{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T18:25:00Z","timestamp":1778869500807,"version":"3.51.4"},"reference-count":33,"publisher":"Georg Thieme Verlag KG","issue":"02","funder":[{"name":"Jeanne and Jean-Louis Levesque Perinatal Research Chair at Universit\u00e9 Laval, Qu\u00e9bec, Canada"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:p>\n            Objective\u2003The study aimed to estimate the predictive value of midtrimester cervical length (CL) and the optimal cut-off of CL that should be applied with asymptomatic nulliparous women for the prediction of spontaneous preterm birth (sPTB).<\/jats:p><jats:p>\n            Study Design\u2003This is a prospective cohort study of asymptomatic nulliparous women with a singleton gestation. Participants underwent CL measurement by transvaginal ultrasound between 20 and 24 weeks of gestation. The participants and their health care providers remained blinded to the results of CL measurement. The primary outcomes were sPTB before 35 weeks and sPTB before 37 weeks. Receiver operating characteristics (ROC) curve analyses were performed. Analyses were repeated by using multiples of median (MoM) of CL adjusted for gestational age.<\/jats:p><jats:p>\n            Results\u2003Of 796 participants, the mean midtrimester CL was 40\u2009\u00b1\u20096\u2009mm with a 1st, 5th, and 10th percentile of 25, 29, and 32\u2009mm, respectively. ROC curve analyses suggest that a cut-off of 30\u2009mm was the optimal CL to predict sPTB before 35 weeks (area under the ROC curve [AUC]: 0.70, 95% confidence interval [CI]: 0.56\u20130.85) and before 37 weeks (AUC: 0.70, 95% CI: 0.59\u20130.80). Midtrimester CL &lt;30\u2009mm could detect 35% of all sPTB before 35 weeks at a false-positive rate of 5% (relative risk: 9.1, 95% CI: 3.5\u201323.5, p\u2009&lt;\u20090.001). We observed similar results using a cut-off of CL &lt;0.75 MoM adjusted for gestational age.<\/jats:p><jats:p>\n            Conclusion\u2003A midtrimester CL cut-off of 30\u2009mm (instead of 25\u2009mm), or CL less than 0.75 MoM, should be used to identify nulliparous women at high risk of sPTB.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/s-0041-1728818","type":"journal-article","created":{"date-parts":[[2021,5,3]],"date-time":"2021-05-03T22:52:08Z","timestamp":1620082328000},"page":"187-193","source":"Crossref","is-referenced-by-count":6,"title":["Midtrimester Cervical Length in Low-Risk Nulliparous Women for the Prediction of Spontaneous Preterm Birth: Should We Consider a New Definition of Short Cervix?"],"prefix":"10.1055","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2662-4351","authenticated-orcid":false,"given":"Paul","family":"Guerby","sequence":"additional","affiliation":[{"name":"Research Center, CHU de Qu\u00e9bec-Universit\u00e9 Laval, Qu\u00e9bec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mario","family":"Girard","sequence":"additional","affiliation":[{"name":"Research Center, CHU de Qu\u00e9bec-Universit\u00e9 Laval, Qu\u00e9bec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Genevi\u00e8ve","family":"Marcoux","sequence":"additional","affiliation":[{"name":"Research Center, CHU de Qu\u00e9bec-Universit\u00e9 Laval, Qu\u00e9bec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annie","family":"Beaudoin","sequence":"additional","affiliation":[{"name":"Research Center, CHU de Qu\u00e9bec-Universit\u00e9 Laval, Qu\u00e9bec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean-Charles","family":"Pasquier","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Universit\u00e9 de Sherbrooke, Facult\u00e9 de M\u00e9decine et des Sciences de la Sant\u00e9 3001, Sherbrooke, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6936-4369","authenticated-orcid":false,"given":"Emmanuel","family":"Bujold","sequence":"additional","affiliation":[{"name":"Research Center, CHU de Qu\u00e9bec-Universit\u00e9 Laval, Qu\u00e9bec, Canada"},{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, Universit\u00e9 Laval, Qu\u00e9bec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2021,5,3]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"e37","DOI":"10.1016\/S2214-109X(18)30451-0","article-title":"Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis","volume":"7","author":"S Chawanpaiboon","year":"2019","journal-title":"Lancet Glob Health"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1056\/NEJMoa0706475","article-title":"Long-term medical and social consequences of preterm birth","volume":"359","author":"D Moster","year":"2008","journal-title":"N Engl J Med"},{"issue":"11","key":"ref3","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.1111\/1471-0528.12281","article-title":"Preterm birth time trends in Europe: a study of 19 countries","volume":"120","author":"J Zeitlin","year":"2013","journal-title":"BJOG"},{"issue":"04","key":"ref4","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1067\/S0002-9378(03)00838-X","article-title":"Failure