Nomogram to predict the risk of preterm birth before 37 weeks and 34
weeks in pregnant women with a short cervix: a retrospective cohort
study
Abstract
Objectives To investigate predictors of preterm birth (PTB) in
pregnancies with a short cervix and to create prediction models. Design
Retrospective cohort study. Method Logistic regression model was used to
identify predictors of PTB. The predictors were used to establish
nomogram, which were validated using receiver operating characteristic
(ROC) curve and calibration curve. Main outcome measures Preterm birth.
Results Overweight or obesity (OR:2.00, 95% CI:1.114-3.51; OR:2.59,
95% CI:1.20-5.60), frequency of pregnancy ≧ 3 times (OR:1.97, 95%
CI:1.14-3.40), twin pregnancy (OR:4.52, 95% CI:2.40-8.51), in vitro
fertilization and embryo transfer (IVF-ET) (OR:2.24, 95% CI:1.19-4.19),
gestational age at first diagnosis of short cervix (1st short cervix)
(OR:0.953, 95% CI:0.910-0.999), cervical length (CL) at diagnosis of
1st short cervix (OR:0.908, 95% CI:0.86-0.96), history of PTB (OR:7.77,
95% CI:2.47-24.41), and autoimmune disease (OR:10.70, 95%
CI:1.87-61.26) were predictors of PTB < 37 weeks, while twin
pregnancy, gestational age of 1st short cervix, CL of 1st short cervix,
history of PTB, and prepregnancy hypertension were predictors of PTB
< 34 weeks. The area under the ROC curve (AUC) of the nomogram
predicting PTB < 37 weeks and PTB < 34 weeks were
0.803 and 0.771, respectively. Both models showed good discrimination.
Conclusions Gestational age of 1st short cervix, CL of 1st short cervix
and other factors are strong predictors of PTB in pregnancies with a
short cervix. Nomogram showed good discrimination and calibration, and
hence might be effective in predicting risk of PTB for pregnancies with
a short cervix. Keywords nomogram; preterm birth; risk factors; short
cervix