Uterine fibroids at routine second-trimester ultrasound survey and risk of sonographic short cervix

Abstract

Objective: To determine whether women with sonographically identified uterine fibroids are at higher risk for a short cervix.

Methods: This retrospective cohort study evaluated all women with singleton gestations who had a routine second-trimester ultrasound at 17–23 weeks gestational age from 2010 to 2013. When fibroids were noted, their presence, number, location and size were recorded. Exclusion criteria included a history of cervical conization or loop electrosurgical excision procedure (LEEP), uterine anomalies, maternal age greater than 40 years, and a previously placed cerclage. The primary variable of interest was short cervix (<25 mm). Secondary variables of interest included gestational age at delivery, mode of delivery, indication for cesarean, malpresentation, birth weight, and Apgar scores. A multivariable logistic regression analysis was performed.

Results: Fibroids were identified in 522/10 314 patients (5.1%). In the final multivariable logistic regression model, short cervix was increased in women with fibroids (OR 2.29, 95% CI: 1.40, 3.74). The number of fibroids did not affect the frequency of short cervix. Fibroids were significantly associated with preterm delivery (<37 weeks), primary cesarean, breech presentation, lower birth weight infants, and lower Apgar scores.

Conclusions: Women with uterine fibroids may be at higher risk for a short cervix. Fibroids are also associated with several adverse obstetric and neonatal outcomes.

Keywords:

• Fibroids
• preterm birth
• short cervix
• ultrasound

Acknowledgements

We thank Preetinder Bassi, Michael Qiu and Remedios Singcuenco of the Business Intelligence Competency Center of the North Shore-LIJ Health System for their assistance with data retrieval.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.