiple logistic regression analysis was used to control for background variables in evaluating the probability of preterm delivery. Results: The mean cervical length was 35.42 mm. Miscarriage (<28 weeks) was occurred in 7,6% (41/538) and preterm birth in 16,4% (88/538). The highest incidence for miscarriage or preterm was under 20 mm cervical length. Funnelling was associated with miscarriage in 28 patients (26,6%) and preterm delivery 50/107 cases (46,72%) with an OR of 12,98 CI 95% (6,35-26,53), respectively 9,075 (CI 95% 5,4715,03) (P<0,001); sensitivity 22-60%, specificity 83-93%, positive predictive value 52-81%, and negative predictive value 83-92%. A low BMI, smoking, obstetrical and cervical surgery history, young maternal age, parity, a poor social economic status determine the cervical shortening and thus influence the outcome of the pregnancy. Conclusions: Transvaginal cervical assessment during routine ultrasound at 1820 weeks' gestation in asymptomatic pregnant help identify women at risk. A cervical length under 20 mm is a certain predictive factor late miscarriage or spontaneous preterm delivery. A shortened cervix (20-30 mm) associated with one or more of the studied risk factors is also a predictive condition.