Does the presence of a funnel increase the risk of adverse perinatal outcome in a patient with a short cervix?
This study was undertaken to determine whether the presence of a dilated internal os (funneling or beaking) alters the outcome of patients with a short cervix documented by transvaginal ultrasound in the second trimester. Between January 1998 and May 2004, all singleton pregnancies with a short cerv...
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| Veröffentlicht in: | American journal of obstetrics and gynecology 2005-04, Vol.192 (4), p.1060-1066 |
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| creator | Rust, Orion A. Atlas, Robert O. Kimmel, Sharon Roberts, William E. Hess, L. Wayne |
| description | This study was undertaken to determine whether the presence of a dilated internal os (funneling or beaking) alters the outcome of patients with a short cervix documented by transvaginal ultrasound in the second trimester.
Between January 1998 and May 2004, all singleton pregnancies with a short cervix (≤2.5 cm) and no funnel between 16 and 24 weeks' gestational age were identified by query and review of the Lehigh Valley Perinatal Ultrasound Database. These no funnel patients were compared with patients with a short cervix and funnel matched in accordance with cervical length and risk factors. Multiple variables of perinatal outcome were identified and compared between the Funnel and No Funnel groups. Correlations between cervical measurements and gestational age at birth were analyzed.
Of the 279 patients with a short cervix identified, 82 were singleton with a T-shaped cervix and no funnel and 82 patients matched with a typical Y-shaped funnel. There was no difference between groups with respect to maternal demographics, previous preterm birth (28.1% No Funnel group vs 36.5% Funnel group
, P
=
.3), prior cervical surgery (24.3% vs 22.0
%, P
=
.8), gestational age at entry (20.5 ± 2.1 vs 21.1 ± 2.4 weeks,
P
=
.1), and cervical length (1.9 ± 0.4 vs 1.8 ± 0.5 cm
, P
=
.1). The No Funnel group had significantly less readmissions for preterm labor (43.2% vs 67.1
%, P
=
.004), chorioamnionitis (2.4% vs 23.2
%, P
=
.0002), abruption (1.2% vs 13.4
%, P
=
.007), preterm rupture of membranes (6.1% vs 23.4%,
P
=
.002), and cerclage placement (23.2% vs 43
%, P
=
.008). The neonates in the no funnel group delivered later (36.2% ± 4.6 vs 33.8 ± 5.4 weeks
, P
=
.003), and had less morbidity and mortality (17.1% vs 37.8
%, P
=
.02) compared with the Funnel group. The width and depth of the funnel did not correlate with perinatal outcome. Cervical length (
R
2
=
0.07,
P
=
.02) and cervical funneling as a categorical variable (
r
=
0.3,
P
=
.0002) did correlate with earlier delivery.
The disruption of the internal os, as documented by funneling, is a significant risk factor for adverse perinatal outcome (ie, preterm labor, chorioamnionitis, abruption, rupture of the membranes, and serious neonatal morbidity and mortality). Cervical funneling is best measured as a categorical variable (present or absent). |
