L van de Mheen1, E Schuit2,3,4, S M S Liem3, A C Lim3, D J Bekedam5, S M T A Goossens6, M T M Franssen7, M M Porath8, M A Oudijk9, K W M Bloemenkamp10, J J Duvekot11, M D Woiski12, I de Graaf3, J M Sikkema13, H C J Scheepers5, J van Eijk14, C J M de Groot1, M G van Pampus4, B W J Mol15. 1. Department of Obstetrics and Gynaecology, VU University Medical Centre Amsterdam, Amsterdam, The Netherlands. 2. Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands. 3. Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands. 4. Stanford Prevention Research Center, Stanford University, Stanford, CA, USA. 5. Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. 6. Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands. 7. Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands. 8. Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, The Netherlands. 9. Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands. 10. Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands. 11. Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, The Netherlands. 12. Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands. 13. Department of Obstetrics and Gynaecology, Zorggroep Twente, Almelo, The Netherlands. 14. Department of Obstetrics and Gynaecology, Isala Clinics Zwolle, Zwolle, The Netherlands. 15. The Robinson Institute, School of Reproductive Health and Paediatrics, University of Adelaide, Adelaide, Australia.
Abstract
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)). CONCLUSION: In nulliparous women with a twin pregnancy, second-trimester CL is not associated with risk of emergency Cesarean delivery.
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)). CONCLUSION: In nulliparous women with a twin pregnancy, second-trimester CL is not associated with risk of emergency Cesarean delivery.