Midtrimester cervical length as a predictor of labour outcomes: a prospective observational study
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20261269Keywords:
Transvaginal ultrasound, Cervical length, Preterm birth, Labour induction, Caesarean delivery, Pregnancy outcomesAbstract
Background: Preterm birth remains a major contributor to neonatal morbidity and mortality worldwide. Mid-trimester cervical length assessment using transvaginal ultrasound is useful in predicting a spectrum of labour outcomes, including preterm birth, post-dated pregnancy, need for labour induction, and operative delivery.
Methods: This hospital-based prospective observational study was conducted at Justice K. S. Hegde Charitable Hospital from June 2023 to November 2024. Mid-trimester cervical length was measured using transvaginal ultrasound between 18 and 24 weeks of gestation in 96 asymptomatic primigravida and second gravida women with singleton pregnancies. Participants were followed until delivery, and labour outcomes were recorded. Statistical analysis was performed using statistical package for the social sciences (SPSS) version 20.0.
Results: The mean cervical length was 3.71±0.38 cm. Spontaneous labour occurred in 72.9% of participants, while 27.1% required labour induction. Vaginal delivery occurred in 72.9% and caesarean section in 27.1%. Cervical length showed a statistically significant association with the onset of labour (p=0.012) and mode of delivery (p=0.023), suggesting its potential role as an independent predictor of labour dynamics beyond traditional risk stratification. Shorter cervical lengths were associated with spontaneous labour, whereas longer cervical lengths were linked to labour induction and caesarean delivery.
Conclusions: Mid-trimester cervical length measurement by transvaginal ultrasound, even within the normal range, serves as a clinically relevant predictor of labour outcomes. Its integration into routine antenatal assessment may enable more precise risk stratification, improved counselling, and individualized obstetric management, extending its role beyond traditional preterm birth prediction.
References
Tin gleff T, Vikanes Å, Räisänen S, Sandvik L, Murzakanova G, Laine K. Risk of preterm birth in relation to history of preterm birth: a population-based registry study of 213 335 women in Norway. BJOG Int J Obstet Gynaecol. 2022;129(6):900-7.
Lee SU, Jung G, Kim HW, Ko HS. How to screen the cervix and reduce the risk of spontaneous preterm birth in asymptomatic women without a prior preterm birth. Obstet Gynecol Sci. 2023;66(5):337-46.
Iams JD, Goldenberg RL, Meis PJ, Mercer BM, Moawad A, Das A, et al. The length of the cervix and the risk of spontaneous premature delivery. National Institute of Child Health and Human Development Maternal Fetal Medicine Unit Network. N Engl J Med. 1996;334(9):567-72.
Ms T, C S, Aw L, A C, Kh N. Cervical length and funneling at 23 weeks of gestation in the prediction of spontaneous early preterm delivery. Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol. 2001;18(3).
Peneva RH, Austin B, Muller BM, Alkis M, Finneran MM. Cervical funnelling is more predictive of preterm birth than cervical length alone in nulliparous women. Am J Obstet Gynecol. 2023;228(1):S722-3.
Hefila NM, Elfazari HA. Transvaginal ultrasound for cervical assessment versus digital vaginal examination during active phase of labour. Int J Reprod Contracept Obstet Gynecol. 2021;10(7):2547.
Zivaljevic J, Jovandaric MZ, Babic S, Raus M. Complications of Preterm Birth—The Importance of Care for the Outcome: A Narrative Review. Medicina (Mex). 2024;60(6):1014.
Sarmah H, Borah BK, Roy DK, Ghosh T. Assessment of maternal and perinatal outcome in postdated pregnancies in a tertiary care center. N Indian J Obstet Gynaecol. 2022;9(1):99-105.
Gonzalez JM, Dong Z, Romero R, Girardi G. Cervical Remodeling/Ripening at Term and Preterm Delivery: The Same Mechanism Initiated by Different Mediators and Different Effector Cells. Plos One. 2011;6(11):e26877.
Berghella V, Saccone G. Foetal fibronectin testing for reducing the risk of preterm birth. Cochrane Database Syst Rev. 2019;2019(7):CD006843.
Malabanan M, Pangilinan N. p. P19.02: Utility of cervical elastography in the prediction of preterm birth at 16–24 weeks of gestation on singleton pregnancy. Ultrasound Obstet Gynecol. 2019;54(S1):217.
