Transvaginal cervical length scans to prevent prematurity in twins: a randomized controlled trial.

Am J Obstet Gynecol

Department of Obstetrics and Gynecology, Wilford Hall Medical Center, Lackland Air Force Base, TX; Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Published: February 2016

Background: Twin pregnancies are associated with an increased risk of perinatal morbidity and mortality primarily due to spontaneous preterm deliveries. The mean gestational age for delivery is 35.3 weeks and twins account for 23% of preterm births <32 weeks. A number of strategies have been proposed to prevent preterm deliveries: tocolytics, bed rest, hospitalization, home uterine activity monitoring, cerclage, and most recently, progesterone. Unfortunately, none have proven effective. Recent metaanalyses and reviews suggest that transvaginal cervical length (TVCL) ultrasound in the second trimester is a powerful predictor of preterm birth among asymptomatic women. Indeed, TVCL has the highest positive and negative predictive values for determining the risk of spontaneous preterm delivery in twin pregnancies. It follows that TVCL assessment may allow identification of a subset of twin pregnancies that re better candidates for interventions intended to prevent prematurity.

Objective: We sought to determine whether use of TVCL prolongs gestation in twin pregnancies.

Study Design: This is a multicenter, randomized, controlled trial of 125 dichorionic or monochorionic/diamniotic twin pregnancies without prior preterm birth <28 weeks. The study group (n = 63) had TVCL and digital exams monthly from 16-28 weeks and were managed with a standard algorithm for activity restriction and cerclage. The control group (n = 62) had monthly digital cervical examinations but no routine TVCL ultrasound examinations. The primary outcome was gestational age at delivery. Secondary outcomes included percentage of deliveries <35 weeks, and maternal and neonatal outcomes.

Results: The mean gestational age at delivery was 35.7 weeks (95% confidence interval [CI], 35.2-36.2) among those managed with TVCL and 35.5 weeks (95% CI, 34.7-36.4) among the control patients. The Kaplan-Meier estimates of deliveries <38 weeks were not significantly different between groups. This was true whether we compared curves with a log-rank test (P = .67), Breslow test (P = .67), or Tarone-Ware test (P = .64). The percentage of deliveries <35 0/7 weeks did not differ: 27.4% for subjects managed with routine TVCL and 28.6% for control subjects (relative risk, 0.96; 95% CI, 0.60-1.54). Our study had an 80% power to detect a 12-day difference in the gestational age at delivery with 95% confidence.

Conclusion: The overall mean length of gestation and the percentage of women delivering <35 weeks did not differ between twin gestations managed with TVCL and digital exams monthly from 16-28 weeks with a standard algorithm for activity restriction and cerclage and controls who had monthly digital cervical examinations but no routine TVCL. Routine second-trimester transvaginal ultrasound assessment of cervical length is not associated with improved outcomes when incorporated into the standard management of otherwise low-risk twin pregnancies.

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajog.2015.08.065DOI Listing

Publication Analysis

Top Keywords

transvaginal cervical
4
cervical length
4
length scans
4
scans prevent
4
prevent prematurity
4
prematurity twins
4
twins randomized
4
randomized controlled
4
controlled trial
4
trial background
4

Similar Publications

Purpose: To assess the effects of bladder fullness and lower uterine contractions ultrasound on transabdominal and transvaginal cervical length measurements at the mid-trimester fetal anomaly scan (FAS).

Methods: Transabdominal and transvaginal cervical length measurements from 925 mid-trimester FAS examinations were retrospectively analysed. Images were assessed for lower uterine contraction and bladder fullness using a novel qualitative assessment.

View Article and Find Full Text PDF

This study aimed to evaluate our center's experience in diagnosing and managing placenta accreta spectrum (PAS) in a high-risk population, focusing on prenatal ultrasound features associated with PAS severity and maternal outcomes. We conducted a retrospective analysis of 102 high-risk patients with confirmed placenta previa who delivered at our center between 2018 and 2023. Patients underwent transabdominal and transvaginal ultrasound scans, assessing typical sonographic features.

View Article and Find Full Text PDF

The Application of the NOSES System to Treat Cheek Squamous Cell Carcinoma.

J Craniofac Surg

December 2024

State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial, School of Stomatology, The Fourth Military Medical University.

Purpose: Oral squamous cell carcinoma is one of the most common types of cancer in the head and neck. Squamous cell carcinoma of the buccal mucosa is an important part of it. The traditional surgical method leads to great injury and is accompanied by unacceptable scars.

View Article and Find Full Text PDF

Objective: To characterize the ultrasonographic findings in female inmates in a prison unit in the state of São Paulo, Brazil, and to analyze the associations between ultrasonographic findings and sociodemographic characteristics.

Materials And Methods: This was a retrospective cohort study that analyzed the ultrasonographic examinations performed in consecutive female inmates in a prison unit in the city of São Paulo, between 2015 and 2020. The following ultrasound examinations were performed: soft tissue, thyroid, cervical, breast, transvaginal, pelvic gynecology, total abdomen, upper abdomen, and kidney/urinary tract in B-mode, with color Doppler, or both.

View Article and Find Full Text PDF

Purpose: This study investigated the hypothesis of early dehiscence of hysterorrhaphy as the initial stage of post-cesarean uterine scar defects, examining the possible influence of barbed suture in this process.

Methods: This longitudinal, prospective, double-blind study included 54 pregnant women with no history of cesarean section, randomized into two suture groups: #0 polyglactin or #1 barbed PDS threads. Sutures were continuous, unlocked, involved the entire myometrium in a single layer, and included the endometrium.

View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!