Routine cervical length and fetal fibronectin screening in asymptomatic twin pregnancies: is there clinical benefit?

Lifshitz, Shirlee Jaffe; Razavi, Armin S.; Bibbo, Carolina; Rebarber, Andrei; Roman, Ashley S.; Saltzman, Daniel H.; Fox, Nathan S.

doi:10.3109/14767058.2013.831067

Cited by 13 publications

(8 citation statements)

References 18 publications

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“…147 Although the rates of preterm birth were similar between the two groups, the routine use of these tests was associated with significantly improved rates and timing of antenatal corticosteroid administration among patients who delivered prematurely. These findings suggest that routine measurement of sonographic CL and fetal fibronectin could potentially improve the perinatal outcomes in twin gestations delivered preterm by increasing antenatal corticosteroid exposure.…”

Section: Discussionmentioning

confidence: 86%

Prediction of preterm birth in twin gestations using biophysical and biochemical tests

Conde-Agudelo

Romero

2014

American Journal of Obstetrics and Gynecology

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The objective of this study was to determine the performance of biophysical and biochemical tests for the prediction of preterm birth in both asymptomatic and symptomatic women with twin gestations. We identified a total of 19 tests proposed to predict preterm birth, mainly in asymptomatic women. In these women, a single measurement of cervical length with transvaginal ultrasound before 25 weeks of gestation appears to be a good test to predict preterm birth. Its clinical potential is enhanced by the evidence that vaginal progesterone administration in asymptomatic women with twin gestations and a short cervix reduces neonatal morbidity and mortality associated with spontaneous preterm delivery. Other tests proposed for the early identification of asymptomatic women at increased risk of preterm birth showed minimal to moderate predictive accuracy. None of the tests evaluated in this review meet the criteria to be considered clinically useful to predict preterm birth among patients with an episode of preterm labor. However, a negative cervicovaginal fetal fibronectin test could be useful in identifying women who are not at risk for delivering within the next week, which could avoid unnecessary hospitalization and treatment. This review underscores the need to develop accurate tests for predicting preterm birth in twin gestations. Moreover, the use of interventions in these patients based on test results should be associated with the improvement of perinatal outcomes.

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Section: Discussionmentioning

confidence: 86%

Prediction of preterm birth in twin gestations using biophysical and biochemical tests

Conde-Agudelo

Romero

2014

American Journal of Obstetrics and Gynecology

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“…Finally, we have shown previously from retrospective data that these screening tests could potentially improve antenatal corticosteroid administration rates to twins delivered prior to 34 weeks. 27 Ultimately, however, until a prospective study that randomizes twin pregnancies to routine screening or no screening demonstrates significant benefit with routine screening, the decision whether or not to use these tests routinely needs to be individualized.…”

Section: Discussionmentioning

confidence: 99%

The Independent Association of a Short Cervix, Positive Fetal Fibronectin, Amniotic Fluid Sludge, and Cervical Funneling with Spontaneous Preterm Birth in Twin Pregnancies

et al. 2016

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Objective To estimate the independent association of a short cervical length (CL), positive fetal fibronectin (fFN), amniotic fluid (AF) sludge, and cervical funneling with spontaneous preterm birth in twin pregnancies. Methods Retrospective cohort study of twin pregnancies managed by a single maternal-fetal medicine practice from June 2005 to February 2014. All patients underwent transvaginal sonographic CL and fFN testing. We reviewed all images from the first CL at 22(0/7) to 25(6/7) weeks for the presence of (1) a short CL, which is defined as ≤25 mm, (2) AF sludge, and (3) cervical funneling, and also recorded (4) the fFN result from that time. Image reviewers were blinded to pregnancy outcomes. Patients with cerclage were excluded. Using logistic regression, we calculated the independent association between these four biomarkers and spontaneous preterm birth. Results A total of 635 patients with twin pregnancies were included. The markers independently associated with spontaneous preterm birth <35 weeks were short CL (adjusted odds ratio [aOR]: 10.73; 95% confidence interval [CI]: 3.21-35.81), positive fFN (aOR: 3.25; 95% CI: 1.13-9.33), and AF sludge (aOR: 2.11; 95% CI: 1.04-4.27). Similarly, these three markers were independently associated with earlier gestational ages at delivery. Cervical funneling was not independently associated with spontaneous preterm birth <35 weeks nor gestational age at delivery. The risk of spontaneous preterm birth increased significantly with the number of positive biomarkers (short CL, positive fFN, and AF sludge). Conclusion In twin pregnancies, a short CL, positive fFN, and AF sludge are independently associated with spontaneous preterm birth. Cervical funneling is not independently associated with spontaneous preterm birth in twins.

