Turkan Dikici AKTAS, Mehmet ÇINAR, Selen YAMAN, Sevgi AYHAN, Nuri DANIŞMAN

Predictive role of transvaginal ultrasonographic measurement of cervical length at 22-26 weeks of gestation for preterm deliveries in twin pregnancies

Aim of this study is to investigate the predictive role of transvaginal ultrasonographic measurement of cervical length (CL) at 22-26 weeks of gestation in determining preterm deliveries in twin pregnancies. CL was measured by transvaginal ultrasonography at 22-26 weeks in 75 twin pregnancies. Signs of preterm labor, ruptured membranes, vaginal bleeding, patients with systemic disease, cervical incompetence were excluded. The primary outcome was spontaneous preterm birth at before 37 weeks of gestation. 63 pregnancies delivered with cesarean section and 10 (% 13.3) babies had NICU requirement. The mean CLM was 37±7.26 mm in patients. Twenty patient (%27) were hospitalized with a diagnosis of preterm labor. 46 patients were delivered at small than 37 gestational weeks and the mean CLM was 37.63±6.53 mm. 29 patients occurred term delivery with 38.64±6.23mm CLM. According to the ROC curve analysis CLM was found to be a discriminative parameter in patients. The area under curve (AUC), cut off values, sensitivity and specificity were 0.794, 34.95 and %70-80; respectively (p=0.029). In twin pregnancies, measurement of CL with transvaginal ultrasonography at 22-26 weeks of gestation can be of beneficial in predicting the risk of preterm deliveries

PDF

___

1. Chauhan SP, Scardo JA, Hayes E, Abuhamad AZ, Berghella V. Twins: prevalence, problems, and preterm births. Am J Obstet Gynecol. 2010;203(4):305-15.

2. Leppert PC.Anatomy and physiology of cervical ripening. Clin Obstet Gynecol. 1995;38(2):267-79.

3. Moroz LA, Simhan HN. Rate of sonographic cervical shortening and the risk of spontaneous preterm birth. Am J Obstet Gynecol. 2012;206(3):234.-5.

4. Moroz LA, Simhan HN. Rate of sonographic cervical shortening and the risk of spontaneous preterm birth. Am J Obstet Gynecol. 2012;206(3):234-5.

5. Gómez Laencina AM, Sánchez FG, Gimenez JH, Martínez MS, Valverde Martínez JA, Vizcaíno VM. Comparison of ultrasonographic cervical length and the Bishop score in predicting successful labor induction. Acta Obstet Gynecol Scand. 2007;86(7):799-804.

6. Committee on Practice Bulletins—Obstetrics, The American College of Obstetricians and Gynecologists. Practice bulletin no. 130: prediction and prevention of preterm birth. Obstet Gynecol. 2012;120(4):964-73.

7. Conde-Agudelo A, Romero R, Hassan SS, Yeo L. Transvaginal sonographic cervical length for the prediction of spontaneous preterm birth in twin pregnancies: a systematic review and metaanalysis. Am J Obstet Gynecol. 2010;203(2):128-12.

8. Goldenberg RL, Iams JD, Miodovnik M, Van Dorsten JP, Thurnau G, Bottoms S, Mercer BM, Meis PJ, Moawad AH, Das A,Caritis SN, McNellis D. The preterm prediction study: risk factors in twin gestations. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Am J Obstet Gynecol. 1996;175(4Pt1):1047-53.

9. Ozkaya E, Baser E, Cinar M, Korkmaz V, Kucukozkan T.Does diurnal rhythm have an impact on fetal biophysical profile? J Matern Fetal Neonatal Med. 2012;25(4):335-8.

10. Fetal growth and the etiology of preterm delivery. Rossavik IK. Obstet Gynecol. 1995;85(6):1062-3.

11. Souka AP, Heath V, Flint S, Sevastopoulou I, Nicolaides KH. Cervical length at 23 weeks in twins in predicting spontaneous preterm delivery. Obstet Gynecol. 1999;94(3):450-4.

12. Iams JD, Johnson FF, Sonek J, Sachs L, Gebauer C, Samuels P. Cervical competence as a continuum: a study of ultrasonographic cervical length and obstetric performance. . Am J Obstet Gynecol. 1995;172(4 Pt 1):1097-103; discussion 1104-6.

13. Bergelin, I. and L. Valentin, Patterns of normal change in cervical length and width during pregnancy in nulliparous women: a prospective, longitudinal ultrasound study. Ultrasound Obstet Gynecol. 2001;18(3):217-22.

14. Gramellini D, Fieni S, Molina E, Berretta R, Vadora E. Transvaginal sonographic cervical length changes during normal pregnancy. J Ultrasound Med. 2002;21(3):227-32; quiz 234-5.

15. Campbell, S. Universal cervical-length screening and vaginal progesterone prevents early preterm births, reduces neonatal morbidity and is cost saving: doing nothing is no longer an option. Ultrasound Obstet Gynecol, 2011;38(1): p. 1-9.

16. Parry S, Simhan H, Elovitz M, Iams J. Am J Obstet Gynecol. Universal maternal cervical length screening during the second trimester: pros and cons of a strategy to identify women at risk of spontaneous preterm delivery. 2012;207(2):101-6.

17. Fuchs I, Tsoi E, Henrich W, Dudenhausen JW, Nicolaides KH. Sonographic measurement of cervical length in twin pregnancies in threatened preterm labor. Ultrasound Obstet Gynecol. 2004;23(1):42- 5.

18. Imseis HM, Albert TA, Iams JD.Am J Obstet Gynecol. Identifying twin gestations at low risk for preterm birth with a transvaginal ultrasonographic cervical measurement at 24 to 26 weeks' gestation. 1997;177(5):1149-55.