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Keywords:

  • cervical assessment;
  • multiple pregnancy;
  • preterm delivery;
  • screening;
  • twin pregnancy;
  • ultrasonography

Abstract

Objective

The aim of this study was to evaluate transvaginal sonographic assessment of cervical length at 23 weeks as a screening test for spontaneous preterm delivery in order to define a cut-off value that could be used to select twin pregnancies at low risk of spontaneous preterm delivery.

Methods

In a prospective multicenter study of 383 twin pregnancies included before 14 + 6 weeks a cervical scan with measurement of the cervical length was performed at 23 weeks' gestation. The results were blinded for the clinicians if the cervical length was ≥ 15 mm. The rates of spontaneous delivery at different cut-off levels of cervical length were determined.

Results

Eighty-nine percent of the twins had dichorionic placentation and 58% were conceived after assisted reproduction. The rate of spontaneous preterm delivery was 2.3% (1.5% for dichorionic (DC) and 9.1% for (MC) monochorionic twins) before 28 weeks and 18.5% (17.1% for DC and 29.5% for MC twins) before 35 weeks. The screen-positive rate was 5% for a cervical length ≤ 20, 7–8% at ≤ 25, 16–17% at ≤ 30 and 34–48% at ≤ 35 mm depending on chorionicity. The false-negative rate (1 − negative predictive value) ranged from 1.2% at 28 weeks to 18.6% at 35 weeks for all twins. Receiver–operating characteristics curves showed that the sensitivity increased with declining gestational age with cut-off levels of highest accuracy at 21 mm for 28 weeks and 29 mm for 33 weeks.

Conclusions

Cervical length measurement at 23 weeks of gestation is a good screening test for predicting twins at low risk of preterm and very preterm delivery, especially in DC twins. The present results suggest that a cut-off of 25 mm should be recommended. Copyright © 2005 ISUOG. Published by John Wiley & Sons, Ltd.