Prognosis in cervical insufficiency at less than 32 weeks of gestation
Received 19 January 2005; received in revised form 9 May 2005; accepted 11 June 2005.
Abstract
Objective
To identify prenatal events associated with adverse outcome in babies at less than 32 weeks of gestation in cases of cervical insufficiency and preterm labor (PTL)/premature rupture of the membranes (PROM).
Study design
A case-control study was performed using a logistic regression model at 17 tertiary hospitals in Japan. Adverse outcome was defined as neonatal death or abnormal cerebral ultrasound scans (intraventricular hemorrhage [IVH] and periventricular leukomalacia [PVL]) prior to discharge from hospital.
Results
Data were analyzed for 307 cases (74 for cervical insufficiency and 233 for PTL/PROM). Neonatal death and IVH/PVL were noted in 25 and 29 cases, respectively. A significant association of cervical insufficiency (odds ratio (OR) 1.32, 95% confidence interval (CI) 1.02–1.68), gestational age at delivery (<26 weeks) (OR 4.64, 95% CI 1.73–12.44), and Apgar score <7 at 5min (OR 3.3, 95% CI 1.42–7.64) with combined neonatal death or IVH and PVL was found in a logistic regression model that controlled for in utero transportation, gestational age on admission, clinical chorioamnionitis, and histopathologic chorioamnionitis.
Conclusion
Cervical insufficiency is a significant factor related to the occurrence of adverse outcome.
aDepartment of Obstetrics and Gynecology, Perinatal Medical Center, Tokyo Women's Medical University Hospital, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
bPerinatal Medical Center, Tokyo Women's Medical University,Tokyo, Japan
ABSTRACT