Rate of sonographic cervical shortening and biologic pathways of spontaneous preterm birth

Am J Obstet Gynecol. 2014 Jun;210(6):555.e1-5. doi: 10.1016/j.ajog.2013.12.037. Epub 2013 Dec 27.

Abstract

Objective: The objective of the study was to estimate the relationship between midtrimester cervical length (CL) and maternal serum markers of systemic inflammation, activation of the maternal-fetal hypothalamic-pituitary axis, and alterations in thrombosis-hemostasis.

Study design: This is a secondary analysis of a prospective cohort study designed to predict preterm birth in the general obstetric population. Women had serial CL ultrasounds and assessment of maternal serum corticotrophin-releasing hormone, C-reactive protein, and thrombin-antithrombin III complexes between 20 and 33 weeks' gestation and were followed up until delivery.

Results: Shortening of CL was associated with the rate of rise in corticotrophin-releasing hormone (r(2) = 0.34, P = .014) and C-reactive protein (r(2) = 0.44, P = .001) for women with CL less than 25 mm but not for the cohort overall. There was no association of change in CL with change in thrombin-antithrombin III concentration.

Conclusion: Among women with a midtrimester sonographically short cervix, changes in serum markers suggest that a shortening CL may be associated with systemic inflammation and activation of the maternal-fetal hypothalamic-pituitary axis but not systemic thrombosis-hemostasis.

Keywords: cervical length; corticotrophin-releasing hormone; inflammation; preterm birth.

MeSH terms

  • Adolescent
  • Adult
  • Antithrombin III / analysis
  • Biomarkers / analysis*
  • C-Reactive Protein / analysis
  • Cervix Uteri / anatomy & histology*
  • Cervix Uteri / diagnostic imaging
  • Corticotropin-Releasing Hormone / analysis
  • Female
  • Humans
  • Hypothalamo-Hypophyseal System / metabolism*
  • Linear Models
  • Obstetric Labor, Premature / physiopathology*
  • Predictive Value of Tests
  • Pregnancy
  • Pregnancy Complications / diagnostic imaging*
  • Pregnancy Complications / metabolism
  • Pregnancy Trimester, Second / physiology*
  • Premature Birth / diagnostic imaging
  • Premature Birth / metabolism*
  • Prospective Studies
  • Ultrasonography

Substances

  • Biomarkers
  • Antithrombin III
  • C-Reactive Protein
  • Corticotropin-Releasing Hormone