Mid-pregnancy cervical length as a risk factor for cesarean section in women with twin pregnancies

Abstract

Objective: It is well known that a short cervix at mid-pregnancy is a risk factor for spontaneous preterm birth in both singleton and twin gestations. Recent evidence also suggests that a long cervix at mid-pregnancy is a predictor of the risk of cesarean section (C/S) in singleton gestation. The purpose of this study was to determine whether a long cervix at mid-pregnancy was associated with an increased risk of C/S in women with twin pregnancies. Methods: We enrolled 746 women pregnant with twins whose cervical length was measured by trans-vaginal ultrasonography at a mean of 22 weeks of gestation and who delivered in our institution. Cases with a short cervix [cervical length (CL) <15 mm] were excluded. Cases were divided into four groups according to the quartile of CL. Results: The rate of C/S increased according to the quartile of CL (47% in the 1st quartile, 51% in the 2nd quartile, 56% in the 3rd quartile and 62% in the 4th quartile, P<0.005, χ2 for trend). CL was an independent risk factor for C/S even after adjustment for confounding variables. When confining analysis to women who delivered after a trial of labor (n=418), to nulliparous women (n=633) or to those who delivered at late preterm or full term (n=666), the rate of C/S also increased according to the quartile of CL, and the relationship between CL and the risk of C/S remained significant after adjustment in each group. Conclusion: In women pregnant with twins, long CL at mid-pregnancy was a risk factor for C/S.

Can the cervical length in mid-trimester predict the use of vacuum in vaginal delivery?

“…Van de Mheen et al [17] performed a similar study on twin pregnancy; however, the mid-trimester CL was not associated with a risk of cesarean section. Unlike that study, Sung et al [16] reported that a longer CL in mid-pregnancy was a risk factor for cesarean section in twins and higher rates of cesarean deliveries as the quartiles of the study population increased.…”

“…Numerous trial of labor studies have examined the success of vaginal delivery and the rate of cesarean sections [12]; however, attempts to predict operative delivery are lacking, and studies are usually limited to the identification of risk factors in a large population or meta-analysis [5,13,14]. Several studies reported that an increased mid-trimester cervical length (CL) was associated with a higher risk of cesarean section [15][16][17][18]. Nevertheless, there are conflicting results of the association between a longer mid-trimester CL and the rate of cesarean delivery unlike the relationship between a short CL and the likelihood of preterm birth [19][20][21].…”

Pregnancy-specific transcriptional changes upon endotoxin exposure in mice

“…The cervix also serves as a gatekeeper of pregnancy and has a central role in the physiological process of parturition [181][182][183]. Throughout pregnancy, the cervix undergoes remodeling, permitting the transformation from closed and rigid to a distensible structure that stretches to allow the passage of the fetus [181][182][183][184][185][186][187][188]. The premature process of cervical remodeling can lead to preterm birth in a subset of women [119,123,[189][190][191][192][193][194][195].…”