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Cervical length and quantitative fetal fibronectin in the prediction of spontaneous preterm birth in asymptomatic women with congenital uterine anomaly

      Background

      Congenital uterine anomalies are associated with late miscarriage and spontaneous preterm birth.

      Objective

      Our aim was 1) to determine the rate of spontaneous preterm birth in each type of congenital uterine anomaly, and 2) to assess the performance of quantitative fetal fibronectin and cervical length measurement by transvaginal ultrasound in asymptomatic women with congenital uterine anomalies for the prediction of spontaneous preterm birth at <34 and <37 weeks of gestation.

      Materials and Methods

      This was a retrospective cohort of women with congenital uterine anomalies asymptomatic for spontaneous preterm birth, from 4 tertiary referral centers in the United Kingdom (2001–2016). Congenital uterine anomalies were categorized into fusion (unicornuate, didelphic, and bicornuate uteri) or resorption defects (septate, with or without resection, and arcuate uteri), based on prepregnancy diagnosis. All women underwent serial transvaginal ultrasound cervical length assessment in the second trimester (16 to 24 weeks’ gestation); a subgroup underwent quantitative fetal fibronectin testing from 18 weeks’ gestation. We investigated the relationship between congenital uterine anomalies and predictive test performance for spontaneous preterm birth at <34 and <37 weeks’ gestation.

      Results

      A total of 319 women were identified as having congenital uterine anomalies in our high-risk population. Of the women, 7% (23/319) delivered spontaneously at <34 weeks’ gestation and 18% (56/319) at <37 weeks’ gestation. Rates of spontaneous preterm birth by type were as follows: 26% (7/27) for unicornuate, 21% (7/34) for didelphic, 16% (31/189) for bicornuate, 13% (7/56) for septate, and 31% (4/13) for arcuate. In all, 80% (45/56) of women who had spontaneous preterm birth at <37 weeks did not develop a short cervical length (<25 mm) during the surveillance period (16–24 weeks). The diagnostic accuracy of short cervical length had a low sensitivity (20.3) for predicting spontaneous preterm birth at <34 weeks. Cervical length had an area under the receiver operating curve of 0.56 (95% confidence interval, 0.48–0.64) and 0.59 (95% confidence interval, 0.55–0.64) for prediction of spontaneous preterm birth at <34 and <37 weeks, respectively. The area under the curve for cervical length to predict spontaneous preterm birth at <34 weeks was 0.48 for fusion defects (95% confidence interval, 0.39–0.57) but 0.78 (95% confidence interval, 0.66–0.91) for women with resorption defects. Overall quantitative fetal fibronectin had an area under the curve of 0.63 (95% confidence interval, 0.49–0.77) and 0.58 (95% confidence interval, 0.49– 0.68) for prediction of spontaneous preterm birth at <34 and <37 weeks, respectively. The area under the curve for prediction of spontaneous preterm birth at <37 weeks with quantitative fetal fibronectin for fusion defects was 0.52 (95% confidence interval, 0.41–0.63) but 0.79 (95% confidence interval, 0.63–0.95) for women with resorption defects. Results were similar when women with intervention were excluded.

      Conclusion

      The commonly used markers cervical length and quantitative fetal fibronectin have utility in prediction of spontaneous preterm birth in resorption congenital uterine defects but not in fusion defects. This is contrary to findings in other high-risk populations. These findings need to be accounted for when planning antenatal care, and have potential implications for predictive tests used in spontaneous preterm birth surveillance and intervention.

