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

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.