Twin transvaginal cervical length at 16–20 weeks and prediction of preterm birth*

Hester, Ashley; Ankumah, Nana Ama E; Chauhan, Suneet P.; Sibai, Bahaeddine M

doi:10.1080/14767058.2017.1384806

Cited by 8 publications

(5 citation statements)

References 18 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%

“…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 ].…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Introductionmentioning

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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“…11 Moreover, approaches used in singleton pregnancies to attenuate the risk of preterm birth have not been widely successful in multiple gestations. 12 13 14 15 Despite these potential differences, a prior preterm birth seems to confer a similarly increased risk for preterm birth in twins. 16 17…”

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confidence: 99%

“…11 Moreover, approaches used in singleton pregnancies to attenuate the risk of preterm birth have not been widely successful in multiple gestations. [12][13][14][15] Despite these potential differences, a prior preterm birth seems to confer a similarly increased risk for preterm birth in twins. 16,17 In contrast, the protective role a previous term delivery may play in attenuating the risk of spontaneous preterm birth is less well defined.…”

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confidence: 99%

Prior Term Birth Decreases the Risk of Preterm Birth in a Subsequent Twin Gestation

2021

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Objective The aim of the study is to examine the association between the risk of preterm delivery among women with twin pregnancies and their obstetric history. Study Design We designed a retrospective cohort study of live twin births in 2008 in the United States that delivered after 240/7 weeks. Women were categorized into nulliparas, multiparas with prior term delivery, and multiparas with prior preterm delivery. The incidence of preterm birth was compared using Chi-square test and multivariable logistic regression models. Results A total of 32,895 nulliparous and 64,701 multiparous women with twin pregnancies were included in the study. Of the multiparous women, 2,505 (4%) had a history of a prior preterm delivery. Multiparous women with prior term birth were more likely to deliver at term (43%) in the index twin pregnancy than nulliparous women (40%) and multiparous women with a prior preterm birth (21%; p < 0.001). Compared with nulliparous women, prior term birth was protective against preterm delivery (adjusted odds ratio [aOR] = 0.67 [95% confidence interval 0.60–0.74] for delivery <28 weeks and aOR = 0.79 [0.71–0.77] for delivery <34 weeks). Conclusion Among multiparous women with twins, a prior term delivery appeared to be protective against preterm delivery compared with nulliparous women with twins. Key Points

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“…An a priori total sample size of 57 was calculated, of 38 controls and 19 cases. At the time of setting up the study, no twin CCI data was available, and the sample size was based upon a previous publication of CCI in high-risk singletons [10] that noted an AUC for CL of 0.51 and CCI of 0.73 and keeping account for the wide variety of AUCs published for the prediction of PTB in twins using CL [23,24]. This calculation included a type I error of 0.05, power of 0.90 with an allocation ratio of 2 and an anticipated sPTB rate of >20%.…”

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confidence: 99%

The Predictive Value of the Cervical Consistency Index to Predict Spontaneous Preterm Birth in Asymptomatic Twin Pregnancies at the Second-Trimester Ultrasound Scan: A Prospective Cohort Study

Merwe

Couck

Russo

et al. 2020

JCM

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Novel transvaginal ultrasound (TVU) markers have been proposed to improve spontaneous preterm birth (sPTB) prediction. Preliminary results of the cervical consistency index (CCI), uterocervical angle (UCA), and cervical texture (CTx) have been promising in singletons. However, in twin pregnancies, the results have been inconsistent. In this prospective cohort study of asymptomatic twin pregnancies assessed between 18+0–22+0 weeks, we evaluated TVU derived cervical length (CL), CCI, UCA, and the CTx to predict sPTB < 34+0 weeks. All iatrogenic PTB were excluded. In the final cohort of 63 pregnancies, the sPTB rate < 34+0 was 16.3%. The CCI, UCA, and CTx, including the CL was significantly different in the sPTB < 34+0 weeks group. The best area under the receiver operating characteristic curve (AUC) for sPTB < 34+0 weeks was achieved by the CCI 0.82 (95%CI, 0.72–0.93), followed by the UCA with AUC 0.72 (95%CI, 0.57–0.87). A logistic regression model incorporating parity, chorionicity, CCI, and UCA resulted in an AUC of 0.91 with a sensitivity of 55.3% and specificity of 88.1% for predicting sPTB < 34+0. The CCI performed better than other TVU markers to predict sPTB < 34+0 in twin gestations, and the best diagnostic accuracy was achieved by a combination of parity, chorionicity, CCI, and UCA.

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Twin transvaginal cervical length at 16–20 weeks and prediction of preterm birth*

Cited by 8 publications

References 18 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

Prior Term Birth Decreases the Risk of Preterm Birth in a Subsequent Twin Gestation

The Predictive Value of the Cervical Consistency Index to Predict Spontaneous Preterm Birth in Asymptomatic Twin Pregnancies at the Second-Trimester Ultrasound Scan: A Prospective Cohort Study

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