of physiologic transformation of the spiral arteries in patients with preterm labor and intact membranes","volume":"189","author":"Y M Kim","year":"2003","journal-title":"Am J Obstet Gynecol"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1002\/uog.9017","article-title":"Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized, double-blind, placebo-controlled trial","volume":"38","author":"S S Hassan","year":"2011","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"05","key":"ref6","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1056\/NEJMoa067815","article-title":"Progesterone and the risk of preterm birth among women with a short cervix","volume":"357","author":"E B Fonseca","year":"2007","journal-title":"N Engl J Med"},{"key":"ref7","first-page":"CD012505","article-title":"Interventions during pregnancy to prevent preterm birth: an overview of Cochrane systematic reviews","volume":"11","author":"N Medley","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"issue":"23","key":"ref8","doi-asserted-by":"crossref","first-page":"2317","DOI":"10.1001\/jama.2017.18956","article-title":"Effect of cervical pessary on spontaneous preterm birth in women with singleton pregnancies and short cervical length: a randomized clinical trial","volume":"318","author":"G Saccone","year":"2017","journal-title":"JAMA"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"1849","DOI":"10.1016\/S0140-6736(04)16351-4","article-title":"Cervical cerclage for prevention of preterm delivery in women with short cervix: randomised controlled trial","volume":"363","author":"M S To","year":"2004","journal-title":"Lancet"},{"issue":"02","key":"ref10","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1055\/s-0038-1668547","article-title":"Cervical cerclage versus vaginal progesterone for management of short cervix in low-risk women","volume":"36","author":"A M Wood","year":"2019","journal-title":"Am J Perinatol"},{"issue":"01","key":"ref11","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1186\/s12884-020-02940-w","article-title":"The association between parity and spontaneous preterm birth: a population based study","volume":"20","author":"B Koullali","year":"2020","journal-title":"BMC Pregnancy Childbirth"},{"issue":"09","key":"ref12","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1056\/NEJM199602293340904","article-title":"The length of the cervix and the risk of spontaneous premature delivery","volume":"334","author":"J D Iams","year":"1996","journal-title":"N Engl J Med"},{"issue":"12","key":"ref13","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1055\/s-0040-1705169","article-title":"The impact of previous obstetric history on the risk of spontaneous preterm birth in women with a sonographic Short cervix","volume":"37","author":"C M Dude","year":"2020","journal-title":"Am J Perinatol"},{"issue":"06","key":"ref14","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1055\/s-0039-1685444","article-title":"Change in cervical length across pregnancies and preterm delivery","volume":"37","author":"A Dude","year":"2020","journal-title":"Am J Perinatol"},{"issue":"03","key":"ref15","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1002\/uog.202","article-title":"Accuracy of cervical transvaginal sonography in predicting preterm birth: a systematic review","volume":"22","author":"H Honest","year":"2003","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"03","key":"ref16","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1097\/AOG.0000000000000428","article-title":"A universal transvaginal cervical length screening program for preterm birth prevention","volume":"124","author":"K M Orzechowski","year":"2014","journal-title":"Obstet Gynecol"},{"issue":"03","key":"ref17","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1002\/uog.19050","article-title":"Implementation of universal screening for preterm delivery by mid-trimester cervical-length measurement","volume":"53","author":"A P Souka","year":"2019","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"06","key":"ref18","first-page":"972","article-title":"Cervical length at 16-22 weeks' gestation and risk for preterm delivery","volume":"96","author":"J U Hibbard","year":"2000","journal-title":"Obstet Gynecol"},{"issue":"07","key":"ref19","doi-asserted-by":"crossref","first-page":"1587","DOI":"10.1002\/jum.14677","article-title":"AIUM practice parameter for the performance of limited obstetric ultrasound examinations by advanced clinical providers","volume":"37","author":"AIUM Practice Parameter for the Performance of Limited Obstetric Ultrasound Examinations by Advanced Clinical Providers","year":"2018","journal-title":"J Ultrasound Med"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1055\/s-0040-1712950","article-title":"Ultrasonographic transabdominal