Diagnosis or prognosis?: An umbrella review of mid-trimester cervical length and spontaneous preterm birth

Kelly Hughes; Heather Ford; Shakila Thangaratinam; Shaun Brennecke; Ben W Mol; Rui Wang

doi:10.1111/1471-0528.17443

Diagnosis or prognosis? An umbrella review of mid-trimester cervical length and spontaneous preterm birth

Kelly Hughes^* (Corresponding Author), Heather Ford, Shakila Thangaratinam, Shaun Brennecke, Ben W Mol, Rui Wang

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

3 Citations (Scopus)

2 Downloads (Pure)

Abstract

BACKGROUND: Cervical length is widely used to assess a woman's risk of spontaneous preterm birth (SPTB).

OBJECTIVES: To summarise and critically appraise the evidence from systematic reviews on the prognostic capacity of transvaginal sonographic cervical length in the second trimester in asymptomatic women with singleton or twin pregnancy.

SEARCH STRATEGY: Searches were performed in Medline, Embase, CINAHL and grey literature from 1 January 1995 to 6 July 2021, including keywords 'cervical length', 'preterm birth', 'obstetric labour, premature', 'review' and others, without language restriction.

SELECTION CRITERIA: We included systematic reviews including women who did not receive treatments to reduce SPTB risk.

DATA COLLECTION AND ANALYSIS: From 2472 articles, 14 systematic reviews were included. Summary statistics were independently extracted by two reviewers, tabulated and analysed descriptively. The ROBIS tool was used to evaluate risk of bias of included systematic reviews.

MAIN RESULTS: Twelve reviews performed meta-analyses: two were reported as systematic reviews of prognostic factor studies, ten used diagnostic test accuracy methodology. Ten systematic reviews were at high or unclear risk of bias. Meta-analyses reported up to 80 combinations of cervical length, gestational age at measurement and definition of preterm birth. Cervical length was consistently associated with SPTB, with a likelihood ratio for a positive test of 1.70-142.

CONCLUSIONS: The ability of cervical length to predict SPTB is a prognostic research question; systematic reviews typically analysed diagnostic test accuracy. Individual participant data meta-analysis using prognostic factor research methods is recommended to better quantify how well transvaginal ultrasonographic cervical length can predict SPTB.

Original language	English
Pages (from-to)	866-879
Number of pages	14
Journal	BJOG : an international journal of obstetrics and gynaecology
Volume	130
Issue number	8
Early online date	5 Mar 2023
DOIs	https://doi.org/10.1111/1471-0528.17443
Publication status	Published - Jul 2023

Bibliographical note

Funding Information:
This work is funded by an Australian National Health and Medical Research Council project grant (GNT1146590). The funder was not involved in conducting research or writing the paper.

Funding Information:
BWM is supported by an NHMRC Practitioner Fellowship (GNT1082548) and reports a consultancy for ObsEva, Merck Merck KGaA, and Guerbet. Completed disclosure of interests form available to view online as supporting information.

Funding Information:
An earlier, abbreviated form of this manuscript was presented as a virtual free communication at the Royal Australian and New Zealand College of Obstetricians and Gynaecologists’ Annual Scientific Meeting 2021 (Monday 15 February, online-only event). Open access publishing facilitated by Monash University, as part of the Wiley - Monash University agreement via the Council of Australian University Librarians.

Publisher Copyright:
© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.

Keywords

CERVICAL LENGTH
Preterm birth
prognosis
systematic review
ultrasonography

Access to Document

10.1111/1471-0528.17443Licence: CC BY

Hughes_etal_BJOG_Diagnosis_or_prognosis_VOR
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. https://creativecommons.org/licenses/by/4.0/ © 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.
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Cite this

Diagnosis or prognosis? An umbrella review of mid-trimester cervical length and spontaneous preterm birth. / Hughes, Kelly (Corresponding Author); Ford, Heather; Thangaratinam, Shakila et al.
In: BJOG : an international journal of obstetrics and gynaecology, Vol. 130, No. 8, 07.2023, p. 866-879.

Research output: Contribution to journal › Review article › peer-review

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abstract = "BACKGROUND: Cervical length is widely used to assess a woman's risk of spontaneous preterm birth (SPTB).OBJECTIVES: To summarise and critically appraise the evidence from systematic reviews on the prognostic capacity of transvaginal sonographic cervical length in the second trimester in asymptomatic women with singleton or twin pregnancy.SEARCH STRATEGY: Searches were performed in Medline, Embase, CINAHL and grey literature from 1 January 1995 to 6 July 2021, including keywords 'cervical length', 'preterm birth', 'obstetric labour, premature', 'review' and others, without language restriction.SELECTION CRITERIA: We included systematic reviews including women who did not receive treatments to reduce SPTB risk.DATA COLLECTION AND ANALYSIS: From 2472 articles, 14 systematic reviews were included. Summary statistics were independently extracted by two reviewers, tabulated and analysed descriptively. The ROBIS tool was used to evaluate risk of bias of included systematic reviews.MAIN RESULTS: Twelve reviews performed meta-analyses: two were reported as systematic reviews of prognostic factor studies, ten used diagnostic test accuracy methodology. Ten systematic reviews were at high or unclear risk of bias. Meta-analyses reported up to 80 combinations of cervical length, gestational age at measurement and definition of preterm birth. Cervical length was consistently associated with SPTB, with a likelihood ratio for a positive test of 1.70-142.CONCLUSIONS: The ability of cervical length to predict SPTB is a prognostic research question; systematic reviews typically analysed diagnostic test accuracy. Individual participant data meta-analysis using prognostic factor research methods is recommended to better quantify how well transvaginal ultrasonographic cervical length can predict SPTB.",

