Predictive score for early preterm birth in decisions about emergency cervical cerclage in singleton pregnancies

Abstract

Objective: To develop a simple score for assessing the risk of early preterm delivery before 32 weeks in women with singleton pregnancies receiving emergency cervical cerclage.

Design: Retrospective study.

Setting: French tertiary care center from 1994 to 2006.

Population: A total of 134 pregnant women underwent emergency cervical cerclage procedure at 15-26 weeks. The analysis concerned 85 singleton pregnancies after exclusion of women with a dilated cervix without visible membranes, or presenting for revision of failed prophylactic cerclage, or who had either preterm premature rupture of membranes or clinical signs of chorioamnionitis.

Methods: Multivariate logistic regression methods with rounded coefficients were used to develop a score to predict early preterm delivery before 32 weeks.

Main outcome measures: Early preterm delivery before 32 weeks.

Results: The score, ranging from 0 to 15 points, was based on the following four criteria independently associated with early preterm delivery: obstetric history; cervical dilatation; membranes bulging into the vagina; and infection. Each score value was associated with a predicted probability of early preterm birth.

Conclusions: The score and its associated early preterm probabilities may be a valuable tool to help physicians in advising women about the need for emergency cerclage.