| doi_str_mv | 10.1016/j.ajog.2005.01.076 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_67767428</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S000293780500284X</els_id><sourcerecordid>67767428</sourcerecordid><originalsourceid>FETCH-LOGICAL-c384t-d23b05c4e6e4ee76236080d881e79f4b09d2bf1db6e032201742161d6847d2753</originalsourceid><addsrcrecordid>eNp9kU1v1DAQhi0EokvhD3BAvtBbwtjJ2o6EhFDLl1SJS3u2HHvCesnGwXYW-Pc43ZV64zSa8fOORo8Jec2gZsDEu31t9uFHzQG2NbAapHhCNgw6WQkl1FOyAQBedY1UF-RFSvu15R1_Ti7YVrWCKdiQ6SZgonmHdI6YcLJIw0ANHZZpwpH6yUY0CR-I6NPPh1d3xFhmM0Y_mWxGGpZswwELXqKzyR6nTH_7vCtt2oWYqcV49H8-vCTPBjMmfHWul-T-86e766_V7fcv364_3la2UW2uHG962NoWBbaIUvBGgAKnFEPZDW0PneP9wFwvEBrOgcmWM8GcUK10XG6bS3J12jvH8GvBlPXBJ4vjaCYMS9JCSlEyqoD8BNoYUoo46Dn6g4l_NQO9WtZ7vVrWq2UNTBfLJfTmvH3pD-geI2etBXh7BkyyZhyimaxPj5yQDbSNLNz7E4fFxdFj1Mn69ROcj2izdsH_745_qO6abg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>67767428</pqid></control><display><type>article</type><title>Does the presence of a funnel increase the risk of adverse perinatal outcome in a patient with a short cervix?</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Rust, Orion A. ; Atlas, Robert O. ; Kimmel, Sharon ; Roberts, William E. ; Hess, L. Wayne</creator><creatorcontrib>Rust, Orion A. ; Atlas, Robert O. ; Kimmel, Sharon ; Roberts, William E. ; Hess, L. Wayne</creatorcontrib><description>This study was undertaken to determine whether the presence of a dilated internal os (funneling or beaking) alters the outcome of patients with a short cervix documented by transvaginal ultrasound in the second trimester.
Between January 1998 and May 2004, all singleton pregnancies with a short cervix (≤2.5 cm) and no funnel between 16 and 24 weeks' gestational age were identified by query and review of the Lehigh Valley Perinatal Ultrasound Database. These no funnel patients were compared with patients with a short cervix and funnel matched in accordance with cervical length and risk factors. Multiple variables of perinatal outcome were identified and compared between the Funnel and No Funnel groups. Correlations between cervical measurements and gestational age at birth were analyzed.
Of the 279 patients with a short cervix identified, 82 were singleton with a T-shaped cervix and no funnel and 82 patients matched with a typical Y-shaped funnel. There was no difference between groups with respect to maternal demographics, previous preterm birth (28.1% No Funnel group vs 36.5% Funnel group
, P
=
.3), prior cervical surgery (24.3% vs 22.0
%, P
=
.8), gestational age at entry (20.5 ± 2.1 vs 21.1 ± 2.4 weeks,
P
=
.1), and cervical length (1.9 ± 0.4 vs 1.8 ± 0.5 cm
, P
=
.1). The No Funnel group had significantly less readmissions for preterm labor (43.2% vs 67.1
%, P
=
.004), chorioamnionitis (2.4% vs 23.2
%, P
=
.0002), abruption (1.2% vs 13.4
%, P
=
.007), preterm rupture of membranes (6.1% vs 23.4%,
P
=
.002), and cerclage placement (23.2% vs 43
%, P
=
.008). The neonates in the no funnel group delivered later (36.2% ± 4.6 vs 33.8 ± 5.4 weeks
, P
=
.003), and had less morbidity and mortality (17.1% vs 37.8
%, P
=
.02) compared with the Funnel group. The width and depth of the funnel did not correlate with perinatal outcome. Cervical length (
R
2
=
0.07,
P
=
.02) and cervical funneling as a categorical variable (
r
=
0.3,
P
=
.0002) did correlate with earlier delivery.
