Prognosis in cervical insufficiency at less than 32 weeks of gestation

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.

Keywords: Apgar score, Cervical insufficiency, Intraventricular hemorrhage, Periventricular leukomalacia, Preterm birth