Nir Melamed1, Alex Pittini2, Liran Hiersch3, Yariv Yogev3, Steven S Korzeniewski4, Roberto Romero5, Jon Barrett2. 1. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada. Electronic address: nir.melamed@sunnybrook.ca. 2. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada. 3. Department of Obstetrics and Gynecology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 4. Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI. 5. Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, and Detroit, MI; Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI.
Abstract
BACKGROUND: Women with a twin gestation are at increased risk for preterm birth (PTB), and sonographic cervical length (CL) is a powerful predictor for spontaneous PTB. Obstetricians frequently monitor CL in multiple gestations; yet, the optimal method to integrate and interpret the results of serial sonographic CL has not been determined. OBJECTIVE: We sought to determine whether there are different patterns of cervical shortening in twin gestations, and whether such patterns are related to the risk of PTB. STUDY DESIGN: We conducted a retrospective study of all women with twins followed up in a single tertiary referral center during 2012 through 2014. All women underwent serial measurements of CL every 2-3 weeks starting from 14-18 weeks and until 28-32 weeks of gestation. Changes in CL were analyzed and classified into distinct patterns that were initially identified by visual inspection of all individual cases. Each pattern was then characterized by several parameters including information about when cervical shortening began, the rate of shortening, and whether a plateau was observed. Locally weighted regression mean profiles were generated to describe each pattern of CL over time. The association of these patterns with spontaneous PTB was determined. The specific characteristics of each pattern that further determined the risk of PTB were identified using multivariable logistic regression analysis. RESULTS: We studied 441 women who had a total of 2826 measurements of CL done. Overall, 4 main patterns of change in CL were identified: pattern I, stable cervix (n = 196); pattern II, early and rapid shortening (n = 18); pattern III, late shortening (n = 109); and pattern IV, early shortening with a plateau (n = 118). The rate of PTB at <34 weeks was lowest in cases of pattern I (11.7%), followed by pattern IV (14.4%) and pattern III (20.2%), and was highest for women with pattern II (44.4%) (P < .001). In cases with pattern III (late shortening), the most important factors affecting the risk of PTB were the shortening rate, the gestational age at the onset of cervical shortening, and the initial plateau of CL. In the case of pattern IV (early shortening with a plateau), it was only the new plateau at which cervical shortening stopped that was associated with the risk of PTB. CONCLUSION: Changes in sonographic CL over time in twin gestations can be classified into 4 patterns, each associated with a different risk of PTB.
BACKGROUND:Women with a twin gestation are at increased risk for preterm birth (PTB), and sonographic cervical length (CL) is a powerful predictor for spontaneous PTB. Obstetricians frequently monitor CL in multiple gestations; yet, the optimal method to integrate and interpret the results of serial sonographic CL has not been determined. OBJECTIVE: We sought to determine whether there are different patterns of cervical shortening in twin gestations, and whether such patterns are related to the risk of PTB. STUDY DESIGN: We conducted a retrospective study of all women with twins followed up in a single tertiary referral center during 2012 through 2014. All women underwent serial measurements of CL every 2-3 weeks starting from 14-18 weeks and until 28-32 weeks of gestation. Changes in CL were analyzed and classified into distinct patterns that were initially identified by visual inspection of all individual cases. Each pattern was then characterized by several parameters including information about when cervical shortening began, the rate of shortening, and whether a plateau was observed. Locally weighted regression mean profiles were generated to describe each pattern of CL over time. The association of these patterns with spontaneous PTB was determined. The specific characteristics of each pattern that further determined the risk of PTB were identified using multivariable logistic regression analysis. RESULTS: We studied 441 women who had a total of 2826 measurements of CL done. Overall, 4 main patterns of change in CL were identified: pattern I, stable cervix (n = 196); pattern II, early and rapid shortening (n = 18); pattern III, late shortening (n = 109); and pattern IV, early shortening with a plateau (n = 118). The rate of PTB at <34 weeks was lowest in cases of pattern I (11.7%), followed by pattern IV (14.4%) and pattern III (20.2%), and was highest for women with pattern II (44.4%) (P < .001). In cases with pattern III (late shortening), the most important factors affecting the risk of PTB were the shortening rate, the gestational age at the onset of cervical shortening, and the initial plateau of CL. In the case of pattern IV (early shortening with a plateau), it was only the new plateau at which cervical shortening stopped that was associated with the risk of PTB. CONCLUSION: Changes in sonographic CL over time in twin gestations can be classified into 4 patterns, each associated with a different risk of PTB.
Authors: Carolina Hofmeister; Maria de Lourdes Brizot; Adolfo Liao; Rossana P V Francisco; Marcelo Zugaib Journal: J Perinat Med Date: 2010-09 Impact factor: 1.901
Authors: Meekai S To; Eduardo B Fonseca; Francisca S Molina; Ana M Cacho; Kypros H Nicolaides Journal: Am J Obstet Gynecol Date: 2006-04-21 Impact factor: 8.661
Authors: Nathan S Fox; Daniel H Saltzman; Chad K Klauser; Danielle Peress; Christina V Gutierrez; Andrei Rebarber Journal: Am J Obstet Gynecol Date: 2009-09 Impact factor: 8.661
Authors: S S Hassan; R Romero; S M Berry; K Dang; S C Blackwell; M C Treadwell; H M Wolfe Journal: Am J Obstet Gynecol Date: 2000-06 Impact factor: 8.661
Authors: Agustin Conde-Agudelo; Roberto Romero; Eduardo Da Fonseca; John M O'Brien; Elcin Cetingoz; George W Creasy; Sonia S Hassan; Offer Erez; Percy Pacora; Kypros H Nicolaides Journal: Am J Obstet Gynecol Date: 2018-04-07 Impact factor: 8.661
Authors: R Romero; A Conde-Agudelo; W El-Refaie; L Rode; M L Brizot; E Cetingoz; V Serra; E Da Fonseca; M S Abdelhafez; A Tabor; A Perales; S S Hassan; K H Nicolaides Journal: Ultrasound Obstet Gynecol Date: 2017-03 Impact factor: 7.299
Authors: Hope M Wolf; Roberto Romero; Jerome F Strauss; Sonia S Hassan; Shawn J Latendresse; Bradley T Webb; Adi L Tarca; Nardhy Gomez-Lopez; Chaur-Dong Hsu; Timothy P York Journal: BMJ Open Date: 2022-03-17 Impact factor: 2.692
Authors: Hassendrini N Peiris; Roberto Romero; Kanchan Vaswani; Sarah Reed; Nardhy Gomez-Lopez; Adi L Tarca; Dereje W Gudicha; Offer Erez; Eli Maymon; Murray D Mitchell Journal: J Matern Fetal Neonatal Med Date: 2019-12-29
Authors: Dereje W Gudicha; Roberto Romero; Doron Kabiri; Edgar Hernandez-Andrade; Percy Pacora; Offer Erez; Juan Pedro Kusanovic; Eunjung Jung; Carmen Paredes; Stanley M Berry; Lami Yeo; Sonia S Hassan; Chaur-Dong Hsu; Adi L Tarca Journal: Am J Obstet Gynecol Date: 2020-09-09 Impact factor: 8.661
Authors: Roberto Romero; Agustin Conde-Agudelo; Eduardo Da Fonseca; John M O'Brien; Elcin Cetingoz; George W Creasy; Sonia S Hassan; Kypros H Nicolaides Journal: Am J Obstet Gynecol Date: 2017-11-17 Impact factor: 8.661