Cervical length in mid-pregnancy predicts caesarean delivery

A short cervix (≤15 mm) in mid-pregnancy increases the risk of spontaneous preterm birth, but the effects of a long cervix on delivery have not been studied until now⇑. The study included 27 472 primiparous women with a cervical length of 16 mm or more—as measured by transvaginal ultrasonography at a median of 23 weeks’ gestation—who delivered a live infant in labour at term at eight hospitals in and around London between 1998 and 2006.

The risk of caesarean delivery was lowest (16%) in women with the shortest cervical length (16-30 mm) and increased as cervical length increased (18.4% 31-35 mm; 21.7% 36-39 mm; 25.7% 40-67 mm; P for trend <0.001). Women in the fourth group had a 1.81 times greater odds of delivering by caesarean section than women in the first group (95% CI 1.66 to 1.97); the association was attenuated but still significant after adjusting for maternal age, body mass index, smoking status, ethnic group, gestational age at birth, spontaneous or induced labour, birthweight centile, and hospital of delivery (odds ratio 1.68, 1.53 to 1.84; P<0.001).

The authors attribute the increased risk to poor progress during labour and suggest that this may be related to dysfunctional development of the uterus at earlier stages of pregnancy.

Coronary calcium predicts cardiovascular events irrespective of ethnicity

In a population based cohort of 6722 men and women (39% white, 28% black, 22% Hispanic, and 12% Chinese), coronary calcium—measured by computed tomography—predicted risk for cardiovascular events irrespective of ethnicity⇑. The participants were followed up for a median of 3.8 years, during which time 162 coronary heart disease events occurred, including 89 major events (non-fatal myocardial infarctions or deaths from coronary heart disease).

Compared with people with a coronary calcium score of 0, those with a score between 1 and 100 had a hazard ratio of 3.61 (95% CI …