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Cervical length in high-risk pregnancies

      To the Editors:

      I read with interest the work of Iams et al. (Iams JD, Johnson FF, Sonek J, Sachs L, Gebauer C, Samuels P. Cervical competence as a continuum: A study of ultrasonographic cervical length and obstetric performance. Am J Obstet Gynecol 1995;172:1097-106) and agree with their conclusion that cervical competence is a continuum. There are two points I would like to raise. First, as the authors discussed, the results may be complicated by the variable use of cerclage in each of the individual “reproductive history” groups. They report the differences in cervical length at each gestational age in the current pregnancy between women with or without cerclage. However, it would be interesting to know whether there was any difference in cervical length between the two groups (with or without cerclage) on the basis of “reproductive history.” In other words, did the 42% of women whose first preterm birth was delivered before 26 weeks and who did not undergo cerclage in the current pregnancy have any difference in cervical length measurements compared with the 58% who received a suture? Cervical change after cerclage has been demonstrated by several authors,
      • Andersen HF
      • Karimi A
      • Sakala EP
      • Kalugdan R
      Prediction of cervical cerclage outcome by endovaginal ultrasonography.
      but what remains unclear is whether the operation actually prevents or reduces subsequent shortening. There is an obvious paucity of randomized trials comparing surgical with nonsurgical management in this situation. Second, a cervical length of ≤25 mm is commonly being quoted as the diagnostic criteria for a short cervix.
      • Iams JD
      • Goldenberg RL
      • Meis PJ
      • et al.
      The length of the cervix and the risk of spontaneous prematurity.
      I note that most of the “reproductive history” groups reached this cervical length at approximately the same gestational age in the current pregnancy as in their first preterm births, possibly implying an element of biologic timing.
      Response declined

      References

        • Andersen HF
        • Karimi A
        • Sakala EP
        • Kalugdan R
        Prediction of cervical cerclage outcome by endovaginal ultrasonography.
        Am J Obstet Gynecol. 1994; 171: 1102-1106
        • Iams JD
        • Goldenberg RL
        • Meis PJ
        • et al.
        The length of the cervix and the risk of spontaneous prematurity.
        N Engl J Med. 1996; 334: 567-572