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Meta-Analysis
. 2021 Feb 16;16(2):e0245746.
doi: 10.1371/journal.pone.0245746. eCollection 2021.

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

T G Bortoletto  1 , T V Silva  1   2 , A Borovac-Pinheiro  1 , C M Pereira  1 , A D Silva  1 , M S França  3 , A R Hatanaka  3 , J P Argenton  1 , R Passini Jr  1 , B W Mol  4 , J G Cecatti  1 , R C Pacagnella  1
Affiliations
Meta-Analysis

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

T G Bortoletto et al. PLoS One. .

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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA diagram.
Flow diagram of included articles according to PRISMA 2009 guidelines.
Fig 2
Fig 2. Forest plot of cervical length measurements (in millimeters) of 57 publications included in the meta-analysis.
Fig 3
Fig 3. Forest plots for the cervical length of women from each continent (Africa, South America, North America, Asia and Europe).
Fig 4
Fig 4. Comparison of cervical length according to low/medium-income versus high-income countries.
Fig 5
Fig 5. Comparison of cervical length according body mass index (BMI).
Fig 6
Fig 6. Forest plots of mean cervical length measurements in pregnancies evolving to term and preterm births.
Fig 7
Fig 7. Cervical length measurement according to percentile.
See this image and copyright information in PMC

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