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Re: cervical length in twins From: art fougner, md (evsono@pipeline.com) Thu Jan 29 19:24:08 2004 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Anna Meenan, MD: "Re: cervical length in twins" Previous message: David Priver, MD: "Re: cervical length in twins" In reply to: Charlie Chambers: "cervical length in twins" Next in thread: Anna Meenan, MD: "Re: cervical length in twins" Reply: Anna Meenan, MD: "Re: cervical length in twins" This timely article appears in the latest issue of Ultrasound in Obstetrics and Gynecology - Sonographic measurement of cervical length in twin pregnancies in threatened preterm labor I. Fuchs 1, E. Tsoi 1, W. Henrich 1, J. W. Dudenhausen 1, K. H. Nicolaides 2 * 1Virchow Clinic Charité, Berlin, Germany 2Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK email: K. H. Nicolaides (fmf@fetalmedicine.com) *Correspondence to K. H. Nicolaides, Harris Birthright Research Centre for Fetal Medicine, King's College Hospital Medical School, Denmark Hill, London SE5 8RX, UK Funded by: The Fetal Medicine Foundation Keywords cervical length • preterm labor • twin pregnancy • ultrasound Abstract Objective To determine whether sonographic measurement of cervical length in twin pregnancies presenting with threatened preterm labor helps distinguish between true and false labor. Methods In 87 women with twin pregnancies presenting with regular and painful uterine contractions at 24-36 (median, 30) weeks of gestation, cervical length was measured by transvaginal ultrasound. Women presenting in active labor, defined by the presence of cervical dilation of 3 cm or more, with ruptured membranes and those who underwent a prior or subsequent cervical cerclage, were excluded from the study. The clinical management was determined by the attending obstetrician without taking into account the cervical length. Primary outcome of the study was delivery within 7 days of presentation. Results Delivery within 7 days of presentation occurred in 19/87 (22%) pregnancies and this was inversely related to cervical length, decreasing from 80% (4/5) at 1-5 mm, to 46% (6/13) at 6-10 mm, 29% (4/14) at 11-15 mm, 21% (4/19) at 16-20 mm, 7% (1/15) at 21-25 mm and 0% (0/21) at >25 mm. Logistic regression analysis demonstrated that significant independent contribution in the prediction of delivery within 7 days was provided by cervical length (odds ratio (OR) = 0.78, 95% CI 0.68-0.89, P < 0.001) and use of tocolytics (OR = 0.13, 95% CI 0.02-0.76, P = 0.024), with no significant contribution from gestation at presentation, chorionicity, ethnic origin, maternal age, body mass index, parity, previous history of preterm delivery, cigarette smoking, contraction frequency, vaginal bleeding or the administration of antibiotics or steroids. Conclusion In women with twin pregnancies presenting with threatened preterm labor, sonographic measurement of cervical length helps distinguish between those who deliver within 7 days and those who do not. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd. art At Thu, 29 Jan 2004, Charlie Chambers wrote: > >Curious how others would manage this patient. 24 year old with twin >gestation at 28 weeks otherwise no risk factors including no preterm >deliveries. To date, pregnancy has been uneventful and diamniotic twins >remain concordant with good growth. Comes in for routine clinic visit. >She has absolutely no complaints. > >Question 1. >Would you do cervical length measurement routinely? > >Question 2. >If done, and measurement is 1-1.5 cm, and patient still denies >contractions, what would you do? > >Question 3. >You are in a small hospital that handles 36 weeks and greater, would >you transfer care immediately if upon digital exam, she is found to be >1 cm dilated? > >We were debating this topic and came up with a few hypotheticals. >Wanted to see what others would do. > >************************************************************************ >****** > >-- >************************************************************************ >Charlie Chambers >Hood River, OR USA >cchamber@alumni.rice.edu > >"All good things...come by grace, >and grace comes by art, >and art does not come easy." > >Norman Maclean >************************************************************************ >******* >************************************************************************ > -- art fougner, md ich bin ein New Yorker Next message: Anna Meenan, MD: "Re: cervical length in twins" Previous message: David Priver, MD: "Re: cervical length in twins" In reply to: Charlie Chambers: "cervical length in twins" Next in thread: Anna Meenan, MD: "Re: cervical length in twins" Reply: Anna Meenan, MD: "Re: cervical length in twins"

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