Society for Maternal-Foetal Medicine (SMFM), McIntosh J, Feltovich H, Berghella V, Manuck T. The role of routine cervical length screening in selected high-and low-risk women for preterm birth prevention. Am J Obstet Gynecol. 2016;215(3):B2-7.
Salomon LJ, Diaz-Garcia C, Bernard JP, Ville Y. Reference range for cervical length throughout pregnancy: non-parametric LMS-based model applied to a large sample. Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol. 2009;33(4):459-64.
Arora P, Maitra NK, Agarwal S. Cervical length measurement by transvaginal ultrasound at 20 to 24 weeks gestation and the timing and mode of delivery. J South Asian Fed Obstet Gynaecol. 2012;4(1):22-4.
Hassan SS, Romero R, Vidyadhari D, Fusey S, Baxter JK, Khandelwal M, et al. Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized, double‐blind, placebo‐controlled trial. Ultrasound Obstet Gynecol. 2011;38(1):18-31.
Hassan SS, Romero R, Berry SM, Dang BK, Blackwell SC, Treadwell MC, et al. Patients with an ultrasonographic cervical length ≤15 mm have nearly a 50% risk of early spontaneous preterm delivery. Am J Obstet Gynecol. 2000;182(6):1458-67.
Taipale PP, Hiilesmaa VV. Sonographic measurement of uterine cervix at 18–22 weeks' gestation and the risk of preterm delivery. Obstet Gynecol. 1998;92(6):902-7.
Li PC, Tsui WL, Ding DC. The Association between Cervical Length and Successful Labour Induction: A Retrospective Cohort Study. Int J Environ Res Public Health. 2023 n 9;20(2):1138.
Soysal C, Işıkalan MM. The value of measuring cervical length between 24 and 28 weeks of gestation for predicting the risk of late and post-term pregnancy. J Matern-Foetal Neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2021;34(20):3402-7.
van der Ven AJ, van Os MA, Kleinrouweler CE, Verhoeven CJM, de Miranda E, Bossuyt PM, et al. Midpregnancy Cervical Length in Nulliparous Women and its Association with Postterm Delivery and Intrapartum CaesareanDelivery. Am J Perinatol. 2016;33(1):40-6.
Smith GCS, Celik E, To M, Khouri O, Nicolaides KH, Foetal Medicine Foundation Second Trimester Screening Group. Cervical length at mid-pregnancy and the risk of primary caesarean delivery. N Engl J Med. 2008;358(13):1346-53.
Rani SU, Aruna M, Padmanaban V. Cervical length in midpregnancy and labour outcome. Int J Scientific Study. 2017;6(7).
Datta M, Parashar S, Mukherjee P, Kumari S. Mid Trimester Transvaginal Ultrasound Assessment of Cervix for Prediction of Primary Caesarean Section. Open J Obstet Gynecol. 2015;05:855-63.
Coutinho CM, Sotiriadis A, Odibo A, Khalil A, D’Antonio F, Feltovich H, et al. ISUOG Practice Guidelines: role of ultrasound in the prediction of spontaneous preterm birth. Ultrasound Obstet Gynecol. 2022;60(3):435-56.
World Health Organization. Preterm birth. 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/preterm-birth. Accessed on 12 January 2026.
Rai S, Pande PB, Poudel S, Upadhyaya PC, Shah P. Ultrasonographic measurement of cervical length versus Bishop score for prediction of successful induction of labor. Int J Reprod Contracept Obstet Gynecol. 2024;13(10):2636-40.
Li PC, Tsui WL, Ding DC. The association between cervical length and successful labor induction: a retrospective cohort study. Int J Environ Res Public Health. 2023;20(2):1138.
Sreenivas A, Geetha K, Subhashini M. Transvaginal sonographic cervical length assessment in predicting the outcome of induction of labor. Int J Reprod Contracept Obstet Gynecol. 2022;11(3):853-8.
Sinha P, Gupta M, Meena S. Comparing Transvaginal Ultrasound Measurements of Cervical Length to Bishop Score in Predicting Cesarean Section Following Induction of Labor: A Prospective Observational Study. Cureus. 2024;16(2):e54335.
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