keywords = "CERVICAL LENGTH, Preterm birth, prognosis, systematic review, ultrasonography",

author = "Kelly Hughes and Heather Ford and Shakila Thangaratinam and Shaun Brennecke and Mol, {Ben W} and Rui Wang",

note = "Funding Information: This work is funded by an Australian National Health and Medical Research Council project grant (GNT1146590). The funder was not involved in conducting research or writing the paper. Funding Information: BWM is supported by an NHMRC Practitioner Fellowship (GNT1082548) and reports a consultancy for ObsEva, Merck Merck KGaA, and Guerbet. Completed disclosure of interests form available to view online as supporting information. Funding Information: An earlier, abbreviated form of this manuscript was presented as a virtual free communication at the Royal Australian and New Zealand College of Obstetricians and Gynaecologists{\textquoteright} Annual Scientific Meeting 2021 (Monday 15 February, online-only event). Open access publishing facilitated by Monash University, as part of the Wiley - Monash University agreement via the Council of Australian University Librarians. Publisher Copyright: {\textcopyright} 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.",

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AU - Mol, Ben W

AU - Wang, Rui

N1 - Funding Information: This work is funded by an Australian National Health and Medical Research Council project grant (GNT1146590). The funder was not involved in conducting research or writing the paper. Funding Information: BWM is supported by an NHMRC Practitioner Fellowship (GNT1082548) and reports a consultancy for ObsEva, Merck Merck KGaA, and Guerbet. Completed disclosure of interests form available to view online as supporting information. Funding Information: An earlier, abbreviated form of this manuscript was presented as a virtual free communication at the Royal Australian and New Zealand College of Obstetricians and Gynaecologists’ Annual Scientific Meeting 2021 (Monday 15 February, online-only event). Open access publishing facilitated by Monash University, as part of the Wiley - Monash University agreement via the Council of Australian University Librarians. Publisher Copyright: © 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.

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N2 - BACKGROUND: Cervical length is widely used to assess a woman's risk of spontaneous preterm birth (SPTB).OBJECTIVES: To summarise and critically appraise the evidence from systematic reviews on the prognostic capacity of transvaginal sonographic cervical length in the second trimester in asymptomatic women with singleton or twin pregnancy.SEARCH STRATEGY: Searches were performed in Medline, Embase, CINAHL and grey literature from 1 January 1995 to 6 July 2021, including keywords 'cervical length', 'preterm birth', 'obstetric labour, premature', 'review' and others, without language restriction.SELECTION CRITERIA: We included systematic reviews including women who did not receive treatments to reduce SPTB risk.DATA COLLECTION AND ANALYSIS: From 2472 articles, 14 systematic reviews were included. Summary statistics were independently extracted by two reviewers, tabulated and analysed descriptively. The ROBIS tool was used to evaluate risk of bias of included systematic reviews.MAIN RESULTS: Twelve reviews performed meta-analyses: two were reported as systematic reviews of prognostic factor studies, ten used diagnostic test accuracy methodology. Ten systematic reviews were at high or unclear risk of bias. Meta-analyses reported up to 80 combinations of cervical length, gestational age at measurement and definition of preterm birth. Cervical length was consistently associated with SPTB, with a likelihood ratio for a positive test of 1.70-142.CONCLUSIONS: The ability of cervical length to predict SPTB is a prognostic research question; systematic reviews typically analysed diagnostic test accuracy. Individual participant data meta-analysis using prognostic factor research methods is recommended to better quantify how well transvaginal ultrasonographic cervical length can predict SPTB.

AB - BACKGROUND: Cervical length is widely used to assess a woman's risk of spontaneous preterm birth (SPTB).OBJECTIVES: To summarise and critically appraise the evidence from systematic reviews on the prognostic capacity of transvaginal sonographic cervical length in the second trimester in asymptomatic women with singleton or twin pregnancy.SEARCH STRATEGY: Searches were performed in Medline, Embase, CINAHL and grey literature from 1 January 1995 to 6 July 2021, including keywords 'cervical length', 'preterm birth', 'obstetric labour, premature', 'review' and others, without language restriction.SELECTION CRITERIA: We included systematic reviews including women who did not receive treatments to reduce SPTB risk.DATA COLLECTION AND ANALYSIS: From 2472 articles, 14 systematic reviews were included. Summary statistics were independently extracted by two reviewers, tabulated and analysed descriptively. The ROBIS tool was used to evaluate risk of bias of included systematic reviews.MAIN RESULTS: Twelve reviews performed meta-analyses: two were reported as systematic reviews of prognostic factor studies, ten used diagnostic test accuracy methodology. Ten systematic reviews were at high or unclear risk of bias. Meta-analyses reported up to 80 combinations of cervical length, gestational age at measurement and definition of preterm birth. Cervical length was consistently associated with SPTB, with a likelihood ratio for a positive test of 1.70-142.CONCLUSIONS: The ability of cervical length to predict SPTB is a prognostic research question; systematic reviews typically analysed diagnostic test accuracy. Individual participant data meta-analysis using prognostic factor research methods is recommended to better quantify how well transvaginal ultrasonographic cervical length can predict SPTB.

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KW - Preterm birth

KW - prognosis

KW - systematic review

KW - ultrasonography

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