title: Cervical funneling: effect on gestational length and ultrasound-indicated cerclage in high-risk women.
abstract: OBJECTIVE
  The purpose of this study was to assess funnel type and pregnancy duration in women with previous spontaneous preterm birth and cervical length <25 mm.
  
  
  METHODS
  We performed a secondary analysis of a multicenter randomized trial of cerclage. At the randomization scan that documented short cervix, the presence and type of funnel (U or V) were recorded.
  
  
  RESULTS
  One hundred forty-seven of 301 women (49%) had funneling: V-shaped funnel, 99 women; U-shaped funnel, 48 women. U-shaped funnel was associated significantly with preterm birth at <24, <28, <35, and <37 weeks of gestation. In multivariable models that controlled for randomization cervical length and cerclage, women with U-shaped funnel delivered earlier than women with either V-shaped funnel or no funnel. Interaction between cerclage and U-shaped funnel was observed, and analyses that were stratified by cerclage showed that women with a U-shaped funnel and cerclage delivered at a mean of 33.8 +/- 6.6 weeks of gestation, compared with women who did not receive cerclage (28.9 +/- 6.9 weeks of gestation).
  
  
  CONCLUSIONS
  U-shaped funnels in high-risk women with a short cervix are associated with earlier birth.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama, Birmingham, AL, USA.
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Mancuso
authors.forename: Jeff M
authors.initials: JM
authors.lastname: Szychowski
authors.forename: John
authors.initials: J
authors.lastname: Owen
authors.forename: Gary
authors.initials: G
authors.lastname: Hankins
authors.forename: Jay D
authors.initials: JD
authors.lastname: Iams
authors.forename: Jeanne S
authors.initials: JS
authors.lastname: Sheffield
authors.forename: Annette
authors.initials: A
authors.lastname: Perez-Delboy
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Berghella
authors.forename: Debora A
authors.initials: DA
authors.lastname: Wing
authors.forename: Edwin R
authors.initials: ER
authors.lastname: Guzman
mesh_terms: D000328:Adult; D000650:Amnion / Q000000981:diagnostic imaging*; D023802:Cerclage, Cervical; D054791:Cervical Length Measurement; D002584:Cervix Uteri / Q000000981:diagnostic imaging*; D005260:Female; D005865:Gestational Age; D006801:Humans; D015999:Multivariate Analysis; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D047928:Premature Birth / Q000453:epidemiology* / Q000517:prevention & control
references.citation: J Ultrasound Med. 1995 Oct;14(10):719-24
references.pmid: 8544236
references.citation: Obstet Gynecol. 2007 Aug;110(2 Pt 1):405-15
references.pmid: 17666618
references.citation: Ultrasound Obstet Gynecol. 1997 Mar;9(3):188-93
references.pmid: 9165682
references.citation: Obstet Gynecol. 2004 Mar;103(3):457-62
references.pmid: 14990406
references.citation: N Engl J Med. 1996 Feb 29;334(9):567-72
references.pmid: 8569824
references.citation: Obstet Gynecol. 2007 Apr;109(4):863-9
references.pmid: 17400847
references.citation: JAMA. 2001 Sep 19;286(11):1340-8
references.pmid: 11560539
references.citation: Ultrasound Obstet Gynecol. 2000 Mar;15(3):242-5
references.pmid: 10846781
references.citation: Obstet Gynecol Clin North Am. 2004 Mar;31(1):125-39
references.pmid: 15062450
references.citation: Am J Obstet Gynecol. 2005 Apr;192(4):1060-6
references.pmid: 15846180
references.citation: Obstet Gynecol. 1991 Mar;77(3):343-7
references.pmid: 1992395
references.citation: Am J Obstet Gynecol. 2009 Oct;201(4):375.e1-8
references.pmid: 19788970
references.citation: Am J Obstet Gynecol. 2003 Oct;189(4):907-10
references.pmid: 14586323
references.citation: Obstet Gynecol. 1990 Aug;76(2):172-5
references.pmid: 2196494