{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T18:42:05Z","timestamp":1791312125648,"version":"4.3.1"},"reference-count":29,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,4,17]],"date-time":"2023-04-17T00:00:00Z","timestamp":1681689600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine the performance of the predictive markers of spontaneous preterm birth, cervicovaginal quantitative fetal fibronectin (fFN) and cervical length, in asymptomatic high\u2010risk women with transabdominal, history\u2010indicated or ultrasound\u2010indicated cervical cerclage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a secondary analysis of a prospective cohort of asymptomatic high\u2010risk women with cervical cerclage and no other prophylactic intervention (including progesterone), who attended the preterm birth clinic at a central London teaching hospital between October 2010 and September 2016. Women had either transabdominal cerclage, placed prior to conception, history\u2010indicated cerclage, placed before 14\u2009weeks' gestation, or ultrasound\u2010indicated cerclage for a short cervix (&lt;\u200925\u2009mm), placed before 24\u2009weeks. All women underwent serial cervical length assessment on transvaginal ultrasound in the second trimester (16\u201328\u2009weeks), and quantitative fFN testing from 18\u2009weeks onward. Test performance was analyzed for the prediction of spontaneous preterm birth before 30\u2009weeks (cerclage failure), 34\u2009weeks and 37\u2009weeks, using receiver\u2010operating\u2010characteristics (ROC)\u2010curve analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall, 181 women were included in the analysis. Cervical length and fFN were strong predictors of spontaneous preterm birth before 30\u2009weeks in women with cerclage, with areas under the ROC curve (AUC) of 0.86 (95%\u2009CI, 0.79\u20130.94) and 0.84 (95%\u2009CI, 0.75\u20130.92), respectively. Cervical length was a better predictor of preterm birth before 30\u2009weeks in women with history\u2010indicated compared to those with ultrasound\u2010indicated cerclage, although both showed clinical utility (AUC, 0.96 (95%\u2009CI, 0.91\u20131.00)\n                      <jats:italic>vs<\/jats:italic>\n                      0.79 (95%\u2009CI, 0.66\u20130.91);\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.01). Quantitative fFN was a strong predictor of spontaneous preterm birth before 30\u2009weeks in women with history\u2010indicated cerclage (AUC, 0.91 (95%\u2009CI, 0.75\u20131.00)) and retained clinical utility in those with ultrasound\u2010indicated cerclage (AUC, 0.76 (95%\u2009CI, 0.64\u20130.89)). There were no spontaneous deliveries before 34\u2009weeks in women with a transabdominal cerclage, so AUC was not calculated. Delivery was delayed significantly in this group (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Cervical length and quantitative fFN retain clinical utility for the prediction of spontaneous preterm birth in women with cervical cerclage, and prediction is best in women with a history\u2010indicated stitch. These tests can be relied upon to discriminate risk and have utility when planning clinical management with regard to treatment failure. \u00a9 2023 The Authors.\n                      <jats:italic>Ultrasound in Obstetrics &amp; Gynecology<\/jats:italic>\n                      published by John Wiley &amp; Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.26161","type":"journal-article","created":{"date-parts":[[2023,1,17]],"date-time":"2023-01-17T02:03:43Z","timestamp":1673921023000},"page":"617-623","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Predicting spontaneous preterm birth in asymptomatic high\u2010risk women with cervical cerclage"],"prefix":"10.1002","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0988-7229","authenticated-orcid":false,"given":"A. E.","family":"Ridout","sequence":"first","affiliation":[{"name":"Department of Women and Children's Health, School of Life Course Sciences King's College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Ross","sequence":"additional","affiliation":[{"name":"University of Newcastle  Callaghan NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. T.","family":"Seed","sequence":"additional","affiliation":[{"name":"Department of Women and Children's Health, School of Life Course Sciences King's College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N. L.","family":"Hezelgrave","sequence":"additional","affiliation":[{"name":"Department of Women and Children's Health, School of Life Course Sciences King's College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. M.","family":"Tribe","sequence":"additional","affiliation":[{"name":"Department of Women and Children's Health, School of Life Course Sciences King's College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. H.","family":"Shennan","sequence":"additional","affiliation":[{"name":"Department of Women and Children's Health, School of Life Course Sciences King's College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,4,17]]},"reference":[{"key":"e_1_2_8_2_1","first-page":"CD003253","article-title":"Cervical stitch (cerclage) for preventing pregnancy loss in women","volume":"2003","author":"Drakeley AJ","year":"2003","journal-title":"Cochrane Database Syst Rev"},{"issue":"478","key":"e_1_2_8_3_1","first-page":"e1","article-title":"A new paradigm for the role of smooth muscle cells in the human cervix","volume":"215","author":"Vink JY","year":"2016","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.3109\/00016348209156548"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dev274"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.a1343"},{"key":"e_1_2_8_7_1","first-page":"516","article-title":"MRC\/RCOG Working Party on Cervical Cerclage","volume":"100","author":"Final report of the Medical Research Council\/Royal College of Obstetricians and Gynaecologists multicentre randomised trial of cervical cerclage","year":"1993","journal-title":"Br J Obstet Gynaecol"},{"issue":"261","key":"e_1_2_8_8_1","first-page":"e1","article-title":"MAVRIC: a multicentre randomised controlled trial of transabdominal vs transvaginal cervical cerclage","volume":"222","author":"Shennan A","year":"2020","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2016.01.035"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2000.108837"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1479-828X.2010.01212.x"},{"issue":"317","key":"e_1_2_8_12_1","first-page":"e1","article-title":"Transabdominal cerclage after comprehensive evaluation of women with previous unsuccessful transvaginal cerclage","volume":"197","author":"Debbs RH","year":"2007","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001240"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000754"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15925"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14865"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199602293340904"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2002.123937"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2016.1143928"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1067\/S0002-9378(03)00656-2"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0052412"},{"issue":"122","key":"e_1_2_8_22_1","first-page":"e1","article-title":"Evaluation of a quantitative fetal fibronectin test for spontaneous preterm birth in symptomatic women","volume":"208","author":"Abbott DS","year":"2013","journal-title":"Am J Obstet Gynecol"},{"issue":"480","key":"e_1_2_8_23_1","first-page":"e1","article-title":"Quantitative fetal fibronectin and cervical length to predict preterm birth in asymptomatic women with previous cervical surgery","volume":"215","author":"Vandermolen BI","year":"2016","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_8_24_1","first-page":"14","article-title":"The development and validation of a new tool to predict spontaneous preterm birth in high\u2010risk women using quantitative fetal fibronectin and cervical length","volume":"120","author":"Kuhrt K","year":"2013","journal-title":"BJOG"},{"issue":"705","key":"e_1_2_8_25_1","first-page":"e1","article-title":"Is there value for serial ultrasonographic assessment of cervical lengths after a cerclage?","volume":"198","author":"Hedriana HL","year":"2008","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0178072"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-016-0866-3"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.3389\/fgwh.2021.777643"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2009.02137.x"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.aag1026"}],"container-title":["Ultrasound in Obstetrics &amp; 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