Predictive value of cervical length in women with twin pregnancy presenting with threatened preterm labor

Melamed, Nir; Hiersch, Liran; Gabbay‐Benziv, Rinat; Bardin, Ron; Meizner, Israel; Wiznitzer, Arnon; Yogev, Yariv

doi:10.1002/uog.14665

Cited by 19 publications

(12 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The reason we comprehensively considered all the above factors when building the model was that the predictive performance of a single maternal factor or cervix geometry (including length) is not satisfactory, primarily due to poor sensitivity. [36][37][38][39][40] The mechanism of SPTB involves various mechanical stimuli (two continuously growing foetuses and the expanding uterus) and biochemical stimuli (in ammatory factors, fetoplacental signals and steroid hormones). 41,42 Compared to that in singleton pregnancies, the mechanism of SPTB in twin pregnancies is predominantly determined by overdistension, whereas the role of in ammation and microbiologic invasion of the amniotic cavity (MIAC) is relatively minor.…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of Mid-Trimester Cervical Measurement Data Combined With Maternal Characteristics for Twin Preterm Birth at < 32 Weeks: A Retrospective Analysis and External Validation Study

Zhang

Zhan

Lin

et al. 2021

Preprint

View full text Add to dashboard Cite

Objective The purpose of this study was to develop a dynamic model to predict the risk of spontaneous preterm birth at < 32 weeks in twin pregnancy. Methods Women with twin pregnancies were followed up from January 2017 to December 2019 in two tertiary medical centres—data from one were used to construct the model, and data from the other were used to evaluate the model. Data on maternal demographic characteristics, transvaginal cervical length and funnelling during 20–24 weeks were extracted. The prediction model was constructed with independent variables determined by logistic regression analyses. Results After applying specified exclusion criteria, an algorithm with maternal and biophysical factors was developed based on 92 twin pregnancies with a preterm birth < 32 weeks and 672 twin pregnancies with a delivery ≥ 32 weeks. It was then evaluated among 36 pregnancies with a preterm birth < 32 weeks and 261 pregnancies with a delivery ≥ 32 weeks in a second tertiary centre without specific training. The model reached a sensitivity of 78.26%, specificity of 88.84%, false positive rate of 11.16% and negative predictive value of 96.76%; ROC characteristics proved that the model was superior to any single parameter with an AUC of 0.856. Conclusions We developed and validated a dynamic nomogram model to predict the individual probability of early preterm birth in order to better represent the complex aetiology of twin pregnancies and hopefully improve the prediction and indication of interventions.

show abstract

Section: Discussionmentioning

confidence: 99%

Predictive Value of Mid-Trimester Cervical Measurement Data Combined With Maternal Characteristics for Twin Preterm Birth at < 32 Weeks: A Retrospective Analysis and External Validation Study

Zhang

Zhan

Lin

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Their results also showed that none of the women with CL ≥ 25 mm delivered within Table 4 Binary logistic regression analysis for prediction of preterm delivery within 7 days after first assessment and before 34 weeks' gestation, in twin pregnancies presenting with symptoms of threatened preterm labor 7 days after presentation. Melamed et al 6 evaluated the predictive accuracy of sonographic CL for preterm birth in 216 twin pregnancies with threatened preterm labor, focusing on the negative predictive value (NPV), and found that a NPV of 95% can be achieved with a CL cut-off of 28-30 mm.…”

Section: Discussionmentioning

confidence: 99%

“…To date, most studies investigating assessment of twin pregnancy for risk of preterm birth have focused on asymptomatic patients. A large study comparing the value of CL measurement in symptomatic women with a twin ( n = 218) vs those with a singleton ( n = 1077) gestation, reported that, in order to achieve a negative predictive value of 95%, a threshold of 28–30 mm had to be used in twin pregnancy as compared to 11.5–12 mm in singletons. In a systematic review of the literature investigating CL measurements in twin pregnancies with threatened preterm labor, Liem et al .…”

Section: Introductionmentioning

confidence: 99%

Single and repeat cervical‐length measurement in twin gestation with threatened preterm labor

