title: Prediction of preterm birth in twin gestations using biophysical and biochemical tests.
abstract: The objective of this study was to determine the performance of biophysical and biochemical tests for the prediction of preterm birth in both asymptomatic and symptomatic women with twin gestations. We identified a total of 19 tests proposed to predict preterm birth, mainly in asymptomatic women. In these women, a single measurement of cervical length with transvaginal ultrasound before 25 weeks of gestation appears to be a good test to predict preterm birth. Its clinical potential is enhanced by the evidence that vaginal progesterone administration in asymptomatic women with twin gestations and a short cervix reduces neonatal morbidity and mortality associated with spontaneous preterm delivery. Other tests proposed for the early identification of asymptomatic women at increased risk of preterm birth showed minimal to moderate predictive accuracy. None of the tests evaluated in this review meet the criteria to be considered clinically useful to predict preterm birth among patients with an episode of preterm labor. However, a negative cervicovaginal fetal fibronectin test could be useful in identifying women who are not at risk for delivering within the next week, which could avoid unnecessary hospitalization and treatment. This review underscores the need to develop accurate tests for predicting preterm birth in twin gestations. Moreover, the use of interventions in these patients based on test results should be associated with the improvement of perinatal outcomes.
authors: Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, and Detroit, MI.
authors: Agustin
authors: A
authors: Conde-Agudelo
authors: Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI. Electronic address: romeror@mail.nih.gov.
authors: Roberto
authors: R
authors: Romero
mesh_terms: D054791:Cervical Length Measurement; D002584:Cervix Uteri / Q000000981:diagnostic imaging; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D004731:Endotoxins; D005260:Female; D005353:Fibronectins; D006801:Humans; D048208:Nuchal Translucency Measurement; D011237:Predictive Value of Tests; D011247:Pregnancy; D059285:Pregnancy, Twin; D011266:Pregnancy-Associated Plasma Protein-A; D047928:Premature Birth / Q000175:diagnosis* / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods*; D018608:Ultrasonography, Doppler; D055988:Uterine Artery / Q000000981:diagnostic imaging; D018590:Uterine Monitoring; D016585:Vaginosis, Bacterial / Q000453:epidemiology; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D000509:alpha-Fetoproteins
chemical_list: D018997:Chorionic Gonadotropin, beta Subunit, Human; D004731:Endotoxins; C403421:FFN protein, human; D005353:Fibronectins; D000509:alpha-Fetoproteins; D014807:Vitamin D; C104450:25-hydroxyvitamin D; D011266:Pregnancy-Associated Plasma Protein-A
keywords: cervical length; fetal fibronectin; predictive value of tests; pregnancy; premature birth