Cervical funneling: effect on gestational length and ultrasound-indicated cerclage in high-risk women.
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.
Mancuso
Melissa S
MS
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama, Birmingham, AL, USA.
Szychowski
Jeff M
JM
Owen
John
J
Hankins
Gary
G
Iams
Jay D
JD
Sheffield
Jeanne S
JS
Perez-Delboy
Annette
A
Berghella
Vincenzo
V
Wing
Debora A
DA
Guzman
Edwin R
ER
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
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