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

Abstract

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. 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. 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. 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.