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“…Better detection of women at risk of PTB is important for patient counseling and can guide decisions regarding patient transfer, admission, frequency of monitoring, and administration of corticosteroids for fetal lung maturation. Indeed, in a recent study, serial monitoring of CL in twins was associated with improved rates of exposure to corticosteroids in women who delivered preterm, 46 although data regarding the beneficial effects of antenatal corticosteroids in twins pregnancies are conflicting. 113–123 In addition, in a recent individual-patient meta-analysis, Romero et al found that the use of progesterone in asymptomatic women with twin pregnancy and a short cervix decreased the rate of PTB at <33 weeks by 30% and the rate of neonatal morbidity by approximately 50%.…”

Section: Commentsmentioning

confidence: 99%

Do serial measurements of cervical length improve the prediction of preterm birth in asymptomatic women with twin gestations?

Melamed

Pittini

Hiersch

et al. 2016

American Journal of Obstetrics and Gynecology

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Objective To determine whether serial measurements of cervical length can improve the prediction of preterm birth in asymptomatic women with twin gestations compared with a single measurement of cervical length at mid-gestation. Materials and Methods This was a retrospective cohort study of women with twin pregnancies followed in a tertiary medical center between 2012 and 2014. All participants underwent routine measurement of cervical length at mid-gestation and every 2–3 weeks thereafter until 28–32 weeks. For each patient, cervical length was determined at the following time periods: 18+0 to 21+6 weeks (Period 1, routine exam), 22+0 to 24+6 weeks (Period 2), 25+0 to 27+6 weeks (Period 3) and 28+0 to 32+0 weeks (Period 4). Measurements of cervical length at Periods 2–4 were analyzed in the form of either absolute length (in mm) or percent shortening relative to cervical length at Period 1. The performance of a stepwise algorithm that incorporates serial measurements of cervical length for the prediction of preterm birth was compared to that achieved with a single measurement of cervical length at Period 1. Results Overall 441 women with twin pregnancies who were eligible for the study underwent a total of 2,374 cervical length measurements. The association of a short cervix (<10th percentile) with preterm birth at <32 weeks persisted in each of the four periods of gestation [Odds ratio (95%-confidence interval): 7.2 (3.1–16.5), 15.3 (6.4–36.7), 10.3 (4.4–24.3) and 23.1(8.3–64.1), respectively]. Compared with a single measurement of cervical length at mid-gestation (Period 1), a stepwise algorithm integrating serial cervical length measurements from all four successive gestational age periods resulted in a significant increase in the area under the ROC curve (0.917 vs. 0.613, p<0.001). Similarly, when a target false positive rate of 5% was used, the same stepwise algorithm was associated with a higher detection rate (69% vs. 28%, p<0.001), higher positive likelihood ratio (14.54 vs. 5.12) and a lower negative likelihood ratio (0.32 vs. 0.76) for preterm birth at <32 weeks compared with a single measurement of cervical length at Period 1. Conclusions Integration of serial measurements of cervical length using a stepwise algorithm in asymptomatic women with twin gestations can improve the detection of women at risk of preterm birth. Prospective studies are needed to validate these findings, and to investigate whether improved risk assessment performance is sufficient to offset the additional costs associated with serial cervical length measurements.

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Routine cervical length and fetal fibronectin screening in asymptomatic twin pregnancies: is there clinical benefit?

Abstract: In twin pregnancies, routine CL and fFN screening does not reduce the risk of PTB or SPTB. However, the routine use of these tests is associated with significantly improved ACS exposure and timing for women who deliver preterm without increasing ACS exposure to women who deliver at term.

Cited by 13 publications

References 18 publications

Prediction of preterm birth in twin gestations using biophysical and biochemical tests

Prediction of preterm birth in twin gestations using biophysical and biochemical tests

The Independent Association of a Short Cervix, Positive Fetal Fibronectin, Amniotic Fluid Sludge, and Cervical Funneling with Spontaneous Preterm Birth in Twin Pregnancies

Do serial measurements of cervical length improve the prediction of preterm birth in asymptomatic women with twin gestations?

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