Single and repeat cervical length measurement in twin gestations with threatened preterm labour

Natalia Prodan, Philipp Wagner, Jiri Sonek, Harald Abele, Markus Hoopmann, Karl Oliver Kagan
Ultrasound in Obstetrics & Gynecology 2019 May 8

OBJECTIVE: To examine the effectiveness of the first and second cervical length measurement in the prediction of preterm delivery in symptomatic women with twin pregnancies.

METHODS: Retrospective study at the perinatal unit at the University Hospital of Tuebingen, Germany which included women with twin gestations with painful and regular uterine contractions at 24+0 to 33+6 weeks of gestation. The cervical length was measurement at the time of admission and several days later after cessation of the contractions. Treatment included administration of tocolytics (usually oral nifedipine) for no more than 48 hours, and administration of steroids if the cervical length is 25mm or less. The first cervical length measurements were clustered into five groups: measurements of less than 10 mm, between 10.0 and 14.9 mm, between 15.0 and 19.9 mm, between 20.0 and 24.9 mm, and 25 mm or greater. For each group, we calculated the test performance of the cervical length measurements for a delivery within the subsequent seven days and before 34 weeks. To examine the impact of the second cervical length measurement, we used a regression analysis to predict preterm delivery within the next seven days after the second measurement.

RESULTS: Our study population consisted of 257 pregnancies. Median maternal and gestational age at the time of admission was 32.0 years and 29.9 weeks' gestation, respectively. 80.2% of the pregnancies were dichorionic-diamniotic. Preterm birth within seven days of admission occurred in 23 (8.9%) pregnancies. 82 (32.9%) patients delivered prior to 34 weeks' gestation. Median cervical length for the entire study population was 17.0 mm. In the cervical length groups <10 mm, 10.0-14.9 mm, 15.0-19.9 mm, 20.0-24.9 mm, and >25.0 mm, delivery within seven days after the initial examination occurred in 29.0%, 10.6%, 4.2%, 6.3% and 0%, respectively. There was a weak but significant association between the cervical length measurements at the time of admission and the time interval between admission and delivery (difference = 27.9 + 0.58 * cervical length, p=0.003, r=0.184).

CONCLUSION: We have found that the cervical length can be helpful predicting preterm delivery within seven days of presentation in symptomatic women with twin gestations. However, the test performance is relatively weak. This article is protected by copyright. All rights reserved.

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