Objective: To estimate the risk of preterm birth in patients with an ultrasound or physical exam indicated cervical cerclage based on the results of fetal fibronectin (fFN) and cervical length (CL) screening.
Methods: Retrospective cohort of patients with a singleton pregnancy and an ultrasound or physical exam indicated Shirodkar cerclage placed by one maternal-fetal medicine practice from November 2005 – January 2015. Patients routinely underwent serial CL and fFN testing from 22-32 weeks. Based on ROC curve analysis, a short CL was defined as ≤15mm. All fFN and CL results included are from after the cerclage placement.
Results: 104 patients were included. Seventy eight (75%) patients had an ultrasound-indicated cerclage and 26 (25%) patients had a physical exam-indicated cerclage. A positive fFN was associate with preterm birth <32 weeks (15.6% vs. 4.2%, p=0.043), <35 weeks (37.5% vs. 11.1%, p=0.002), <37 weeks (65.6% vs. 20.8%, p<0.001), and earlier gestational ages at delivery (35.2+/-3.9 vs. 37.4+/-2.9, p=0.001). A short CL was also associated with preterm birth <35 weeks (50.0% vs. 11.9%, p<0.01), preterm birth <37 weeks (55.0% vs. 29.8%, p=0.033), and earlier gestational ages at delivery (34.8+/-4.1 vs. 37.2+/-3.0, p=0.004). The risk of preterm birth <32, <35, and <37 weeks increased significantly with the number of abnormal markers.
Conclusion: In patients with an ultrasound or physical exam indicated cerclage, a positive fFN and a short CL are both associated with preterm birth. The risk of preterm birth increases with the number of abnormal biomarkers.
|Advisor:||Fox, Nathan S.|
|Commitee:||Hennig, Nils, Rebarber, Andrei|
|School:||Icahn School of Medicine at Mount Sinai|
|School Location:||United States -- New York|
|Source:||MAI 55/04M(E), Masters Abstracts International|
|Subjects:||Health sciences, Public health, Epidemiology|
|Keywords:||Mobile health, Reproductive health, Sex workers|
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