The disruption of the internal os, as documented by funneling, is a significant risk factor for adverse perinatal outcome (ie, preterm labor, chorioamnionitis, abruption, rupture of the membranes, and serious neonatal morbidity and mortality). Cervical funneling is best measured as a categorical variable (present or absent).</description><identifier>ISSN: 0002-9378</identifier><identifier>EISSN: 1097-6868</identifier><identifier>DOI: 10.1016/j.ajog.2005.01.076</identifier><identifier>PMID: 15846180</identifier><identifier>CODEN: AJOGAH</identifier><language>eng</language><publisher>Philadelphia, PA: Mosby, Inc</publisher><subject>Adult ; Biological and medical sciences ; Cervix Uteri - diagnostic imaging ; Cervix Uteri - pathology ; Cohort Studies ; Female ; Gestational Age ; Gynecology. Andrology. Obstetrics ; Humans ; Medical sciences ; Obstetric Labor, Premature - prevention & control ; Predictive Value of Tests ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, Second ; Preterm labor ; Probability ; Reference Values ; Retrospective Studies ; Risk Assessment ; Short cervix ; Statistics, Nonparametric ; Transvaginal ultrasound ; Ultrasonography, Prenatal ; Uterine Cervical Incompetence - diagnostic imaging</subject><ispartof>American journal of obstetrics and gynecology, 2005-04, Vol.192 (4), p.1060-1066</ispartof><rights>2005 Elsevier Inc.</rights><rights>2005 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c384t-d23b05c4e6e4ee76236080d881e79f4b09d2bf1db6e032201742161d6847d2753</citedby><cites>FETCH-LOGICAL-c384t-d23b05c4e6e4ee76236080d881e79f4b09d2bf1db6e032201742161d6847d2753</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ajog.2005.01.076$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>309,310,314,778,782,787,788,3539,23913,23914,25123,27907,27908,45978</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16730437$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15846180$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rust, Orion A.</creatorcontrib><creatorcontrib>Atlas, Robert O.</creatorcontrib><creatorcontrib>Kimmel, Sharon</creatorcontrib><creatorcontrib>Roberts, William E.</creatorcontrib><creatorcontrib>Hess, L. Wayne</creatorcontrib><title>Does the presence of a funnel increase the risk of adverse perinatal outcome in a patient with a short cervix?</title><title>American journal of obstetrics and gynecology</title><addtitle>Am J Obstet Gynecol</addtitle><description>This study was undertaken to determine whether the presence of a dilated internal os (funneling or beaking) alters the outcome of patients with a short cervix documented by transvaginal ultrasound in the second trimester.
Between January 1998 and May 2004, all singleton pregnancies with a short cervix (≤2.5 cm) and no funnel between 16 and 24 weeks' gestational age were identified by query and review of the Lehigh Valley Perinatal Ultrasound Database. These no funnel patients were compared with patients with a short cervix and funnel matched in accordance with cervical length and risk factors. Multiple variables of perinatal outcome were identified and compared between the Funnel and No Funnel groups. Correlations between cervical measurements and gestational age at birth were analyzed.
Of the 279 patients with a short cervix identified, 82 were singleton with a T-shaped cervix and no funnel and 82 patients matched with a typical Y-shaped funnel. There was no difference between groups with respect to maternal demographics, previous preterm birth (28.1% No Funnel group vs 36.5% Funnel group
, P
=
.3), prior cervical surgery (24.3% vs 22.0
%, P
=
.8), gestational age at entry (20.5 ± 2.1 vs 21.1 ± 2.4 weeks,
P
=
.1), and cervical length (1.9 ± 0.4 vs 1.8 ± 0.5 cm
, P
=
.1). The No Funnel group had significantly less readmissions for preterm labor (43.2% vs 67.1
%, P
=
.004), chorioamnionitis (2.4% vs 23.2
%, P
=
.0002), abruption (1.2% vs 13.4
%, P
=
.007), preterm rupture of membranes (6.1% vs 23.4%,
P
=
.002), and cerclage placement (23.2% vs 43
%, P
=
.008). The neonates in the no funnel group delivered later (36.2% ± 4.6 vs 33.8 ± 5.4 weeks
, P
=
.003), and had less morbidity and mortality (17.1% vs 37.8
%, P
=
.02) compared with the Funnel group. The width and depth of the funnel did not correlate with perinatal outcome. Cervical length (
R
2
=
0.07,
P
=
.02) and cervical funneling as a categorical variable (
r
=
0.3,
P
=
.0002) did correlate with earlier delivery.
