10.5061/DRYAD.R7R01
Kindinger, Lindsay M.
Imperial College London
Data from: Preterm birth prevention post-conization: a model of cervical
length screening with targeted cerclage
Dryad
dataset
2017
cervical intra-epithelial neoplasia
2004-2014
Preterm birth
excisional cervical treatment
cervical length
LLETZ
cervical cerclage
2017-09-30T00:00:00Z
2017-09-30T00:00:00Z
en
https://doi.org/10.1371/journal.pone.0163793
128512 bytes
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CC0 1.0 Universal (CC0 1.0) Public Domain Dedication
Women with a history of excisional treatment (conization) for cervical
intra-epithelial neoplasia (CIN) are at increased risk of preterm birth,
perinatal morbidity and mortality in subsequent pregnancy. We aimed to
develop a screening model to effectively differentiate pregnancies
post-conization into low- and high-risk for preterm birth, and to evaluate
the impact of suture material on the efficacy of ultrasound indicated
cervical cerclage. We analysed longitudinal cervical length (CL) data from
725 pregnant women post-conization attending preterm surveillance clinics
at three London university Hospitals over a ten year period (2004–2014).
Rates of preterm birth <37 weeks after targeted cerclage for
CL<25mm were compared with local and national background rates and
expected rates for this cohort. Rates for cerclage using monofilament or
braided suture material were also compared. Of 725 women post-conization
13.5% (98/725) received an ultrasound indicated cerclage and 9.7% (70/725)
delivered prematurely, <37weeks; 24.5% (24/98) of these despite
insertion of cerclage. The preterm birth rate was lower for those that had
monofilament (9/60, 15%) versus braided (15/38, 40%) cerclage (RR 0.7, 95%
CI 0.54 to 0.94, P = 0.008). Accuracy parameters of interval reduction in
CL between longitudinal second trimester screenings were calculated to
identify women at low risk of preterm birth, who could safely discontinue
surveillance. A reduction of CL <10% between screening timepoints
predicts term birth, >37weeks. Our triage model enables timely
discharge of low risk women, eliminating 36% of unnecessary follow-up CL
scans. We demonstrate that preterm birth in women post-conization may be
reduced by targeted cervical cerclage. Cerclage efficacy is however suture
material-dependant: monofilament is preferable to braided suture. The
introduction of triage prediction models has the potential to reduce the
number of unnecessary CL scan for women at low risk of preterm birth.
Kindinger data_Uploaded PlosOneAnonymised individual cervical length and
outcome data of pregnant women who had been treated by excision cervical
cervical treatment for cervical intraepithelial neoplasia, pre-pregnancy.
UK
London