measurement of uterine cervical length for the prediction of a midtrimester short cervix","author":"P Guerby","year":"2020","journal-title":"Am J Perinatol"},{"issue":"03","key":"ref21","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1136\/emj.2003.011148","article-title":"Simple nomograms to calculate sample size in diagnostic studies","volume":"22","author":"S Carley","year":"2005","journal-title":"Emerg Med J"},{"issue":"04","key":"ref22","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1002\/uog.6332","article-title":"Reference range for cervical length throughout pregnancy: non-parametric LMS-based model applied to a large sample","volume":"33","author":"L J Salomon","year":"2009","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"04","key":"ref23","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1097\/AOG.0b013e3182a2dccd","article-title":"Short ultrasonographic cervical length in women with low-risk obstetric history","volume":"122","author":"F L Facco","year":"2013","journal-title":"Obstet Gynecol"},{"issue":"11","key":"ref24","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1111\/aogs.12721","article-title":"The capacity of mid-pregnancy cervical length to predict preterm birth in low-risk women: a national cohort study","volume":"94","author":"J van der Ven","year":"2015","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"10","key":"ref25","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1055\/s-0035-1547327","article-title":"Preventing preterm birth with progesterone in women with a short cervical length from a low-risk population: a multicenter double-blind placebo-controlled randomized trial","volume":"32","author":"M A van Os","year":"2015","journal-title":"Am J Perinatol"},{"issue":"10","key":"ref26","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1001\/jama.2017.1373","article-title":"Predictive accuracy of serial transvaginal cervical lengths and quantitative vaginal fetal fibronectin levels for spontaneous preterm birth among nulliparous women","volume":"317","author":"M S Esplin","year":"2017","journal-title":"JAMA"},{"issue":"05","key":"ref27","doi-asserted-by":"crossref","first-page":"390.e1","DOI":"10.1016\/j.ajog.2012.09.013","article-title":"17 alpha-hydroxyprogesterone caproate to prevent prematurity in nulliparas with cervical length less than 30\u2009mm","volume":"207","author":"W A Grobman","year":"2012","journal-title":"Am J Obstet Gynecol"},{"issue":"01","key":"ref28","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1002\/jum.15091","article-title":"Predictive value of midtrimester universal cervical length screening based on parity","volume":"39","author":"J I Rosenbloom","year":"2020","journal-title":"J Ultrasound Med"},{"issue":"05","key":"ref29","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1002\/uog.5333","article-title":"Cervical length and obstetric history predict spontaneous preterm birth: development and validation of a model to provide individualized risk assessment","volume":"31","author":"E Celik","year":"2008","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"01","key":"ref30","doi-asserted-by":"crossref","first-page":"100.e1","DOI":"10.1016\/j.ajog.2016.01.192","article-title":"Cost-effectiveness of risk-based screening for cervical length to prevent preterm birth","volume":"215","author":"B D Einerson","year":"2016","journal-title":"Am J Obstet Gynecol"},{"issue":"03","key":"ref31","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1002\/uog.15967","article-title":"Influence of cut-off value on prevalence of short cervical length","volume":"49","author":"M A van Os","year":"2017","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"12","key":"ref32","doi-asserted-by":"crossref","first-page":"1938","DOI":"10.1111\/1471-0528.14213","article-title":"Maternal tobacco use and extremely premature birth - a population-based cohort study","volume":"123","author":"S Dahlin","year":"2016","journal-title":"BJOG"},{"issue":"07","key":"ref33","doi-asserted-by":"crossref","first-page":"e769","DOI":"10.1016\/S2214-109X(18)30223-7","article-title":"National, regional, and global prevalence of smoking during pregnancy in the general population: a systematic review and meta-analysis","volume":"6","author":"S Lange","year":"2018","journal-title":"Lancet Glob Health"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0041-1728818.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,31]],"date-time":"2022-12-31T00:30:49Z","timestamp":1672446649000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0041-1728818"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,3]]},"references-count":33,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2022,12,30]]},"published-print":{"date-parts":[[2023,1]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0041-1728818","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,3]]}}}