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An ultrasonographically diagnosed short cervix has been associated with an increased risk of preterm birth, but the obstetric consequences of longer cervical lengths have been less well defined. The objective of this study was to determine the association between cervical length and cesarean delivery among women at term.
This is a cohort study of women with a singleton gestation who underwent routine mid-pregnancy transvaginal cervical length assessment and delivered at term. Women who underwent planned cesarean delivery without intent to labor were excluded from analysis. Women were grouped into quartiles based on cervical length, and the association of their cervical length quartile with cesarean delivery was determined in both univariable and multivariable analysis.
5806 subjects were included in this analysis, of whom 58.1% were nulliparous. There were multiple differences among women in the different cervical length quartiles (Table). The frequency of cesarean delivery among the cohort was 18.9%. As cervical length increased, the chance of cesarean delivery increased as well (14.7%, 19.5%, 19.1%, and 22.4% from the 1st through 4th quartiles, respectively). After controlling for potential confounding factors, cervical length quartile remained significantly associated with an increased odds of cesarean for the second (aOR 1.49, 95% CI 1.18-1.88), third (aOR 1.47, 95% CI 1.16-1.85) and fourth (aOR 1.89, 95% CI 1.50-2.38) quartiles, compared to the first quartile. This relationship held true for nulliparous as well as multiparous women.
1Population characteristics and cervical length per quartile
Increasing mid-trimester cervical length is associated with increasing frequency of cesarean delivery in both nulliparas and multiparas. Preparatory uterine changes that enable successful labor may be initiated as early as the mid-trimester.