Cervical Length Surveillance and Optimal Timing of Antenatal Corticosteroid Exposure in Twins [11J]

Abstract

INTRODUCTION: Cervical shortening in twins is associated with spontaneous preterm birth (sPTB), yet there is limited data on whether increased frequency of transvaginal cervical length (TVCL) surveillance in twins impacts timing of obstetric interventions or perinatal outcomes. Our objective was to determine if an association exists between the frequency of TVCL surveillance and optimal timing of antenatal corticosteroids (ACS) administration. METHODS: Retrospective cohort analysis of all twin pregnancies delivered in a single-tertiary care-center between 1/1/13 and 4/1/16. Those with ≥6 and <6 TVCL measurements were compared. Outcomes of interest was administration of ACS course within 7 days of delivery, magnesium sulfate for neuroprotection, and composite maternal and neonatal morbidity. RESULTS: 359 of 424 twin pregnancies during the study period met inclusion criteria and received a total of 2,305 TVCL measurements. There were no differences in sPTB rates <34 0/7 weeks, magnesium exposure if delivery was <32 0/7 weeks, ACS within 7 days of delivery or composite maternal or neonatal morbidity were lacking. Those with ≥6 TVCL measurements were less likely to receive a first ACS course within 7 days of delivery (11/41 [27%] vs. 19/39 [49%], P=.04). CONCLUSION: More frequent TVCL surveillance did not improve timing of obstetric interventions or perinatal morbidity. The utility of cervical surveillance in twins remains unclear.