Second-trimester cervical length as risk indicator for Cesarean delivery in women with twin pregnancy.
OBJECTIVE
To determine whether second-trimester cervical length (CL) in women with a twin pregnancy is associated with the risk of emergency Cesarean section.


METHODS
This was a secondary analysis of two randomized trials conducted in 57 hospitals in The Netherlands. We assessed the univariable association between risk indicators, including second-trimester CL in quartiles, and emergency Cesarean delivery using a logistic regression model. For multivariable analysis, we assessed whether adjustment for other risk indicators altered the associations found in univariable (unadjusted) analysis. Separate analyses were performed for suspected fetal distress and failure to progress in labor as indications for Cesarean section.


RESULTS
In total, 311 women with a twin pregnancy attempted vaginal delivery after 34 weeks' gestation. Emergency Cesarean delivery was performed in 111 (36%) women, of which 67 (60%) were performed owing to arrest of labor. There was no relationship between second-trimester CL and Cesarean delivery (adjusted odds ratio (aOR): 0.97 for CL 26(th) -50(th) percentiles; 0.71 for CL 51(st)  - 75(th) percentiles; and 0.92 for CL > 75(th) percentile, using CL ≤ 25(th) percentile as reference). In multivariable analysis, the only variables associated with emergency Cesarean delivery were maternal age (aOR, 1.07 (95% CI, 1.00-1.13)), body mass index (BMI) (aOR, 3.99 (95% CI, 1.07-14.9) for BMI 20-23 kg/m(2) ; 5.04 (95% CI, 1.34-19.03) for BMI 24-28 kg/m(2) ; and 3.1 (95% CI, 0.65-14.78) for BMI > 28 kg/m(2) ) and induction of labor (aOR, 1.92 (95% CI, 1.05-3.5)).


CONCLUSIONS
In nulliparous women with a twin pregnancy, second-trimester CL is not associated with risk of emergency Cesarean delivery.
Department of Obstetrics and Gynaecology, VU University Medical Centre Amsterdam, Amsterdam, The Netherlands.
L
L
van de Mheen
Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.|Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands.|Stanford Prevention Research Center, Stanford University, Stanford, CA, USA.
E
E
Schuit
Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands.
S M S
SM
Liem
Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands.
A C
AC
Lim
Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
D J
DJ
Bekedam
Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands.
S M T A
SM
Goossens
Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands.
M T M
MT
Franssen
Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, The Netherlands.
M M
MM
Porath
Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands.
M A
MA
Oudijk
Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands.
K W M
KW
Bloemenkamp
Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, The Netherlands.
J J
JJ
Duvekot
Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands.
M D
MD
Woiski
Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands.
I
I
de Graaf
Department of Obstetrics and Gynaecology, Zorggroep Twente, Almelo, The Netherlands.
J M
JM
Sikkema
Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
H C J
HC
Scheepers
Department of Obstetrics and Gynaecology, Isala Clinics Zwolle, Zwolle, The Netherlands.
J
J
van Eijk
Department of Obstetrics and Gynaecology, VU University Medical Centre Amsterdam, Amsterdam, The Netherlands.
C J M
CJ
de Groot
Stanford Prevention Research Center, Stanford University, Stanford, CA, USA.
M G
MG
van Pampus
The Robinson Institute, School of Reproductive Health and Paediatrics, University of Adelaide, Adelaide, Australia.
B W J
BW
Mol
D000328:Adult; D054791:Cervical Length Measurement / Q000379:methods* / Q000706:statistics & numerical data*; D002584:Cervix Uteri / Q000000981:diagnostic imaging*; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric; D009426:Netherlands / Q000453:epidemiology; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging*; D011262:Pregnancy Trimester, Second; D059285:Pregnancy, Twin; D016032:Randomized Controlled Trials as Topic; D012016:Reference Values; D012307:Risk Factors
Cesarean delivery; cervical-length measurement; twin pregnancy