Cervical length varies considering different populations and gestational outcomes: Results from a systematic review and meta-analysis

T. G. Bortoletto; T. V. Silva; A. Borovac-Pinheiro; C. M. Pereira; A. D. Silva; M. S. França; A. R. Hatanaka; J. P. Argenton; Jr. Passini R.; B. W. Mol; J. G. Cecatti; R. C. Pacagnella

doi:10.1371/journal.pone.0245746

Cervical length varies considering different populations and gestational outcomes: Results from a systematic review and meta-analysis

T. G. Bortoletto, T. V. Silva, A. Borovac-Pinheiro, C. M. Pereira, A. D. Silva, M. S. França, A. R. Hatanaka, J. P. Argenton, Jr. Passini R., B. W. Mol, J. G. Cecatti, R. C. Pacagnella^* (Corresponding Author)

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Background
The uterine cervical length is an important risk factor for preterm birth. The aim of this study was to assess cervical length distribution in women with singleton pregnancies, measured by transvaginal ultrasound between 16 and 24 weeks, and its association with population characteristics.
Materials and methods
We searched electronic databases and other sources for studies published from April 1, 1990 to July 21, 2020. Of the 2019 retrieved publications, full-text versions of 137 articles were considered. We included 77 original articles that reported cervical length measurements of 363,431 women. The main aim of this study was to identify the pattern of cervical length in different populations. We collected demographic and clinical data concerning the population, in addition to information regarding the ultrasound examination and cervical length measurement. Regarding study bias, 56 were at low risk of bias and 21 were at medium risk of bias.
Results
The meta-analysis included 57 articles with data from 158,346 women. The mean cervical length was 37.96. mm (95% CI [36.68, 39.24]). Cervical length was shorter in women from Africa and Asia, in those from low-income countries, with a lower body weight, and in those who delivered before 37 gestational weeks. We found that the cervical length from pooled studies is longer than that usually discussed in the literature. Regarding limitations, we had difficulty assessing our main variable because there was no consistent pattern in the way authors reported cervical length measurement. Another limitation was the great heterogeneity between studies.
Conclusions
The use of a single cutoff value to define a short cervix diagnosis, an important risk factor for preterm birth, may not be correct and cervical length must be considered according to maternal population characteristics. Future studies should identify different specific curves and cutoff values for cervical length in different populations. This meta-analysis was registered in the PROSPERO database under CRD42017070246 at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=70246.

Original language	English
Article number	e0245746
Number of pages	18
Journal	PloS ONE
Volume	16
Issue number	2
Early online date	16 Feb 2021
DOIs	https://doi.org/10.1371/journal.pone.0245746
Publication status	Published - 16 Feb 2021

Bibliographical note

Funding: This work was supported by the Bill & Melinda Gates Foundation, Seattle, WA [OPP1107597], the Brazilian Ministry of Health and the Brazilian National Council for Scientific and Technological Development (CNPq) [401615/20138]. RCP and BM received funds for the study. No author received salary from any funders and the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Copyright: © 2021 Bortoletto et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. https://creativecommons.org/licenses/by/4.0/
Final published version, 3.36 MBLicence: CC BY

Cite this

Bortoletto, T. G., Silva, T. V., Borovac-Pinheiro, A., Pereira, C. M., Silva, A. D., França, M. S., Hatanaka, A. R., Argenton, J. P., Passini R., J., Mol, B. W., Cecatti, J. G., & Pacagnella, R. C. (2021). Cervical length varies considering different populations and gestational outcomes: Results from a systematic review and meta-analysis. PloS ONE, 16(2), Article e0245746. https://doi.org/10.1371/journal.pone.0245746

Bortoletto, TG, Silva, TV, Borovac-Pinheiro, A, Pereira, CM, Silva, AD, França, MS, Hatanaka, AR, Argenton, JP, Passini R., J, Mol, BW, Cecatti, JG & Pacagnella, RC 2021, 'Cervical length varies considering different populations and gestational outcomes: Results from a systematic review and meta-analysis', PloS ONE, vol. 16, no. 2, e0245746. https://doi.org/10.1371/journal.pone.0245746

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title = "Cervical length varies considering different populations and gestational outcomes: Results from a systematic review and meta-analysis",

abstract = "Background The uterine cervical length is an important risk factor for preterm birth. The aim of this study was to assess cervical length distribution in women with singleton pregnancies, measured by transvaginal ultrasound between 16 and 24 weeks, and its association with population characteristics. Materials and methods We searched electronic databases and other sources for studies published from April 1, 1990 to July 21, 2020. Of the 2019 retrieved publications, full-text versions of 137 articles were considered. We included 77 original articles that reported cervical length measurements of 363,431 women. The main aim of this study was to identify the pattern of cervical length in different populations. We collected demographic and clinical data concerning the population, in addition to information regarding the ultrasound examination and cervical length measurement. Regarding study bias, 56 were at low risk of bias and 21 were at medium risk of bias. Results The meta-analysis included 57 articles with data from 158,346 women. The mean cervical length was 37.96. mm (95% CI [36.68, 39.24]). Cervical length was shorter in women from Africa and Asia, in those from low-income countries, with a lower body weight, and in those who delivered before 37 gestational weeks. We found that the cervical length from pooled studies is longer than that usually discussed in the literature. Regarding limitations, we had difficulty assessing our main variable because there was no consistent pattern in the way authors reported cervical length measurement. Another limitation was the great heterogeneity between studies. Conclusions The use of a single cutoff value to define a short cervix diagnosis, an important risk factor for preterm birth, may not be correct and cervical length must be considered according to maternal population characteristics. Future studies should identify different specific curves and cutoff values for cervical length in different populations. This meta-analysis was registered in the PROSPERO database under CRD42017070246 at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=70246.",

