The length of the cervix and the risk of spontaneous premature delivery
Open accessAbstract
BACKGROUND: The role of the cervix in the pathogenesis of premature delivery is controversial. In a prospective, multicenter study of pregnant women, we used vaginal ultrasonography to measure the length of the cervix; we also documented the incidence of spontaneous delivery before 35 weeks' gestation. METHODS: At 10 university-affiliated prenatal clinics, we performed vaginal ultrasonography at approximately 24 and 28 weeks of gestation in women with singleton pregnancies. We then assessed the relation between the length of the cervix and the risk of spontaneous preterm delivery. RESULTS: We examined 2915 women at approximately 24 weeks of gestation and 2531 of these women again at approximately 28 weeks. Spontaneous preterm delivery (at less than 35 weeks) occurred in 126 of the women (4.3 percent) examined at 24 weeks. The length of the cervix was normally distributed at 24 and 28 weeks (mean [+/- SD], 35.2 +/- 8.3 mm and 33.7 +/- 8.5 mm, respectively). The relative risk of preterm delivery increased as the length of the cervix decreased. When women with shorter cervixes at 24 weeks were compared with women with values above the 75th percentile, the relative risks of preterm delivery among the women with shorter cervixes were as follows: 1.98 for cervical lengths at or below the 75th percentile (40 mm), 2.35 for lengths at or below the 50th percentile (35 mm), 3.79 for lengths at or below the 25th percentile (30 mm), 6.19 for lengths at or below the 10th percentile (26 mm), 9.49 for lengths at or below the 5th percentile (22 mm), and 13.99 for lengths at or below the 1st percentile (13 mm) (P < 0.001 for values at or below the 50th percentile; P = 0.008 for values at or below the 75th percentile). For the lengths measured at 28 weeks, the corresponding relative risks were 2.80, 3.52, 5.39, 9.57, 13.88, and 24.94 (P < 0.001 for values at or below the 50th percentile; P = 0.003 for values at the 75th percentile). CONCLUSIONS: The risk of spontaneous preterm delivery is increased in women who are found to have a short cervix by vaginal ultrasonography during pregnancy.
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Cervical shortening is a risk factor for preterm delivery.
“Both digital and ultrasound examinations of the cervix have shown that cervical shortening is a risk factor for preterm delivery.121, 122, 123”
From Epidemiology and causes of preterm birth (2008) · cites this paper as [122]
In asymptomatic women at 24 weeks' gestation, a cervical length of less than 25 mm defines increased risk of preterm birth, and the shorter the cervix, the greater the risk.
“In asymptomatic women, at 24 weeks' gestation, a cervical length of less than 25 mm defines increased risk of preterm birth. The shorter the cervix, the greater the risk.122, 123”
From Epidemiology and causes of preterm birth (2008) · cites this paper as [122]
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- Authors
- Iams, J. D., Goldenberg, R. L., Meis, P. J., Mercer, B. M., Moawad, A., Das, A., Thom, E., McNellis, D., Copper, R. L., Johnson, F., & Roberts, J. M.
- Affiliations
- The Ohio State University (US)
- University of Alabama at Birmingham (US)
- Atrium Health Wake Forest Baptist (US)
- University of Chicago (US)
- George Washington University (US)
- National Institutes of Health (US)
- University of Pittsburgh (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1996-02-29
- Volume
- 334
- Issue
- 9
- Pages
- 567-573
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2327234524
- Cited by
- 1,894
- References
- 9
- Citations by year
- 2026: 67 · 2025: 67 · 2024: 81 · 2023: 73 · 2022: 76 · 2021: 75 · 2020: 91 · 2019: 73 · 2018: 70 · 2017: 152 · 2016: 93 · 2015: 76 · 2014: 65 · 2013: 77 · 2012: 77
- FWCI
- 20.56
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Wayne State University
- Ohio State University
- George Washington University
- University of Oklahoma
- University of Cincinnati
- University of South Carolina
- Claude Pepper Older Americans Independence Center, Wake Forest School of Medicine
- National Institute of Child Health and Human Development
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (U10-HD27917, U10HD027915, U10HD027917, U10 HD 27915, U10HD021410, U10 HD21410)
- Topics
- Health Sciences › Medicine › Epidemiology › Preterm Birth and Chorioamnionitis
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Keywords
- cervical length, spontaneous preterm birth, preterm birth risk, cervical shortening, vaginal ultrasonography, singleton pregnancy, cervical incompetence, pregnancy outcome prediction, cervical cerclage
- MeSH terms
- Uterine Cervical Incompetence, Cervix Uteri, Female, Humans, Obstetric Labor, Premature, Pregnancy, Pregnancy Trimester, Second, Prospective Studies, Regression Analysis, Risk, Sensitivity and Specificity, Ultrasonography, Prenatal
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