Prior uterine evacuation and the risk of short cervical length: A retrospective cohort study

Rupsa C. Boelig, Michela Villani, Eva Jiang, Kelly M. Orzechowski, Vincenzo Berghella

Research output: Contribution to journalArticle

Abstract

Objectives—To determine whether a prior uterine evacuation procedure is associated with an increased risk of short cervical length (≤20 mm) in women without prior spontaneous preterm birth. Methods—This work was a retrospective cohort study from January 2012 to December 2014 of singletons without prior spontaneous preterm birth with cervical length screening between 18 weeks and 23 weeks 6 days. Women with a prior miscarriage/ abortion were excluded if management (medical, surgical, or expectant) was not specified. Prior uterine evacuation was defined as dilation and curettage or dilation and evacuation of a spontaneous or induced abortion. The primary outcome was the risk of short cervical length (≤20mm) among women with and without 1 of more prior uterine evacuations at any gestational age, assessed by the odds ratio and adjusted odds ratio for confounders. Results—Of 2672 women included, 714 (27%) had at least 1 prior uterine evacuation. The overall incidence of short cervical length in the cohort was 1% (n527). Women with at least 1 prior uterine evacuation were more likely to be African American (64% versus 41%; P<.001), smoke (14% versus 8%; P<.001), have a higher body mass index (mean6SD, 28.167.1 versus 26.867.1 kg/m2; P<.001), and have had prior full-term delivery (60% versus 41%; P<.001). Women with at least 1 prior uterine evacuation had a significantly higher incidence of short cervical length (2% versus 0.7%; P5.003; odds ratio, 2.99 [95% confidence interval, 1.40–6.40]). After adjustment for confounders, prior uterine evacuation remained a source of increased risk of short cervical length (adjusted odds ratio, 2.63 [95% confidence interval, 1.19–5.80]). Conclusions—Although the overall incidence of short cervical length is low (1%– 2%), women with at least 1 prior uterine evacuation have at least a 2-fold increased risk of a short second-trimester cervical length compared to women without a prior uterine evacuation.

Original languageEnglish
Pages (from-to)1763-1769
Number of pages7
JournalJournal of Ultrasound in Medicine
Volume37
Issue number7
DOIs
Publication statusPublished - Jan 1 2018

Keywords

  • Cervical length
  • Dilation and curettage
  • Dilation and evacuation
  • Obstetrics (second trimester)
  • Preterm birth
  • Short cervix
  • Uterine evacuation

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging

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