Biweekly ultrasound assessment of cervical shortening in triplet pregnancies and the effect of cerclage placement

Moragianni, Vasiliki A.; Aronis, Konstantinos N.; Craparo, Frank

doi:10.1002/uog.8905

Cited by 22 publications

(13 citation statements)

References 7 publications

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“…Notably, optimized cut-off values for absolute CL were 34–35 mm in our study which resulted in sensitivity and specificity values of 60–80 and 70–90%, respectively. Previous studies on triplet pregnancies often used a lower cut-off value of 25 mm [14, 20] or calculated similar optimized cut-off values [11–13]. We find it hard to comment on these differences.…”

Section: Commentmentioning

confidence: 89%

Cervical length dynamics in triplet pregnancies: a retrospective cohort study

Pils

Springer

Wehrmann

et al. 2017

Arch Gynecol Obstet

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PurposeTo review our experience with a screening program that included sequential cervical length measurements in our large population of triplet pregnancies.MethodsSeventy-eight triplet pregnancies were retrospectively included. Cervical length measurements were performed by transvaginal ultrasound in 2-week intervals from week 16 + 0 onwards in a tertiary-care center in Vienna. The main outcome measurement was preterm delivery prior to 32 + 0 weeks of gestation. Statistical analyses were performed using paired and unpaired t tests and a stepwise linear regression model.ResultsThere were 26 cases of preterm delivery (33.3%). Women with preterm delivery revealed significant cervical length shortening from week 22 + 0 (median 33 mm, interquartile range, IQR 17–39) to 24 + 0 (median 21 mm, IQR 7–30; p = 0.005). This was not observed in women without preterm delivery. From week 22 + 0 onwards, both groups showed further significant 2-week differences in cervical length (p < 0.05). Univariate analysis of cervical length in weeks 20 + 0, 22 + 0, and 24 + 0 as well as cervical length dynamics from 22 + 0 to 24 + 0 predicted preterm delivery.ConclusionsIn triplet pregnancies, a decrease in cervical length seems physiological from week 22 + 0 onwards. A sharp decrease in cervical length from the 22 + 0 to the 24 + 0 week as well as the smaller cervical length in weeks 20 + 0, 22 + 0, and 24 + 0 increase the risk of preterm delivery.

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Section: Commentmentioning

confidence: 89%

Cervical length dynamics in triplet pregnancies: a retrospective cohort study

Pils

Springer

Wehrmann

et al. 2017

Arch Gynecol Obstet

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“…Prophylactic cerclage placement in women with a twin gestation or a triplet gestation without a history of cervical insufficiency has not been shown to be beneficial (41)(42)(43). Moreover, the placement of cerclage in women with a twin gestation with an ultrasonographically detected short cervical length has been observed to double the rate of spontaneous preterm birth (RR, 2.2; 95% confidence interval [CI], 1.2-4.0) (44,45).…”

Section: Prophylactic Cerclagementioning

confidence: 99%

Practice Bulletin No 144

Gynecologists¹

2014

Obstetrics &Amp; Gynecology

163

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The incidence of multifetal gestations in the United States has increased dramatically over the past several decades. The rate of twin births increased 76% between 1980 and 2009, from 18.9 to 33.3 per 1,000 births (). The rate of triplet and higher-order multifetal gestations increased more than 400% during the 1980s and 1990s, peaking at 193.5 per 100,000 births in 1998, followed by a modest decrease to 153.4 per 100,000 births by 2009 (). The increased incidence in multifetal gestations has been attributed to two main factors: 1) a shift toward an older maternal age at conception, when multifetal gestations are more likely to occur naturally, and 2) an increased use of assisted reproductive technology (ART), which is more likely to result in a multifetal gestation ().

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“…Although the study included a greater number of patients, there was concern for bias due to comparisons made between any triplet gestations managed with a prophylactic cerclage (248 patients) against all other triplet gestations, such as those without cerclage (including those with threatened preterm labor). More recently, 2 retrospective studies of sonographically indicated cerclage were performed on 24 triplet pregnancies, 13 of which had cervical shortening with cervical lengths less than 2.5 cm before 24 weeks 13 , 14 . Nearly 50% of these patients had cervical shortening after 24 weeks, when cerclage is typically not performed.…”

Section: Discussionmentioning

confidence: 99%

“…Unlike their study, our study compared outcomes between groups of patients with an asymptomatic short cervix before 24 weeks' gestation. Our cohort of patients (albeit small) comprised an ideal comparison between patients with triplet gestations who would be offered a cervical cerclage with sonographic indications in contrast to previous studies 12 – 14 …”

Section: Discussionmentioning

confidence: 99%

“…More recently, 2 retrospective studies of sonographically indicated cerclage were performed on 24 triplet pregnancies, 13 of which had cervical shortening with cervical lengths less than 2.5 cm before 24 weeks. 13,14 Nearly 50% of these patients had cervical shortening after 24 weeks, when cerclage is typically not performed. They found no difference in GAs at delivery between those treated with cerclage versus those managed expectantly (mean ± SD, 29 ± 3 weeks for each group).…”

Section: Discussionmentioning

confidence: 99%

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