Risk of preterm birth in a twin pregnancy after an early‐term birth in the preceding singleton pregnancy: a retrospective cohort study

Berveiller, Paul; Rousseau, Anne; Rousseau, Manon; Bitumba, Iris; Goffinet, François; Rozenberg, Patrick

doi:10.1111/1471-0528.16071

Cited by 14 publications

(11 citation statements)

References 35 publications

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“…Many studies have used cervical length, cervical elastography or cervical consistency index to identify singleton pregnancy at risk of PTD. In twin pregnancies, most studies have focused on cervical length as a predictor for PTD [ 18 , 40 – 43 ], very few have used cervical SWE as a tool to investigate the predictive effect of cervical changes on PTD. Ono et al reported that SWE is a helpful tool for measuring the changes in cervical stiffness in 254 singleton pregnancies and 26 twin pregnancies [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical application of cervical shear wave elastography in predicting the risk of preterm delivery in DCDA twin pregnancy

Sun

Jian

et al. 2022

BMC Pregnancy Childbirth

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Background Limited studies have used cervical shear wave elastography (SWE) as a tool to investigate the predictive effect of cervical changes on preterm delivery (PTD) in twin pregnancy. This study is aimed to predict the risk of PTD by cervical SWE in dichorionic diamniotic (DCDA) twin pregnancy. Methods A total of 138 women with dichorionic diamniotic (DCDA) twins were included in this prospective study. The mean SWE value of the cervix was obtained from the inner, middle and outer regions of the anterior and posterior cervical lips using a transvaginal ultrasound transducer and measured consecutively across three different gestations (20–23+ 6 weeks, 24–27+ 6 weeks, and 28–32 weeks). Follow-up was performed on all subjects, and we compared the mean SWE value between the PTD and term delivery (TD) groups. Results A total of 1656 cervical mean SWE data were collected for analysis. Among the 138 twin pregnant women, only 92 women completed the three elastography examinations; PTD occurred in 58.7% (54/92), and TD in 41.3% (38/92). The mean (SD) maternal age was 33.1 ± 4.1 years, and the mean (SD) body mass index was 21.1 ± 2.6 kg/m2. As gestational age increased, the mean SWE value of each part of the cervix decreased. The cervical mean SWE value was lower in the preterm group than in the term group in all three gestations, except for the anterior cervical lip at 28–32 weeks. Receiver operating characteristics (ROC) curves showed the sensitivity of mean SWE value of the anterior cervical lip was 83.3% (95% CI, 70.7–92.1) with a specificity of 57.9% (95% CI, 40.8–73.7) for predicting PTD at a cutoff value of 7.94 kPa. The positive likelihood ratio (LR+) was 1.67 (95% CI, 1.19–2.34), and the negative likelihood ratio (LR–) was 0.33 (95% CI, 0.17–0.64). Conclusions There is a significant negative correlation between cervical stiffness and gestational age in DCDA twin pregnancy. SWE is a potential tool for assessing cervical stiffness and predicting PTD in DCDA twin pregnancy.

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Section: Discussionmentioning

confidence: 99%

Clinical application of cervical shear wave elastography in predicting the risk of preterm delivery in DCDA twin pregnancy

Sun

Jian

et al. 2022

BMC Pregnancy Childbirth

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“…The twin birth rate in China has dramatically risen over the last decade, from 16.4‰ in 2007 to 21.7‰ in 2014, owing to the widespread use of assisted reproductive technology and increased maternal age 1 . Twin pregnancies are associated with increased perinatal morbidity and mortality, given that they are at increased risk for spontaneous preterm birth (sPTB), about half of twin pregnancies are delivered preterm, 2,3 and it is unclear whether any intervention reduces this risk 4–8 …”

Section: Introductionmentioning

confidence: 99%

“…are delivered preterm, 2,3 and it is unclear whether any intervention reduces this risk. [4][5][6][7][8] Cervical cerclage represents one of the best-known surgical interventions to prevent sPTB in obstetrics.…”

mentioning

confidence: 99%

Pregnancy outcomes and factors affecting the clinical effects of emergency cerclage in twin pregnancies with cervical dilation and prolapsed membranes

Zeng

Pei

et al. 2021

Intl J Gynecology & Obste

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Objective To determine the effect of mid‐trimester emergency cerclage in women with twin pregnancies with cervical dilation and prolapsed membranes, and to identify risk factors predicting spontaneous preterm birth (sPTB) before 28 weeks, after cerclage. Methods Retrospective analysis of twin gestations with cervical dilation and prolapsed membranes treated with emergency cerclage or expectant management (2015–2020). The primary outcomes were the rate of sPTB before 28 weeks and the gestational latency. Multiple logistic regression analysis was used to determine the factors associated with sPTB before 28 weeks, after cerclage. Results Ninety‐seven women were included, cerclage (n = 58) or no cerclage (n = 39). Cerclage placement was associated with significantly lower incidence of sPTB before 28 weeks of pregnancy (34.5% vs 82.1%) and prolongation of the gestational latency (46.71 ± 27.52 vs 10.95 ± 11.71 days). Positive cervical culture (odds ratio [OR] 10.69, 95% confidence interval [CI] 1.82–62.95), pregnancy duration at diagnosis less than 22 weeks (OR 9.42; 95% CI 1.69–52.69) and cervical dilation at least 4 cm (OR 7.92; 95% CI 1.40–44.71) were found to be independent risk factors for sPTB before 28 weeks, after cerclage. Conclusion Emergency cerclage in women with twin pregnancies with cervical dilation and prolapsed membranes was associated with an overall 40% decrease in sPTB before 28 weeks and a prolongation of latency by 5 weeks. The strongest predictor of sPTB before 28 weeks after cerclage was a positive cervical culture.

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“…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. 4,33 Assessment of the individual maternal prognosis requires clinicians to consider an array of maternal demographic factors and clinical variables that may be clinically challenging to synthesize.…”

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

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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.

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Risk of preterm birth in a twin pregnancy after an early‐term birth in the preceding singleton pregnancy: a retrospective cohort study

Cited by 14 publications

References 35 publications

Clinical application of cervical shear wave elastography in predicting the risk of preterm delivery in DCDA twin pregnancy

Clinical application of cervical shear wave elastography in predicting the risk of preterm delivery in DCDA twin pregnancy

Pregnancy outcomes and factors affecting the clinical effects of emergency cerclage in twin pregnancies with cervical dilation and prolapsed membranes

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

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