Does hospitalization prevent preterm delivery in the patient with a short cervix?
This study considers whether admission to the hospital of a patient diagnosed with a short cervix delayed delivery, prevented preterm delivery, and/or decreased the rate of change in the cervical length (CL) on follow-up measurements. The design was a retrospective cohort study of women carrying singleton pregnancies with cervical lengths <or= 25 mm at gestational ages 16 to 28 weeks managed expectantly from July 2002 through July 2005. Eighty-two patients met criteria for inclusion, 26 (32%) of whom were hospitalized. On univariate analysis, hospitalization correlated with delivery < 34 weeks ( p=0.027), an earlier gestational age (GA) at delivery ( p=0.046), and a shorter time from diagnosis to delivery ( p< .001). Multivariate regression analysis of significant factors (age, prior preterm births, initial CL, GA at diagnosis, and hospitalization) showed a correlation between hospitalization and increased rate of cervical shortening ( p=0.005), and a trend toward hospitalization as an independent risk factor for delivery less than 34 weeks ( p=0.066), an earlier GA at delivery ( p=0.058), and a shorter time from diagnosis to delivery ( p=0.078). There also was no benefit seen from hospitalization when the initial CL was < 15 mm, although we were underpowered for this analysis. Admission to the hospital was not associated with a decreased rate of preterm delivery and there was a trend toward hospitalization as an independent risk factor for delivery at < 34 weeks, an earlier GA at delivery, and a shorter time from diagnosis to delivery. Hospitalization was independently associated with an increased rate of cervical shortening.
Fox
Nathan S
NS
Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY, USA.
Jean-Pierre
Claudel
C
Predanic
Mladen
M
Chasen
Stephen T
ST
D000328:Adult; D002584:Cervix Uteri / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008499:Medical Records; D009519:New York City / Q000453:epidemiology; D007752:Obstetric Labor, Premature / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D011295:Prenatal Care; D012189:Retrospective Studies; D012307:Risk Factors