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

Abstract

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...

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

“…Premature softening and ripening of the cervix are related to shortening and PTD. Currently, various methods have been suggested for predicting PTD in twin pregnancies, and transvaginal cervical length (TVCL) measurement in the second trimester has been shown to help predict spontaneous PTD [ 15 – 17 ]. However, the major limitation of using cervical length alone in the second trimester is its low sensitivity and positive predictive value for PTD [ 16 , 18 ].…”

Role of Uterocervical Angle, Cervical Length and Cervicovaginal Fetal Fibronectin (FFN) for Prediction of Labor Onset in Women Who Present with Preterm Labor

“…In keeping with these findings, research on uterocervical angle assessment for predicting PTB in symptomatic women discovered that delivery within two days was exclusively linked with GA and CL at presentation. UCA measurement was unsuccessful in predicting PTB after the beginning of symptoms [15]. Sochacki-Wojcicka et al, 2015 determined an expected sPTB detection rate of 66.7% at 34 weeks with a 10% false-positive rate in case-control studies [16].…”

Measurement of the uterocervical angle for the prediction of preterm birth in symptomatic women

“…The most relevant ultrasound parameter for the prediction of delivery within the next few days in women with preterm delivery remains the cervical length. Several studies have focused on this parameter and have proven its effectiveness in different conditions such as singleton and twin pregnancies and symptomatic and asymptomatic women [ 3 , 6 , 7 , 14 , 15 ]. Most commonly, a cut-off of 15 mm is used to stratify the further management of these pregnancies [ 7 , 18 , 19 ].…”