{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T18:19:49Z","timestamp":1770488389478,"version":"3.49.0"},"reference-count":29,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,10,26]],"date-time":"2018-10-26T00:00:00Z","timestamp":1540512000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["HD21410, UL1 RR024153; UL1 TR000005; HD27869, HD27915, HD27917, HD34116, HD34208, 5UL1RR025764, HD36801, HD40500, HD40512, HD40544, M01 RR00080, UL1 RR024989 (NCRR), HD40545, HD40560, HD40485, HD53097, HD53118"],"award-info":[{"award-number":["HD21410, UL1 RR024153; UL1 TR000005; HD27869, HD27915, HD27917, HD34116, HD34208, 5UL1RR025764, HD36801, HD40500, HD40512, HD40544, M01 RR00080, UL1 RR024989 (NCRR), HD40545, HD40560, HD40485, HD53097, HD53118"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate whether the presence of cervical funneling or intra\u2010amniotic debris identified in the second trimester is associated with a higher rate of preterm birth (PTB) in asymptomatic nulliparous pregnant women with a midtrimester cervical length (CL) less than 30 mm (i.e. below the 10<jats:sup>th<\/jats:sup> percentile).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a secondary cohort analysis of data from a multicenter trial in nulliparous women between 16 and 22 weeks' gestation with a singleton gestation and CL less than 30 mm on transvaginal ultrasound, randomized to treatment with either 17\u2010alpha\u2010hydroxyprogesterone caproate or placebo. Sonographers were centrally certified in CL measurement, as well as in identification of intra\u2010amniotic debris and cervical funneling. Univariable and multivariable analysis was performed to assess the associations of cervical funneling and intra\u2010amniotic debris with PTB.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 657 women randomized, 112 (17%) had cervical funneling only, 33 (5%) had intra\u2010amniotic debris only and 45 (7%) had both on second\u2010trimester ultrasound. Women with either of these findings had a shorter median CL than those without (21.0\u2009mm <jats:italic>vs<\/jats:italic> 26.4\u2009mm; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). PTB prior to 37 weeks was more likely in women with cervical funneling (37% <jats:italic>vs<\/jats:italic> 21%; odds ratio (OR), 2.2 (95% CI, 1.5\u20133.3)) or intra\u2010amniotic debris (35% <jats:italic>vs<\/jats:italic> 23%; OR, 1.7 (95% CI, 1.1\u20132.9)). Results were similar for PTB before 34 and before 32 weeks' gestation. After multivariable adjustment that included CL, PTB &lt;\u200934 and &lt;\u200932\u2009weeks continued to be associated with the presence of intra\u2010amniotic debris (adjusted OR (aOR), 1.85 (95% CI, 1.00\u20133.44) and aOR, 2.78 (95% CI, 1.42\u20135.45), respectively), but not cervical funneling (aOR, 1.17 (95% CI, 0.63\u20132.17) and aOR, 1.45 (95% CI, 0.71\u20132.96), respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Among asymptomatic nulliparous women with midtrimester CL less than 30 mm, the presence of intra\u2010amniotic debris, but not cervical funneling, is associated with an increased risk for PTB before 34 and 32\u2009weeks' gestation, independently of CL. Copyright \u00a9 2017 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.18960","type":"journal-article","created":{"date-parts":[[2017,11,20]],"date-time":"2017-11-20T15:26:38Z","timestamp":1511191598000},"page":"757-762","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Cervical funneling or intra\u2010amniotic debris and preterm birth in nulliparous women with midtrimester cervical length less than 30 mm"],"prefix":"10.1002","volume":"52","author":[{"given":"G. R.","family":"Saade","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Texas Medical Branch  Galveston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E. A.","family":"Thom","sequence":"additional","affiliation":[{"name":"The George Washington University Biostatistics Center  Washington DC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3979-0738","authenticated-orcid":false,"given":"W. A.","family":"Grobman","sequence":"additional","affiliation":[{"name":"Northwestern University  Chicago IL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. D.","family":"Iams","sequence":"additional","affiliation":[{"name":"Ohio State University  Columbus OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B. M.","family":"Mercer","sequence":"additional","affiliation":[{"name":"MetroHealth Medical Center\u2010Case Western Reserve University  Cleveland OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"U. M.","family":"Reddy","sequence":"additional","affiliation":[{"name":"The Eunice Kennedy Shriver National Institute of Child Health and Human Development  Bethesda MD USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. T. N.","family":"Tita","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham  Birmingham AL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D. J.","family":"Rouse","sequence":"additional","affiliation":[{"name":"Brown University  Providence RI USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Y.","family":"Sorokin","sequence":"additional","affiliation":[{"name":"Wayne State University  Detroit MI USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R. J.","family":"Wapner","sequence":"additional","affiliation":[{"name":"Columbia University  New York NY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K. J.","family":"Leveno","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical Center  Dallas TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. C.","family":"Blackwell","sequence":"additional","affiliation":[{"name":"The University of Texas Health Science Center at Houston\u2010Children's Memorial Hermann Hospital  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. S.","family":"Esplin","sequence":"additional","affiliation":[{"name":"University of Utah Health Sciences Center  Salt Lake City UT USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. E.","family":"Tolosa","sequence":"additional","affiliation":[{"name":"Oregon Health &amp; Science University  Portland OR USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. M.","family":"Thorp","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill  Chapel Hill NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. N.","family":"Caritis","sequence":"additional","affiliation":[{"name":"University of Pittsburgh  Pittsburgh PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. P.","family":"Vandorsten","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina  Charleston SC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal\u2013Fetal Medicine Units (MFMU) Network","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,10,26]]},"reference":[{"key":"e_1_2_6_2_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000275287.08520.4a"},{"key":"e_1_2_6_2_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lfs.2011.07.017"},{"key":"e_1_2_6_2_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/485020a"},{"key":"e_1_2_6_2_5_1","first-page":"78","article-title":"Centers for Disease Control and Prevention (CDC). 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