Utility of volumetric assessment of cervical funneling to predict cerclage failure.
OBJECTIVE
To assess the utility of cervical funnel volume as a predictor of cerclage failure.


METHODS
We performed a retrospective cohort study of pregnant women with a McDonald cerclage and sonographic evidence of cervical funneling between 1/2008 and 2/2014. Funnel volume (FV) was calculated and used as a correction factor for cervical length (CL) or cerclage height (CH). Receiver operating characteristic (ROC) curves were used to compare the predictive value of CL, CL:FV, CH and CH:FV for cerclage failure at <28 or <34 weeks. CL:FV was further stratified to the <5th, <10th and >10th percentiles and analyzed for prediction of preterm delivery.


RESULTS
Subjects with cerclage failure (n = 30) delivered at a mean gestational age of 29.8 +/- 5.3 weeks compared to 38.1+/- 1.39 weeks in those without failure (n = 27; p < 0.001). ROC curves demonstrated CL:FV was the best predictor of delivery <28 weeks (AUC 0.80), while CL was the best predictor of delivery <34 weeks (AUC 0.76). Stratification of CL:FV into <5th versus >10th percentile groups was predictive of early preterm delivery (25.1 weeks versus 34 weeks, p = 0.01).


CONCLUSIONS
Volumetric assessment of cervical funneling may improve prediction of cerclage failure in the mid-trimester.
a Department of Obstetrics and Gynecology , Indiana University School of Medicine , Indianapolis , IN , USA and.
Jessica S
JS
Sheng
a Department of Obstetrics and Gynecology , Indiana University School of Medicine , Indianapolis , IN , USA and.
Frank P
FP
Schubert
a Department of Obstetrics and Gynecology , Indiana University School of Medicine , Indianapolis , IN , USA and.|b Department of Medicine , Indiana University School of Medicine , Indianapolis , IN , USA.
Avinash S
AS
Patil
D000328:Adult; D016022:Case-Control Studies; D023802:Cerclage, Cervical; D054791:Cervical Length Measurement; D002584:Cervix Uteri / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D047928:Premature Birth / Q000517:prevention & control*; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017211:Treatment Failure; D055815:Young Adult
Cerclage; cervix; preterm delivery