Prodan

Wagner

Sonek

et al. 2020

Ultrasound in Obstet & Gyne

View full text Add to dashboard Cite

Objective To examine the effectiveness of single and repeat sonographic cervical‐length (CL) measurement in predicting preterm delivery in symptomatic women with a twin pregnancy. Methods This was a retrospective study of women with a twin gestation who presented with painful and regular uterine contractions at 24 + 0 to 33 + 6 weeks' gestation at the perinatal unit of the University Hospital of Tübingen, Tübingen, Germany between 2012 and 2018. CL was measured on transvaginal ultrasound at the time of admission and a few days later after cessation of contractions. Treatment included administration of tocolytics (usually oral nifedipine), for no more than 48 h, and administration of steroids if CL was ≤ 25 mm. Patients were clustered into five groups according to the CL measurement obtained at first assessment: < 10.0 mm; between 10.0 and 14.9 mm; between 15.0 and 19.9 mm; between 20.0 and 24.9 mm; and ≥ 25.0 mm. For each group, we calculated the test performance of CL measurement for prediction of preterm delivery within the subsequent 7 days and before 34 weeks' gestation. Regression analysis was used to evaluate the test performance of the second CL measurement for predicting preterm delivery within 7 days after the second assessment. Results The study population consisted of 257 twin pregnancies, of which 80.2% were dichorionic diamniotic. Median maternal and gestational ages at the time of admission were 32.0 years and 29.9 weeks' gestation, respectively. Preterm birth within 7 days of admission occurred in 23 (8.9%) pregnancies, and 82 (31.9%) patients delivered prior to 34 weeks' gestation. Median CL for the entire study population was 17.0 mm. Delivery within 7 days after the first assessment occurred in 29.0%, 10.6%, 4.2%, 6.3% and 0% of women with CL < 10.0 mm, 10.0–14.9 mm, 15.0–19.9 mm, 20.0–24.9 mm and ≥ 25.0 mm, respectively. There was a weak, but significant, association between the CL measurement at the time of admission and the time interval between admission and delivery (interval = 27.9 + 0.58 × CL; P = 0.003, r = 0.184). CL was measured again after a median time interval of 3 (interquartile range (IQR), 2–5) days in 248 cases. Median second CL measurement was 17.0 (IQR, 11.5–22.0) mm. Delivery occurred within the subsequent 7 days after the second measurement in 25/248 (10.1%) cases. Binary regression analysis indicated that the first (odds ratio (OR), 0.895; P = 0.003) and second (OR, 0.908; P = 0.002) CL measurements, but not the difference between the two measurements (OR, 0.961; P = 0.361), were associated significantly with delivery within 7 days after the second measurement. Receiver‐operating‐characteristics (ROC)‐curve analysis for the prediction of delivery within 7 days after the second assessment did not show a significant difference between the predictive performance of the first (area under ROC curve (AUC), 0.676 (95% CI, 0.559–0.793)) and the second (AUC, 0.661 (95% CI, 0.531–0.790)) measurement. Conclusion Sonographic measurement of CL can be helpful in predicting prete...

show abstract

“…Its isolated use as a screening tool has limited value due to low sensitivity. 16,25,26 In addition, previous research has demonstrated that the risk of PTB is also affected by maternal demographic features, such as ethnic origin, age, primiparity, chorionicity, prepregnancy body mass index (BMI) and history of previous preterm delivery or late-term abortion. [27][28][29][30][31][32] In a sense, twin gestation itself is one of the strongest risk factors for PTB.…”

Section: | Introductionmentioning

confidence: 99%

Predictive value of mid-trimester cervical measurement data combined with maternal demographic characteristics for twin preterm birth at < 32 weeks: a retrospective analysis and multicentre validation study

Pan¹,

Zhang²,

Zhan³

et al. 2020

Preprint

View full text Add to dashboard Cite

Objective: The purpose of this study was to develop a dynamic nomogram model to predict the risk of spontaneous preterm birth at <32 weeks in twin pregnancy. Design: A retrospective analysis and multicentre validation study Setting and Population: Women with twin pregnancies followed up in two tertiary medical centres from January 2017 to March 2019. Methods: Data on maternal demographic characteristics, transvaginal cervical length and funneling were extracted. The prediction model was constructed with independent variables determined by logistic regression analyses. The risk score was calculated according to the dynamic nomogram model. Main outcome measures: The risk of spontaneous preterm birth at <32 weeks in twin pregnancy.Results: In total, 1065 twin pregnancies were eligible for the study, of which the data of 764 cases (92 twin preterm cases (<32 weeks) and 672 control cases) were obtained from a tertiary medical centre as the training group and those of 301 cases (36 twin preterm cases (<32 weeks) and 265 control cases) from the other tertiary medical centre as the external validation group. Based on logistic regression analyses, we built a dynamic nomogram model with satisfactory discrimination in both the training group(C-index: 0.856, 95% CI: 0.813-0.899) and external validation group(C-index: 0.808, 95% CI: 0.751-0.865). The restricted cubic splines and ROC curve supported the performance of the prediction model. Conclusions: We developed and validated a dynamic nomogram model to predict the individual probability of preterm birth in twin pregnancy at <32 weeks.

show abstract

Predictive value of cervical length in women with twin pregnancy presenting with threatened preterm labor

Cited by 19 publications

References 31 publications

Predictive Value of Mid-Trimester Cervical Measurement Data Combined With Maternal Characteristics for Twin Preterm Birth at < 32 Weeks: A Retrospective Analysis and External Validation Study

Predictive Value of Mid-Trimester Cervical Measurement Data Combined With Maternal Characteristics for Twin Preterm Birth at < 32 Weeks: A Retrospective Analysis and External Validation Study

Single and repeat cervical‐length measurement in twin gestation with threatened preterm labor

Predictive value of mid-trimester cervical measurement data combined with maternal demographic characteristics for twin preterm birth at < 32 weeks: a retrospective analysis and multicentre validation study

Contact Info

Product

Resources

About

Predictive value of cervical length in women with twin pregnancy presenting with threatened preterm labor

Cited by 19 publications

References 31 publications

Predictive Value of Mid-Trimester Cervical Measurement Data Combined With Maternal Characteristics for Twin Preterm Birth at &lt; 32 Weeks: A Retrospective Analysis and External Validation Study

Predictive Value of Mid-Trimester Cervical Measurement Data Combined With Maternal Characteristics for Twin Preterm Birth at &lt; 32 Weeks: A Retrospective Analysis and External Validation Study

Single and repeat cervical‐length measurement in twin gestation with threatened preterm labor

Predictive value of mid-trimester cervical measurement data combined with maternal demographic characteristics for twin preterm birth at < 32 weeks: a retrospective analysis and multicentre validation study

Contact Info

Product

Resources

About

Predictive Value of Mid-Trimester Cervical Measurement Data Combined With Maternal Characteristics for Twin Preterm Birth at < 32 Weeks: A Retrospective Analysis and External Validation Study

Predictive Value of Mid-Trimester Cervical Measurement Data Combined With Maternal Characteristics for Twin Preterm Birth at < 32 Weeks: A Retrospective Analysis and External Validation Study