      Key words

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      References

        • Hua M.
        • Odibo A.O.
        • Longman R.E.
        • MacOnes G.A.
        • Roehl K.A.
        • Cahill A.G.
        Congenital uterine anomalies and adverse pregnancy outcomes.
        Am J Obstet Gynecol. 2011; 205: 558
        • Chan Y.Y.
        • Jayaprakasan K.
        • Tan A.
        • Thornton J.G.
        • Coomarasamy A.
        • Raine-Fenning N.J.
        Reproductive outcomes in women with congenital uterine anomalies: a systematic review.
        Ultrasound Obstet Gynecol. 2011; 38: 371-382
        • Venetis C.A.
        • Papadopoulos S.P.
        • Campo R.
        • Gordts S.
        • Tarlatzis B.C.
        • Grimbizis G.F.
        Clinical implications of congenital uterine anomalies: a meta-analysis of comparative studies.
        Reprod Biomed Online. 2014; 29: 665-683
        • Chan Y.Y.
        • Jayaprakasan K.
        • Zamora J.
        • Thornton J.G.
        • Raine-Fenning N.
        • Coomarasamy A.
        The prevalence of congenital uterine anomalies in unselected and high-risk populations: a systematic review.
        Hum Reprod Update. 2011; 17: 761-771
        • Acién P.
        • Acién M.I.
        The history of female genital tract malformation classifications and proposal of an updated system.
        Hum Reprod Update. 2011; 17: 693-705
        • Acien P.
        Reproductive performance of women with uterine anomalies.
        Acta Obstet Gynecol Scand. 1982; 61: 157-162
        • Raga F.
        • Bauset C.
        • Remohi J.
        • Bonilla-Musoles F.
        • Simón C.
        • Pellicer A.
        Reproductive impact of congenital Müllerian anomalies.
        Hum Reprod. 1997; 12: 2277-2281
        • Abbott D.S.
        • Hezelgrave N.L.
        • Seed P.T.
        • et al.
        Quantitative fetal fibronectin to predict preterm birth in asymptomatic women at high risk.
        Obstet Gynecol. 2015; 125: 1168-1176
        • Min J.
        • Watson H.A.
        • Hezelgrave N.L.
        • Seed P.T.
        • Shennan A.H.
        Ability of a preterm surveillance clinic to triage risk of preterm birth: a prospective cohort study.
        Ultrasound Obstet Gynecol. 2016; 48: 38-42
        • Kuhrt K.
        • Seed P.
        • Smout E.
        • Hezelgrave N.
        • Shennan A.
        Development and validation of a predictive tool for spontaneous preterm birth incorporating cervical length and quantitative fetal fibronectin in asymptomatic high risk women.
        Ultrasound Obstet Gynecol. 2016; 47: 104-109
        • Iams J.D.
        • Goldenberg R.L.
        • Meis P.J.
        • et al.
        The length of the cervix and the risk of spontaneous premature delivery.
        N Engl J Med. 1996; 334: 567-573
        • Berghella V.
        • Talucci M.
        • Desai A.
        Does transvaginal sonographic measurement of cervical length before 14 weeks predict preterm delivery in high-risk pregnancies?.
        Ultrasound Obstet Gynecol. 2003; 21: 140-144
        • Ng E.S.W.
        • Grieve R.
        • Carpenter J.R.
        Two-stage nonparametric bootstrap sampling with shrinkage correction for clustered data.
        Stata J. 2013; 13: 141-164
        • Leible S.
        • Munoz H.
        • Walton R.
        • Sabaj V.
        • Cumsille F.
        • Sepulveda W.
        Uterine artery blood flow velocity waveforms in pregnant women with mullerian duct anomaly: a biologic model for uteroplacental insufficiency.
        Am J Obstet Gynecol. 1998; 178: 1048-1053
        • Kupesic S.
        Clinical implications of sonographic detection of uterine anomalies for reproductive outcome.
        Ultrasound Obstet Gynecol. 2001; 18: 387-400
        • Simon C.
        • Martinez L.
        • Pardo F.
        • Tortajada M.
        • Pellicer A.
        Mullerian defects in women with normal reproductive outcome.
        Fertil Steril. 1991; 56: 1192-1193
        • Nott J.P.
        • Bonney E.A.
        • Pickering J.D.
        • Simpson N.A.B.
        The structure and function of the cervix during pregnancy.
        Transl Res Anat. 2016; 2: 1-7
        • Akar M.E.
        • Bayar D.
        • Yildiz S.
        • Ozel M.
        • Yilmaz Z.
        Reproductive outcome of women with unicornuate uterus.
        Aust N Z J Obstet Gynaecol. 2005; 45: 148-150
        • van der Krogt L.
        • Ridout A.E.
        • Seed P.T.
        • Shennan A.H.
        Placental inflammation and its relationship to cervicovaginal fetal fibronectin in preterm birth.
        Eur J Obstet Gynecol Reprod Biol. 2017; 214: 173-177
        • Airoldi J.
        Transvaginal ultrasonography of the cervix to predict preterm birth in women with uterine anomalies.
        Obstet Gynecol. 2005; 106: 553-556
        • Crane J.
        • Scott H.
        • Stewart A.
        • Chandra S.
        • Whittle W.
        • Hutchens D.
        Transvaginal ultrasonography to predict preterm birth in women with bicornuate or didelphus uterus.
        J Matern Neonatal Med. 2012; 25: 1960-1964
        • Fox N.S.
        Gestational age at cervical length measurement and incidence of preterm birth.
        Obstet Gynecol. 2007; 110 (author reply 1427): 1427
        • Fox N.S.
        • Saltzman D.H.
        • Gerber R.S.
        • Stern E.
        • Klauser C.K.
        • Rebarber A.
        Prediction of spontaneous preterm birth in patients with congenital uterine anomalies using combined fetal fibronectin and cervical length.
        Am J Clin Exp Obstet Gynecol. 2013; 1: 47-52