How to identify twins at low risk of spontaneous preterm delivery

Lene Sperling, C Kiil, L U Larsen, I Qvist, D Bach, K Wøjdemann, A Bladh, A Nikkilä, C Jørgensen, K Skajaa, J Bang, A Tabor

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

OBJECTIVE: The aim of this study was to evaluate transvaginal sonographic assessment of cervical length at 23 weeks as a screening test for spontaneous preterm delivery in order to define a cut-off value that could be used to select twin pregnancies at low risk of spontaneous preterm delivery.

METHODS: In a prospective multicenter study of 383 twin pregnancies included before 14 + 6 weeks a cervical scan with measurement of the cervical length was performed at 23 weeks' gestation. The results were blinded for the clinicians if the cervical length was > or = 15 mm. The rates of spontaneous delivery at different cut-off levels of cervical length were determined.

RESULTS: Eighty-nine percent of the twins had dichorionic placentation and 58% were conceived after assisted reproduction. The rate of spontaneous preterm delivery was 2.3% (1.5% for dichorionic (DC) and 9.1% for (MC) monochorionic twins) before 28 weeks and 18.5% (17.1% for DC and 29.5% for MC twins) before 35 weeks. The screen-positive rate was 5% for a cervical length < or = 20, 7-8% at < or = 25, 16-17% at < or = 30 and 34-48% at < or = 35 mm depending on chorionicity. The false-negative rate (1 - negative predictive value) ranged from 1.2% at 28 weeks to 18.6% at 35 weeks for all twins. Receiver-operating characteristics curves showed that the sensitivity increased with declining gestational age with cut-off levels of highest accuracy at 21 mm for 28 weeks and 29 mm for 33 weeks.

CONCLUSIONS: Cervical length measurement at 23 weeks of gestation is a good screening test for predicting twins at low risk of preterm and very preterm delivery, especially in DC twins. The present results suggest that a cut-off of 25 mm should be recommended.

OriginalsprogEngelsk
TidsskriftUltrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
Vol/bind26
Udgave nummer2
Sider (fra-til)138-44
Antal sider7
ISSN0960-7692
DOI
StatusUdgivet - aug. 2005

Fingeraftryk

Twin Pregnancy
Placentation
ROC Curve
Gestational Age
Multicenter Studies
Prospective Studies

Citer dette

Sperling, Lene ; Kiil, C ; Larsen, L U ; Qvist, I ; Bach, D ; Wøjdemann, K ; Bladh, A ; Nikkilä, A ; Jørgensen, C ; Skajaa, K ; Bang, J ; Tabor, A. / How to identify twins at low risk of spontaneous preterm delivery. I: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2005 ; Bind 26, Nr. 2. s. 138-44.
@article{b80ae151a7474bd4ad88d8720905c66d,
title = "How to identify twins at low risk of spontaneous preterm delivery",
abstract = "OBJECTIVE: The aim of this study was to evaluate transvaginal sonographic assessment of cervical length at 23 weeks as a screening test for spontaneous preterm delivery in order to define a cut-off value that could be used to select twin pregnancies at low risk of spontaneous preterm delivery.METHODS: In a prospective multicenter study of 383 twin pregnancies included before 14 + 6 weeks a cervical scan with measurement of the cervical length was performed at 23 weeks' gestation. The results were blinded for the clinicians if the cervical length was > or = 15 mm. The rates of spontaneous delivery at different cut-off levels of cervical length were determined.RESULTS: Eighty-nine percent of the twins had dichorionic placentation and 58{\%} were conceived after assisted reproduction. The rate of spontaneous preterm delivery was 2.3{\%} (1.5{\%} for dichorionic (DC) and 9.1{\%} for (MC) monochorionic twins) before 28 weeks and 18.5{\%} (17.1{\%} for DC and 29.5{\%} for MC twins) before 35 weeks. The screen-positive rate was 5{\%} for a cervical length < or = 20, 7-8{\%} at < or = 25, 16-17{\%} at < or = 30 and 34-48{\%} at < or = 35 mm depending on chorionicity. The false-negative rate (1 - negative predictive value) ranged from 1.2{\%} at 28 weeks to 18.6{\%} at 35 weeks for all twins. Receiver-operating characteristics curves showed that the sensitivity increased with declining gestational age with cut-off levels of highest accuracy at 21 mm for 28 weeks and 29 mm for 33 weeks.CONCLUSIONS: Cervical length measurement at 23 weeks of gestation is a good screening test for predicting twins at low risk of preterm and very preterm delivery, especially in DC twins. The present results suggest that a cut-off of 25 mm should be recommended.",
keywords = "Cervical Ripening, Cervix Uteri, Female, Gestational Age, Humans, Obstetric Labor, Premature, Pregnancy, Pregnancy, Multiple, Prospective Studies, Reference Values, Risk Assessment, Single-Blind Method, Twins, Ultrasonography, Prenatal",
author = "Lene Sperling and C Kiil and Larsen, {L U} and I Qvist and D Bach and K W{\o}jdemann and A Bladh and A Nikkil{\"a} and C J{\o}rgensen and K Skajaa and J Bang and A Tabor",
note = "Copyright 2005 ISUOG. Published by John Wiley & Sons, Ltd.",
year = "2005",
month = "8",
doi = "10.1002/uog.1938",
language = "English",
volume = "26",
pages = "138--44",
journal = "Ultrasound in Obstetrics & Gynecology",
issn = "0960-7692",
publisher = "JohnWiley & Sons Ltd.",
number = "2",

}

Sperling, L, Kiil, C, Larsen, LU, Qvist, I, Bach, D, Wøjdemann, K, Bladh, A, Nikkilä, A, Jørgensen, C, Skajaa, K, Bang, J & Tabor, A 2005, 'How to identify twins at low risk of spontaneous preterm delivery', Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, bind 26, nr. 2, s. 138-44. https://doi.org/10.1002/uog.1938

How to identify twins at low risk of spontaneous preterm delivery. / Sperling, Lene ; Kiil, C; Larsen, L U; Qvist, I; Bach, D; Wøjdemann, K; Bladh, A; Nikkilä, A; Jørgensen, C; Skajaa, K; Bang, J; Tabor, A.