The disruption of the internal os, as documented by funneling, is a significant risk factor for adverse perinatal outcome (ie, preterm labor, chorioamnionitis, abruption, rupture of the membranes, and serious neonatal morbidity and mortality). Cervical funneling is best measured as a categorical variable (present or absent).</description><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Cervix Uteri - diagnostic imaging</subject><subject>Cervix Uteri - pathology</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Gestational Age</subject><subject>Gynecology. Andrology. Obstetrics</subject><subject>Humans</subject><subject>Medical sciences</subject><subject>Obstetric Labor, Premature - prevention & control</subject><subject>Predictive Value of Tests</subject><subject>Pregnancy</subject><subject>Pregnancy Outcome</subject><subject>Pregnancy Trimester, Second</subject><subject>Preterm labor</subject><subject>Probability</subject><subject>Reference Values</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Short cervix</subject><subject>Statistics, Nonparametric</subject><subject>Transvaginal ultrasound</subject><subject>Ultrasonography, Prenatal</subject><subject>Uterine Cervical Incompetence - diagnostic imaging</subject><issn>0002-9378</issn><issn>1097-6868</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1v1DAQhi0EokvhD3BAvtBbwtjJ2o6EhFDLl1SJS3u2HHvCesnGwXYW-Pc43ZV64zSa8fOORo8Jec2gZsDEu31t9uFHzQG2NbAapHhCNgw6WQkl1FOyAQBedY1UF-RFSvu15R1_Ti7YVrWCKdiQ6SZgonmHdI6YcLJIw0ANHZZpwpH6yUY0CR-I6NPPh1d3xFhmM0Y_mWxGGpZswwELXqKzyR6nTH_7vCtt2oWYqcV49H8-vCTPBjMmfHWul-T-86e766_V7fcv364_3la2UW2uHG962NoWBbaIUvBGgAKnFEPZDW0PneP9wFwvEBrOgcmWM8GcUK10XG6bS3J12jvH8GvBlPXBJ4vjaCYMS9JCSlEyqoD8BNoYUoo46Dn6g4l_NQO9WtZ7vVrWq2UNTBfLJfTmvH3pD-geI2etBXh7BkyyZhyimaxPj5yQDbSNLNz7E4fFxdFj1Mn69ROcj2izdsH_745_qO6abg</recordid><startdate>20050401</startdate><enddate>20050401</enddate><creator>Rust, Orion A.</creator><creator>Atlas, Robert O.</creator><creator>Kimmel, Sharon</creator><creator>Roberts, William E.</creator><creator>Hess, L. Wayne</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20050401</creationdate><title>Does the presence of a funnel increase the risk of adverse perinatal outcome in a patient with a short cervix?</title><author>Rust, Orion A. ; Atlas, Robert O. ; Kimmel, Sharon ; Roberts, William E. ; Hess, L. Wayne</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c384t-d23b05c4e6e4ee76236080d881e79f4b09d2bf1db6e032201742161d6847d2753</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Cervix Uteri - diagnostic imaging</topic><topic>Cervix Uteri - pathology</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Gestational Age</topic><topic>Gynecology. Andrology. Obstetrics</topic><topic>Humans</topic><topic>Medical sciences</topic><topic>Obstetric Labor, Premature - prevention & control</topic><topic>Predictive Value of Tests</topic><topic>Pregnancy</topic><topic>Pregnancy Outcome</topic><topic>Pregnancy Trimester, Second</topic><topic>Preterm labor</topic><topic>Probability</topic><topic>Reference Values</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Short cervix</topic><topic>Statistics, Nonparametric</topic><topic>Transvaginal ultrasound</topic><topic>Ultrasonography, Prenatal</topic><topic>Uterine Cervical Incompetence - diagnostic imaging</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rust, Orion A.</creatorcontrib><creatorcontrib>Atlas, Robert O.</creatorcontrib><creatorcontrib>Kimmel, Sharon</creatorcontrib><creatorcontrib>Roberts, William E.</creatorcontrib><creatorcontrib>Hess, L. Wayne</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of obstetrics and gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rust, Orion A.</au><au>Atlas, Robert O.</au><au>Kimmel, Sharon</au><au>Roberts, William E.</au><au>Hess, L. Wayne</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Does the presence of a funnel increase the risk of adverse perinatal outcome in a patient with a short cervix?</atitle><jtitle>American journal of obstetrics and gynecology</jtitle><addtitle>Am J Obstet Gynecol</addtitle><date>2005-04-01</date><risdate>2005</risdate><volume>192</volume><issue>4</issue><spage>1060</spage><epage>1066</epage><pages>1060-1066</pages><issn>0002-9378</issn><eissn>1097-6868</eissn><coden>AJOGAH</coden><abstract>This study was undertaken to determine whether the presence of a dilated internal os (funneling or beaking) alters the outcome of patients with a short cervix documented by transvaginal ultrasound in the second trimester.
