Predictive value of cervical length for preterm birth in women with antepartum haemorrhage of unknown origin: a retrospective cohort study

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This study aimed to determine whether transvaginal cervical length at presentation of antepartum haemorrhage of unknown origin (APHUO) can predict preterm birth (PTB), and to determine an optimal cut-off. This retrospective cohort included singleton pregnancies admitted with APHUO at 24–32 weeks of gestation to a Hong Kong tertiary hospital 2019–2025. Transvaginal cervical length was measured. The primary outcome was to evaluate the risk of PTB in women with or without short cervix (< 25 mm). Secondary outcomes included spontaneous PTB, delivery before 32 and 34 weeks, admission-to-delivery interval, and correlation with maternal and foetal outcome. Optimal cervical length cut-offs were determined according to gestational age and presence of other PTB risk factors. Among 321 women with APHUO, 62 (19.3%) had short cervix and 259 (80.7%) had normal cervical length. Short cervix was associated with earlier delivery (median 33 vs. 38 weeks), shorter admission-to-delivery interval (7 vs. 67 days), higher PTB rate ( p < 0.001). After adjustment for confounders, it remained strongly associated with PTB < 37 weeks [aOR 25.16 (95% CI 11.93–53.06)], < 34 weeks [41.67 (17.64–98.42)], < 32 weeks [60.39 (18.30-199.33)]. Cervical length and maternal history of PTB were associated with spontaneous PTB. Receiver operating characteristics analysis showed good predictive ability of cervical length on PTB, with optimal cut-off at 24 mm for 37 weeks with 95% specificity. Cervical length < 25 mm is a useful predictor for PTB in APHUO, and different cervical length thresholds should be applied according to the background PTB risk.

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