Obstetrics & Gynecology Track the topics, authors and articles important to you
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Obstetrics & Gynecology 2008;112:508-515
© 2008 by The American College of Obstetricians and Gynecologists
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Supplement: Appendix
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Google Scholar
Right arrow Articles by Newman, R. B.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Newman, R. B.

ORIGINAL RESEARCH

Preterm Prediction Study

Comparison of the Cervical Score and Bishop Score for Prediction of Spontaneous Preterm Delivery

R. B. Newman, MD8, R. L. Goldenberg, MD1, J. D. Iams, MD6, P. J. Meis, MD2, B. M. Mercer, MD9, A. H. Moawad, MD3, E. Thom, PhD11, M. Miodovnik, MD4, S. N. Caritis, MD5, M. Dombrowski, MD10 for the National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units Network (MFMU)7

From the Departments of Obstetrics and Gynecology at the 1University of Alabama, Birmingham, Alabama; 2Wake Forest University, Winston-Salem, North Carolina; 3University of Chicago, Chicago, Illinois; 4University of Cincinnati, Cincinnati, Ohio; 5University of Pittsburgh, Pittsburgh, Pennsylvania; 6Ohio State University, Columbus, Ohio; 8Medical University of South Carolina, Charleston, South Carolina; 9University of Tennessee, Memphis, Tennessee; 10Wayne State University, Detroit, Michigan; and the 11George Washington University Biostatistics Center, Washington, DC.

OBJECTIVE: To prospectively compare digital cervical score with Bishop score as a predictor of spontaneous preterm delivery before 35 weeks of gestation.

METHODS: Data from a cohort of 2,916 singleton pregnancies enrolled in a multicenter preterm prediction study were available. Patients underwent digital cervical examinations at 22–24 and 26–29 weeks of gestation for calculation of Bishop score and cervical score. Relationships between Bishop score, cervical score, and spontaneous preterm delivery were assessed with multivariable logistic regression analysis, McNemar test, and receiver operating characteristic (ROC) curves to identify appropriate diagnostic thresholds and predictive capability.

RESULTS: One hundred twenty-seven of 2,916 patients (4.4%) undergoing cervical examination at 22–24 weeks had a spontaneous preterm delivery before 35 weeks. Eighty-four of the 2,538 (3.3%) reexamined at 26–29 weeks also had spontaneous preterm delivery. Receiver operating characteristic curves indicated that optimal diagnostic thresholds for Bishop score were at least 4 at 22–24 weeks, at least 5 at 26–29 weeks, and less than 1.5 at both examinations for cervical score. At 22–24 weeks, areas under the ROC curve favored Bishop score. At 26–29 weeks, there was no significant difference in areas under the ROC curve; however, a cervical score less than 1.5 (sensitivity 35.7%, false positive rate 4.8%) was superior to a Bishop score of 5 or more (P<.001).

CONCLUSION: Both cervical evaluations are associated with spontaneous preterm delivery in a singleton population; however, predictive capabilities for spontaneous preterm delivery were modest among women with low event prevalence. Although Bishop score performed better in the mid trimester, by 26–29 weeks a cervical score less than 1.5 was a better predictor of spontaneous preterm delivery before 35 weeks than a Bishop score of at least 5.

LEVEL OF EVIDENCE: II






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2008 by the American College of Obstetricians and Gynecologists.