Re: cervical length in twins
From: Anna Meenan, MD (annam@uic.edu)
Thu Jan 29 21:32:32 2004
This article concerns "women with twin pregnancies presenting with
threatened premature labor", which would not include Charlie's
asymptomatic patient.
--
Anna Meenan, MD
At Thu, 29 Jan 2004, art fougner, md wrote:
>
>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
>
