How to identify twins at low risk of spontaneous preterm delivery

Sperling, L.; Kiil, C.; Larsen, L. U.; Qvist, I.; Bach, Diana; Wøjdemann, K. R.; Bladh, A; Nikkilä, Annamari; Jörgensen, Connie; Skajaa, Kristjar; Bang, J.; Tabor, Ann

doi:10.1002/uog.1938

Cited by 39 publications

(36 citation statements)

References 27 publications

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“…The association between a short sonographic cervical length and the risk of subsequent PTB is well-established in singleton 11, 23-28, 52-61 and twin gestations 12, 29-40, 62-64 . Since cervical length changes over time as the time of the onset of labor approaches, we propose that cervical shortening detected with serial sonographic examinations may yield information about the risk of PTB which is not available at the time of the routine sonographic examination in the midtrimester.…”

Section: Commentmentioning

confidence: 99%

Serial cervical length determination in twin pregnancies reveals 4 distinct patterns with prognostic significance for preterm birth

Melamed

Pittini

Hiersch

et al. 2016

American Journal of Obstetrics and Gynecology

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BACKGROUND Women with a twin gestation are at increased risk for preterm birth, and sonographic cervical length is a powerful predictor for spontaneous preterm birth. Obstetricians frequently monitor cervical length in multiple gestations; yet, the optimal method to integrate and interpret the results of serial sonographic cervical length has not been determined. OBJECTIVE To determine whether there are different patterns of cervical shortening in twin gestations, and whether such patterns are related to the risk of preterm birth. STUDY DESIGN We conducted a retrospective study of all women with twins followed in a single tertiary referral center during 2012-2014. All women underwent serial measurements of cervical length every 2-3 weeks starting from 14-18 weeks and until 28-32 weeks of gestation. Changes in cervical length were analyzed and classified into distinct patterns that were initially identified by visual inspection of all individual cases. Each pattern was then characterized by several parameters including information about when cervical shortening began, the rate of shortening, and whether a plateau was observed. Locally weighted regression mean profiles were generated to describe each pattern of cervical length over time. The association of these patterns with spontaneous preterm birth was determined. The specific characteristics of each pattern that further determined the risk of preterm birth were identified using multivariable logistic regression analysis. RESULTS We studied 441 women who had a total of 2,826 measurements of cervical length done. Overall, 4 main patterns of change in cervical length were identified: Pattern I - stable cervix (n=196), Pattern II - early and rapid shortening (n=18), Pattern III - late shortening (n=109), and Pattern IV – early shortening with a plateau (n=118). The rate of preterm birth at <34 weeks was lowest in cases of Pattern I (11.7%), followed by Pattern IV (14.4%) and Pattern III (20.2%), and was highest for women with Pattern II (44.4%) (p<0.001). In cases with Pattern III (late shortening), the most important factors affecting the risk of preterm birth were the shortening rate, the gestational age at the onset of cervical shortening and the initial plateau of cervical length. In the case of Pattern IV (early shortening with a plateau), it was only the new plateau at which cervical shortening stopped that was associated with the risk of preterm birth. CONCLUSIONS Changes in sonographic cervical length over time in twin gestations can be classified into four patterns, each associated with a different risk of preterm birth.

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Section: Commentmentioning

confidence: 99%

Serial cervical length determination in twin pregnancies reveals 4 distinct patterns with prognostic significance for preterm birth

Melamed

Pittini

Hiersch

et al. 2016

American Journal of Obstetrics and Gynecology

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“…The association between a short sonographic cervical length and the risk of subsequent PTB is well-established in singleton 11, 23-28, 52-61 and twin gestations 12,[29][30][31][32][33][34][35][36][37][38][39][40][62][63][64] . Since cervical length changes over time as the time of the onset of labor approaches, we propose that cervical shortening detected with serial sonographic examinations may yield information about the risk of PTB which is not available at the time of the routine sonographic examination in the midtrimester.…”

Section: Commentmentioning

confidence: 99%

“…This, in turn, has led to the relatively common practice of serial monitoring of CL during the second trimester in women at risk of PTB, including women with twin gestations. [38][39][40][41] However, one question that needs to be answered before such practice becomes accepted into routine care relates to the optimal strategy for the integration and interpretation of the additional information derived from serial measurements of CL. One possible strategy for integrating and interpreting a series of measurements, which is used in the current study, is by classifying them into one of several recognized patterns.…”

Section: Introductionmentioning

confidence: 99%

596: Serial cervical length determination in twin pregnancies reveals four distinct patterns with prognostic significance for preterm birth

Melamed

Pittini

Romero

et al. 2015

American Journal of Obstetrics and Gynecology

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“…A large number of prospective studies [20][21][22][23][24][25][26][27][28][29][30] have shown the predictive value of midtrimester cervical length measurement in twin pregnancies; these data were collected in two large meta-analyses. The first meta-analysis included 21 studies, 16 in asymptomatic women and only 5 in symptomatic women; the collected data included 3,523 women.…”

Section: Prediction Of Preterm Birthmentioning

confidence: 99%

Twin and Preterm Labor: Prediction and Treatment

Aboulghar

Islam

2013

Curr Obstet Gynecol Rep

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Twin pregnancies are increasing. Preterm birth is a major health problem with high incidence all over the world. It is known to have a higher incidence in twin pregnancies as well as being higher in IVF/ICSI pregnancies. Prediction of preterm birth in twins through transvaginal cervical length measurement and vaginal fetal fibronectin measurement are good and well-documented methods. However, this could not be applied to IVF pregnancies. Prevention of preterm birth by administration of vaginal natural progesterone or IM synthetic progesterone injections is not effective in twins. The situation was similar with administration of progesterone to IVF twin pregnancies. Prophylactic cerclage for prevention of preterm birth in twins resulted in an increase of the incidence of preterm birth. Tocolytics also are ineffective, although nifedipine may have a role in treatment of threatened preterm birth in twins.

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How to identify twins at low risk of spontaneous preterm delivery

Abstract: Objective

Cited by 39 publications

References 27 publications

Serial cervical length determination in twin pregnancies reveals 4 distinct patterns with prognostic significance for preterm birth

Serial cervical length determination in twin pregnancies reveals 4 distinct patterns with prognostic significance for preterm birth

596: Serial cervical length determination in twin pregnancies reveals four distinct patterns with prognostic significance for preterm birth

Twin and Preterm Labor: Prediction and Treatment

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