Between January 1998 and May 2004, all singleton pregnancies with a short cervix (≤2.5 cm) and no funnel between 16 and 24 weeks' gestational age were identified by query and review of the Lehigh Valley Perinatal Ultrasound Database. These no funnel patients were compared with patients with a short cervix and funnel matched in accordance with cervical length and risk factors. Multiple variables of perinatal outcome were identified and compared between the Funnel and No Funnel groups. Correlations between cervical measurements and gestational age at birth were analyzed.
Of the 279 patients with a short cervix identified, 82 were singleton with a T-shaped cervix and no funnel and 82 patients matched with a typical Y-shaped funnel. There was no difference between groups with respect to maternal demographics, previous preterm birth (28.1% No Funnel group vs 36.5% Funnel group
, P
=
.3), prior cervical surgery (24.3% vs 22.0
%, P
=
.8), gestational age at entry (20.5 ± 2.1 vs 21.1 ± 2.4 weeks,
P
=
.1), and cervical length (1.9 ± 0.4 vs 1.8 ± 0.5 cm
, P
=
.1). The No Funnel group had significantly less readmissions for preterm labor (43.2% vs 67.1
%, P
=
.004), chorioamnionitis (2.4% vs 23.2
%, P
=
.0002), abruption (1.2% vs 13.4
%, P
=
.007), preterm rupture of membranes (6.1% vs 23.4%,
P
=
.002), and cerclage placement (23.2% vs 43
%, P
=
.008). The neonates in the no funnel group delivered later (36.2% ± 4.6 vs 33.8 ± 5.4 weeks
, P
=
.003), and had less morbidity and mortality (17.1% vs 37.8
%, P
=
.02) compared with the Funnel group. The width and depth of the funnel did not correlate with perinatal outcome. Cervical length (
R
2
=
0.07,
P
=
.02) and cervical funneling as a categorical variable (
r
=
0.3,
P
=
.0002) did correlate with earlier delivery.
The disruption of the internal os, as documented by funneling, is a significant risk factor for adverse perinatal outcome (ie, preterm labor, chorioamnionitis, abruption, rupture of the membranes, and serious neonatal morbidity and mortality). Cervical funneling is best measured as a categorical variable (present or absent).</abstract><cop>Philadelphia, PA</cop><pub>Mosby, Inc</pub><pmid>15846180</pmid><doi>10.1016/j.ajog.2005.01.076</doi><tpages>7</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0002-9378 |
| ispartof | American journal of obstetrics and gynecology, 2005-04, Vol.192 (4), p.1060-1066 |
| issn | 0002-9378 1097-6868 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_67767428 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adult Biological and medical sciences Cervix Uteri - diagnostic imaging Cervix Uteri - pathology Cohort Studies Female Gestational Age Gynecology. Andrology. Obstetrics Humans Medical sciences Obstetric Labor, Premature - prevention & control Predictive Value of Tests Pregnancy Pregnancy Outcome Pregnancy Trimester, Second Preterm labor Probability Reference Values Retrospective Studies Risk Assessment Short cervix Statistics, Nonparametric Transvaginal ultrasound Ultrasonography, Prenatal Uterine Cervical Incompetence - diagnostic imaging |
| title | Does the presence of a funnel increase the risk of adverse perinatal outcome in a patient with a short cervix? |
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