I: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, Bind 26, Nr. 2, 08.2005, s. 138-44.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - How to identify twins at low risk of spontaneous preterm delivery

AU - Sperling, Lene

AU - Kiil, C

AU - Larsen, L U

AU - Qvist, I

AU - Bach, D

AU - Wøjdemann, K

AU - Bladh, A

AU - Nikkilä, A

AU - Jørgensen, C

AU - Skajaa, K

AU - Bang, J

AU - Tabor, A

N1 - Copyright 2005 ISUOG. Published by John Wiley & Sons, Ltd.

PY - 2005/8

Y1 - 2005/8

N2 - OBJECTIVE: The aim of this study was to evaluate transvaginal sonographic assessment of cervical length at 23 weeks as a screening test for spontaneous preterm delivery in order to define a cut-off value that could be used to select twin pregnancies at low risk of spontaneous preterm delivery.METHODS: In a prospective multicenter study of 383 twin pregnancies included before 14 + 6 weeks a cervical scan with measurement of the cervical length was performed at 23 weeks' gestation. The results were blinded for the clinicians if the cervical length was > or = 15 mm. The rates of spontaneous delivery at different cut-off levels of cervical length were determined.RESULTS: Eighty-nine percent of the twins had dichorionic placentation and 58% were conceived after assisted reproduction. The rate of spontaneous preterm delivery was 2.3% (1.5% for dichorionic (DC) and 9.1% for (MC) monochorionic twins) before 28 weeks and 18.5% (17.1% for DC and 29.5% for MC twins) before 35 weeks. The screen-positive rate was 5% for a cervical length < or = 20, 7-8% at < or = 25, 16-17% at < or = 30 and 34-48% at < or = 35 mm depending on chorionicity. The false-negative rate (1 - negative predictive value) ranged from 1.2% at 28 weeks to 18.6% at 35 weeks for all twins. Receiver-operating characteristics curves showed that the sensitivity increased with declining gestational age with cut-off levels of highest accuracy at 21 mm for 28 weeks and 29 mm for 33 weeks.CONCLUSIONS: Cervical length measurement at 23 weeks of gestation is a good screening test for predicting twins at low risk of preterm and very preterm delivery, especially in DC twins. The present results suggest that a cut-off of 25 mm should be recommended.

AB - OBJECTIVE: The aim of this study was to evaluate transvaginal sonographic assessment of cervical length at 23 weeks as a screening test for spontaneous preterm delivery in order to define a cut-off value that could be used to select twin pregnancies at low risk of spontaneous preterm delivery.METHODS: In a prospective multicenter study of 383 twin pregnancies included before 14 + 6 weeks a cervical scan with measurement of the cervical length was performed at 23 weeks' gestation. The results were blinded for the clinicians if the cervical length was > or = 15 mm. The rates of spontaneous delivery at different cut-off levels of cervical length were determined.RESULTS: Eighty-nine percent of the twins had dichorionic placentation and 58% were conceived after assisted reproduction. The rate of spontaneous preterm delivery was 2.3% (1.5% for dichorionic (DC) and 9.1% for (MC) monochorionic twins) before 28 weeks and 18.5% (17.1% for DC and 29.5% for MC twins) before 35 weeks. The screen-positive rate was 5% for a cervical length < or = 20, 7-8% at < or = 25, 16-17% at < or = 30 and 34-48% at < or = 35 mm depending on chorionicity. The false-negative rate (1 - negative predictive value) ranged from 1.2% at 28 weeks to 18.6% at 35 weeks for all twins. Receiver-operating characteristics curves showed that the sensitivity increased with declining gestational age with cut-off levels of highest accuracy at 21 mm for 28 weeks and 29 mm for 33 weeks.CONCLUSIONS: Cervical length measurement at 23 weeks of gestation is a good screening test for predicting twins at low risk of preterm and very preterm delivery, especially in DC twins. The present results suggest that a cut-off of 25 mm should be recommended.

KW - Cervical Ripening

KW - Cervix Uteri

KW - Female

KW - Gestational Age

KW - Humans

KW - Obstetric Labor, Premature

KW - Pregnancy

KW - Pregnancy, Multiple

KW - Prospective Studies

KW - Reference Values

KW - Risk Assessment

KW - Single-Blind Method

KW - Twins

KW - Ultrasonography, Prenatal

U2 - 10.1002/uog.1938

DO - 10.1002/uog.1938

M3 - Journal article

VL - 26

SP - 138

EP - 144

JO - Ultrasound in Obstetrics & Gynecology

JF - Ultrasound in Obstetrics & Gynecology

SN - 0960-7692

IS - 2

ER -