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How to identify twins at low risk of spontaneous preterm delivery

Sperling, L; Kiil, C; Larsen, LU; Qvist, I; Bach, D; Wojdemann, K; Bladh, A; Nikkilä, Annamari LU ; Jörgensen, C and Skajaa, K, et al. (2005) In Ultrasound in Obstetrics & Gynecology 26(2). p.138-144
Abstract
Objective The aim of this study was to evaluate transvaginal sonograpbic 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 >= 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... (More)
Objective The aim of this study was to evaluate transvaginal sonograpbic 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 >= 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 <= 20, 7-8% at <= 25, 16-17% at <= 30 and 34-48% at <= 35mm 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 gestation I 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. (Less)
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organization
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Contribution to journal
publication status
published
subject
keywords
screening, preterm delivery, cervical assessment, multiple pregnancy, twin pregnancy, ultrasonography
in
Ultrasound in Obstetrics & Gynecology
volume
26
issue
2
pages
138 - 144
publisher
John Wiley & Sons
external identifiers
  • wos:000231276700007
  • pmid:16038015
  • scopus:27544474214
ISSN
1469-0705
DOI
10.1002/uog.1938
language
English
LU publication?
yes
id
05f9e070-cea8-42d2-a53d-e3920ceb48f4 (old id 226515)
date added to LUP
2007-08-14 15:34:16
date last changed
2017-10-01 04:35:45
@article{05f9e070-cea8-42d2-a53d-e3920ceb48f4,
  abstract     = {Objective The aim of this study was to evaluate transvaginal sonograpbic 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 &gt;= 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 &lt;= 20, 7-8% at &lt;= 25, 16-17% at &lt;= 30 and 34-48% at &lt;= 35mm 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 gestation I 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.},
  author       = {Sperling, L and Kiil, C and Larsen, LU and Qvist, I and Bach, D and Wojdemann, K and Bladh, A and Nikkilä, Annamari and Jörgensen, C and Skajaa, K and Bang, J and Tabor, A},
  issn         = {1469-0705},
  keyword      = {screening,preterm delivery,cervical assessment,multiple pregnancy,twin pregnancy,ultrasonography},
  language     = {eng},
  number       = {2},
  pages        = {138--144},
  publisher    = {John Wiley & Sons},
  series       = {Ultrasound in Obstetrics & Gynecology},
  title        = {How to identify twins at low risk of spontaneous preterm delivery},
  url          = {http://dx.doi.org/10.1002/uog.1938},
  volume       = {26},
  year         = {2005},
}