How to identify twins at low risk of spontaneous preterm delivery.
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.
Sperling
L
L
Department of Fetal Medicine, Juliane Marie Center, Rigshospitalet, Copenhagen, Denmark. lenesperling@dadlnet.dk
Kiil
C
C
Larsen
L U
LU
Qvist
I
I
Bach
D
D
Wøjdemann
K
K
Bladh
A
A
Nikkilä
A
A
Jørgensen
C
C
Skajaa
K
K
Bang
J
J
Tabor
A
A
D020070:Cervical Ripening; D002584:Cervix Uteri / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007752:Obstetric Labor, Premature / Q000000981:diagnostic imaging* / Q000473:pathology; D011247:Pregnancy; D011272:Pregnancy, Multiple; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment / Q000379:methods; D016037:Single-Blind Method; D014427:Twins; D016216:Ultrasonography, Prenatal / Q000379:methods