Utility of volumetric assessment of cervical funneling to predict cerclage failure

J Matern Fetal Neonatal Med. 2017 May;30(9):1066-1071. doi: 10.1080/14767058.2016.1201470. Epub 2016 Jul 6.

Abstract

Objective: To assess the utility of cervical funnel volume as a predictor of cerclage failure.

Methods: We performed a retrospective cohort study of pregnant women with a McDonald cerclage and sonographic evidence of cervical funneling between 1/2008 and 2/2014. Funnel volume (FV) was calculated and used as a correction factor for cervical length (CL) or cerclage height (CH). Receiver operating characteristic (ROC) curves were used to compare the predictive value of CL, CL:FV, CH and CH:FV for cerclage failure at <28 or <34 weeks. CL:FV was further stratified to the <5th, <10th and >10th percentiles and analyzed for prediction of preterm delivery.

Results: Subjects with cerclage failure (n = 30) delivered at a mean gestational age of 29.8 +/- 5.3 weeks compared to 38.1+/- 1.39 weeks in those without failure (n = 27; p < 0.001). ROC curves demonstrated CL:FV was the best predictor of delivery <28 weeks (AUC 0.80), while CL was the best predictor of delivery <34 weeks (AUC 0.76). Stratification of CL:FV into <5th versus >10th percentile groups was predictive of early preterm delivery (25.1 weeks versus 34 weeks, p = 0.01).

Conclusions: Volumetric assessment of cervical funneling may improve prediction of cerclage failure in the mid-trimester.

Keywords: Cerclage; cervix; preterm delivery.

MeSH terms

  • Adult
  • Case-Control Studies
  • Cerclage, Cervical*
  • Cervical Length Measurement*
  • Cervix Uteri / diagnostic imaging*
  • Cervix Uteri / pathology
  • Female
  • Gestational Age
  • Humans
  • Pregnancy
  • Premature Birth / prevention & control*
  • ROC Curve
  • Retrospective Studies
  • Risk Factors
  • Sensitivity and Specificity
  • Treatment Failure
  • Young Adult