author = "Bortoletto, {T. G.} and Silva, {T. V.} and A. Borovac-Pinheiro and Pereira, {C. M.} and Silva, {A. D.} and Fran{\c c}a, {M. S.} and Hatanaka, {A. R.} and Argenton, {J. P.} and {Passini R.}, Jr. and Mol, {B. W.} and Cecatti, {J. G.} and Pacagnella, {R. C.}",

note = "Funding: This work was supported by the Bill & Melinda Gates Foundation, Seattle, WA [OPP1107597], the Brazilian Ministry of Health and the Brazilian National Council for Scientific and Technological Development (CNPq) [401615/20138]. RCP and BM received funds for the study. No author received salary from any funders and the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ",

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doi = "10.1371/journal.pone.0245746",

language = "English",

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T1 - Cervical length varies considering different populations and gestational outcomes

T2 - Results from a systematic review and meta-analysis

AU - Bortoletto, T. G.

AU - Silva, T. V.

AU - Borovac-Pinheiro, A.

AU - Pereira, C. M.

AU - Silva, A. D.

AU - França, M. S.

AU - Hatanaka, A. R.

AU - Argenton, J. P.

AU - Passini R., Jr.

AU - Mol, B. W.

AU - Cecatti, J. G.

AU - Pacagnella, R. C.

N1 - Funding: This work was supported by the Bill & Melinda Gates Foundation, Seattle, WA [OPP1107597], the Brazilian Ministry of Health and the Brazilian National Council for Scientific and Technological Development (CNPq) [401615/20138]. RCP and BM received funds for the study. No author received salary from any funders and the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

PY - 2021/2/16

Y1 - 2021/2/16

N2 - Background The uterine cervical length is an important risk factor for preterm birth. The aim of this study was to assess cervical length distribution in women with singleton pregnancies, measured by transvaginal ultrasound between 16 and 24 weeks, and its association with population characteristics. Materials and methods We searched electronic databases and other sources for studies published from April 1, 1990 to July 21, 2020. Of the 2019 retrieved publications, full-text versions of 137 articles were considered. We included 77 original articles that reported cervical length measurements of 363,431 women. The main aim of this study was to identify the pattern of cervical length in different populations. We collected demographic and clinical data concerning the population, in addition to information regarding the ultrasound examination and cervical length measurement. Regarding study bias, 56 were at low risk of bias and 21 were at medium risk of bias. Results The meta-analysis included 57 articles with data from 158,346 women. The mean cervical length was 37.96. mm (95% CI [36.68, 39.24]). Cervical length was shorter in women from Africa and Asia, in those from low-income countries, with a lower body weight, and in those who delivered before 37 gestational weeks. We found that the cervical length from pooled studies is longer than that usually discussed in the literature. Regarding limitations, we had difficulty assessing our main variable because there was no consistent pattern in the way authors reported cervical length measurement. Another limitation was the great heterogeneity between studies. Conclusions The use of a single cutoff value to define a short cervix diagnosis, an important risk factor for preterm birth, may not be correct and cervical length must be considered according to maternal population characteristics. Future studies should identify different specific curves and cutoff values for cervical length in different populations. This meta-analysis was registered in the PROSPERO database under CRD42017070246 at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=70246.

AB - Background The uterine cervical length is an important risk factor for preterm birth. The aim of this study was to assess cervical length distribution in women with singleton pregnancies, measured by transvaginal ultrasound between 16 and 24 weeks, and its association with population characteristics. Materials and methods We searched electronic databases and other sources for studies published from April 1, 1990 to July 21, 2020. Of the 2019 retrieved publications, full-text versions of 137 articles were considered. We included 77 original articles that reported cervical length measurements of 363,431 women. The main aim of this study was to identify the pattern of cervical length in different populations. We collected demographic and clinical data concerning the population, in addition to information regarding the ultrasound examination and cervical length measurement. Regarding study bias, 56 were at low risk of bias and 21 were at medium risk of bias. Results The meta-analysis included 57 articles with data from 158,346 women. The mean cervical length was 37.96. mm (95% CI [36.68, 39.24]). Cervical length was shorter in women from Africa and Asia, in those from low-income countries, with a lower body weight, and in those who delivered before 37 gestational weeks. We found that the cervical length from pooled studies is longer than that usually discussed in the literature. Regarding limitations, we had difficulty assessing our main variable because there was no consistent pattern in the way authors reported cervical length measurement. Another limitation was the great heterogeneity between studies. Conclusions The use of a single cutoff value to define a short cervix diagnosis, an important risk factor for preterm birth, may not be correct and cervical length must be considered according to maternal population characteristics. Future studies should identify different specific curves and cutoff values for cervical length in different populations. This meta-analysis was registered in the PROSPERO database under CRD42017070246 at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=70246.

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DO - 10.1371/journal.pone.0245746

M3 - Article

C2 - 33592005

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JO - PloS ONE

JF - PloS ONE

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M1 - e0245746

ER -

Cervical length varies considering different populations and gestational outcomes: Results from a systematic review and meta-analysis

Abstract

Bibliographical note

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