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Rodo C, de la Calle M, Maroto A, Maiz N, Arévalo S, Garcia-Manau P, Mendoza M, Bartha JL, Carreras E. Gestational age-based reference ranges for cervical length and preterm birth prediction in triplet pregnancies: an observational retrospective study. BMC Pregnancy Childbirth 2022; 22:669. [PMID: 36042432 PMCID: PMC9426284 DOI: 10.1186/s12884-022-04997-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/22/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To develop gestational age-based reference ranges for cervical length in triplet pregnancies. The secondary objective was to assess the performance of cervical length measured between 18 and 20 + 6 days for the prediction of preterm delivery before 28 and 32 weeks, respectively. METHODS Observational retrospective study of triplet pregnancies in three Spanish tertiary-care hospitals between 2001 and 2019. Cervical length measurements were consecutively obtained between 15 and 34 weeks of gestation. Pregnancies undergoing multifetal reduction or fetal surgery were excluded. RESULTS Two hundred and six triplet pregnancies were included in the final analysis. There was a quadratic decrease in cervical length with gestational age. The median and fifth centiles for cervical length at 20 weeks were 35 and 13 mm. In the prediction of preterm birth < 28 weeks, for a false positive rate of 5%, and 10%, the detection rates were 40.9%, and 40.9%, respectively, and the prediction of preterm birth < 32 weeks, 22.0% and 26.0%, respectively. CONCLUSIONS In triplet pregnancies, cervical length decreases with gestational age. The performance of cervical length at 18-20 + 6 in screening for preterm birth before 28 and 32 weeks is poor.
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Affiliation(s)
- Carlota Rodo
- Maternal-Fetal Medicine Research Group, Department of Obstetrics, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
| | - María de la Calle
- Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hospital Universitario La Paz-Carlos III, Madrid, Spain
| | - Anna Maroto
- Maternal-Fetal Medicine, Department of Obstetrics, Hospital Universitari Dr Josep Trueta, Girona, Spain
| | - Nerea Maiz
- Maternal-Fetal Medicine Research Group, Department of Obstetrics, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
| | - Silvia Arévalo
- Maternal-Fetal Medicine Research Group, Department of Obstetrics, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Pablo Garcia-Manau
- Maternal-Fetal Medicine Research Group, Department of Obstetrics, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Manel Mendoza
- Maternal-Fetal Medicine Research Group, Department of Obstetrics, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - José Luis Bartha
- Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hospital Universitario La Paz-Carlos III, Madrid, Spain
| | - Elena Carreras
- Maternal-Fetal Medicine Research Group, Department of Obstetrics, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain
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Cervical Assessment for Predicting Preterm Birth-Cervical Length and Beyond. J Clin Med 2021; 10:jcm10040627. [PMID: 33562187 PMCID: PMC7915684 DOI: 10.3390/jcm10040627] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/22/2021] [Accepted: 01/24/2021] [Indexed: 02/07/2023] Open
Abstract
Preterm birth is considered one of the main etiologies of neonatal death, as well as short- and long-term disability worldwide. A number of pathophysiological processes take place in the final unifying factor of cervical modifications that leads to preterm birth. In women at high risk for preterm birth, cervical assessment is commonly used for prediction and further risk stratification. This review outlines the rationale for cervical length screening for preterm birth prediction in different clinical settings within existing and evolving new technologies to assess cervical remodeling.
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Ramji N, Abdulghani SH, Zhang T, Moretti FM, Fung-Kee-Fung KM. Does late second-trimester cervical length predict unscheduled preterm birth in asymptomatic triplet pregnancies? J Matern Fetal Neonatal Med 2020; 35:4597-4606. [PMID: 33292021 DOI: 10.1080/14767058.2020.1857356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Multiple gestation increases the risk of unscheduled preterm birth (PTB), both spontaneous and indicated, leading to increased neonatal morbidity and additional healthcare costs. The purpose of this study was to determine whether cervical length (CL) assessment by 28 weeks could predict unscheduled PTB <34 weeks in triplet pregnancies. Secondary outcomes included prediction of PTB <30 weeks, prediction of PTB based on degree of cervical change and effect of ART-use on PTB. METHODS This was a retrospective cohort of women with triplet pregnancies. The exposure variable of interest was short cervix < 25 and <20 millimeters (mm) by 28 weeks. Maternal characteristics were described. The distribution of CLs was analyzed by the primary outcome of unscheduled PTB < 34 weeks, and by PTB <30 weeks (secondary outcome). Gestational age at delivery was compared between women with and without a short cervix. Changes in CL were compared between the groups with unscheduled PTB and those delivering ≥34 and ≥30 weeks. Statistical analyses were performed using appropriate tests. RESULTS Of 92 triplet pregnancies, 51 met the criteria, with 1233 total (411 shortest) CL measurements from 16 to 34 weeks' gestation. The overall rate of PTB <34 weeks was 31.4% and <30 weeks was 9.8%. The median gestational age at delivery was 32.7 (IQR 2.3) weeks. There were no statistically significant differences in rates of unscheduled PTB in women who had a short cervix and those that did not: PTB <34 weeks with CL <25 mm (p = .53) and CL <20 mm (p = .70); PTB <30 weeks with CL <25 mm (p = .38) and CL <20 mm (p = .26). The degree of cervical change from 18 to 28 weeks was not statistically significant for predicting unscheduled PTB <34 and <30 weeks. Of 70.6% of triplet pregnancies conceived by ARTs, 13.9% had unscheduled PTB <30 weeks, whereas no spontaneously-conceived pregnancies delivered <30 weeks (p = .14). CONCLUSION Short cervix did not predict unscheduled spontaneous PTB <34 weeks nor <30 weeks in our triplet cohort, nor did the degree of cervical change by 28 weeks predict PTB. Triplets conceived by ARTs may have an increased risk of unscheduled PTB.
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Affiliation(s)
- Naila Ramji
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Newborn Care, University of Ottawa, Ottawa, Canada
| | - Sahar H Abdulghani
- Department of Obstetrics and Gynecology, King Saud University Medical City, Riyadh, Saudi Arabia
| | | | - Felipe M Moretti
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Newborn Care, University of Ottawa, Ottawa, Canada
| | - Karen M Fung-Kee-Fung
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Newborn Care, University of Ottawa, Ottawa, Canada
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Mhatre M, Craigo S. Triplet pregnancy: What do we tell the prospective parents. Prenat Diagn 2020; 41:1593-1601. [PMID: 33080664 DOI: 10.1002/pd.5852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/21/2020] [Accepted: 10/18/2020] [Indexed: 11/09/2022]
Abstract
Experience managing triplet pregnancies has increased over the past few decades as the incidence has changed related to assisted reproductive practices. Physicians caring for women carrying triplets cannot predict an individual outcome or pregnancy course but must educate patients about the challenges related to these high risk pregnancies. Obstetric providers can describe the wide range of risks associated with triplet gestations, and the general plan for management, but ultimately parents must make decisions with potentially lifelong consequences. Here, we present the diagnostic criteria, common complications, and management options for triplet pregnancies, to help obstetricians counsel patients on the medical and psychosocial consequences of triplet pregnancy, potential complications, and multifetal reduction.
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Affiliation(s)
- Mohak Mhatre
- Tufts Medical Center, Boston, Massachusetts, USA
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