Routine Cervical Length in Twins and Perinatal Outcomes

ABSTRACT

A retrospective review of twin gestations was undertaken to evaluate whether routine cervical lengths (CLs) in such instances change pregnancy outcome. Data were collected from the ultrasound database and chart review. Exclusion criteria included twins reduced to singletons, twins not delivering at our institution, and incomplete information. Twin gestations with a CL were compared with those without a CL. Outcomes of interest included gestational age (GA) at delivery, preterm delivery (PTD), antepartum admissions, antepartum length of stay (LOS), cerclage placement, birthweight, neonatal intensive care unit admissions, and neonatal LOS. Two hundred sixty-two patients met inclusion criteria. Of those, 184 had CLs and 78 did not. Comparing the CL to the no-CL group, there were no differences with respect to GA at delivery (34.8 versus 35.3 weeks; p = 0.35), antepartum admissions (32.1 versus 23.1%; p = 0.16), cerclage placement (7.1 versus 1.3%; p = 0.06), or tocolysis use (28.6 versus 21.8%; p = 0.26). There was no difference between the two groups with respect to preterm labor (26 versus 19%; p = 0.25), PTD < 28 weeks (8.2 versus 3.9%; p = 0.21), PTD < 34 weeks (26.1 versus 25.6%; p = 0.94), or PTD < 37 weeks (76.1 versus 70.5%; p = 0.34). The only significant difference was antepartum LOS (34.5 versus 31.3 days; p < 0.001). There were no differences in neonatal outcomes. Routine CL did not improve perinatal outcome but increased maternal antepartum LOS.

KEYWORDS

Twins - ultrasound - cervical length

REFERENCES

• 1 Vital and Health Statistics .Health and Demographic Characteristics of Twin Birth: United States, 1988. Series 21: Data on Natality, Marriage, and Divorce, No. 50. Hyattsville, MD; U.S. Department of Health and Human Services 1992
• 2 Iams J D, Goldenberg R L, Meis P J et al.. The length of the cervix and the risk of spontaneous premature delivery.  N Engl J Med. 1996;  334 567-572
• 3 Guzman E R, Walters C, O'Reilly-Green C et al.. Use of cervical ultrasonography in prediction of spontaneous preterm birth in twin gestations.  Am J Obstet Gynecol. 2000;  183 1103-1107
• 4 Berghella V, Odibo A O, To M S, Rust O A, Althuisius S M. Cerclage for short cervix on ultrasonography: meta-analysis of trials using individual patient-level data.  Obstet Gynecol. 2005;  106 181-189
• 5 Guzman E R, Walters C, O'Reilly-Green C et al.. Use of cervical ultrasonography in prediction of spontaneous preterm birth in twin gestations.  Am J Obstet Gynecol. 2000;  183 1103-1107
• 6 Guzman E R, Walters C, O'Reilly-Green C et al.. Use of cervical ultrasonography in prediction of spontaneous preterm birth in triplet gestations.  Am J Obstet Gynecol. 2000;  183 1108-1113
• 7 Vayssiere C, Favre R, Audibert F et al.. Cervical length and funneling at 22 and 27 weeks to predict spontaneous birth before 32 weeks in twin pregnancies: a French prospective multicenter study.  Am J Obstet Gynecol. 2002;  187 1596-1604
• 8 Shulman A, Jauniaux E, Holmes A, Maschiach S, Maymon R. Vaginal sonography of the cervix for the prediction of “time to delivery” in ART twins gestations.  Twin Res. 2002;  5 255-259
• 9 Imseis H M, Albert T A, Iams J D. Identifying twin gestations at low risk for preterm birth with a transvaginal ultrasonographic cervical measurement at 24 to 26 weeks' gestation.  Am J Obstet Gynecol. 1997;  177 1149-1155
• 10 Dor J, Shalev J, Mashiach S, Blankstein J, Serr D M. Elective cervical suture of twin pregnancies diagnosed ultrasonically in the first trimester following induced ovulation.  Gynecol Obstet Invest. 1982;  13 55-60
• 11 Newman R B, Krombach R S, Meyers M C, McGee D L. Effect of cerclage on obstetrical outcomes in twin gestations with a shortened cervical length.  Am J Obstet Gynecol. 2002;  186 634-640
• 12 Rust O A, Altas R O, Jones K J, Benham B N, Balducci J. A randomized trial of cerclage versus no cerclage among patients with ultrasonographically detected second-trimester preterm dilatation of the internal os.  Am J Obstet Gynecol. 2000;  183 830-835
• 13 Berghella V, Odibo A O, Tolosa J E. Cerclage for prevention of preterm birth in women with a short cervix found on transvaginal ultrasound examination: a randomized trial.  Am J Obstet Gynecol. 2004;  191 1311-1317
• 14 Crowther C A, Verkuyl D AA, Neilson J P, Bannerman C, Ashurst H M. The effects of hospitalization for rest on fetal growth, neonatal morbidity and length of gestation in twin pregnancy.  Br J Obstet Gynaecol. 1990;  97 872-877
• 15 Younis J S, Sadovsky E, Eldar-Geva T, Mildwidsky A, Zeevi D, Zajicek G. Twin gestations and prophylactic hospitalization.  Int J Gynaecol Obstet. 1990;  32 325-330
• 16 Elliott J P. Magnesium sulfate as a tocolytics agent.  Am J Obstet Gynecol. 1983;  147 277-284
• 17 Dildy III G A, Moise Jr K J, Smith Jr L G, Kirshon B, Carpenter Jr R J. Indomethacin for the treatment of symptomatic leiomyoma uteri during pregnancy.  Am J Perinatol. 1992;  9 185-189
• 18 Meis P J, Klebanoff M, Thom E et al.. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate.  N Engl J Med. 2003;  348 2379-2385
• 19 da Fonseca E B, Bittar R E, Carvalho M H, Zugaib M. Prophylactic administration of progesterone by vaginal suppository to reduce the incidence of spontaneous preterm birth in women at increased risk: a randomized placebo-controlled double-blind study.  Am J Obstet Gynecol. 2003;  188 419-424
• 20 Crowther C A, Hiller J E, Doyle L W. Magnesium sulphate for preventing preterm birth in threatened preterm labour.  Cochrane Database Syst Rev. 2002;  (4) CD001060. Review
• 21 King J F, Flenady V J, Papatsonis D N, Dekker G A, Carbonne B. Calcium channel blockers for inhibiting preterm labour.  Cochrane Database Syst Rev. 2003;  (1) CD002255. Review