Comparison of management options for twin pregnancies with cervical shortening
| Autor: | Joanne N. Quiñones, Albert P. Sarno, Emma Qureshey, Orion Rust, Meredith Rochon |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Obstetrics business.industry medicine.medical_treatment Infant Newborn Obstetrics and Gynecology Infant Cervix Uteri Cervical shortening Cervical Length Measurement Pregnancy Twin gestation Pediatrics Perinatology and Child Health medicine Pregnancy Twin Gestation Humans Premature Birth Cervical cerclage Female Prospective Studies business Expectant management Cerclage Cervical Retrospective Studies |
| Zdroj: | The journal of maternal-fetalneonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. 35(1) |
| ISSN: | 1476-4954 |
| Popis: | To compare the effectiveness of expectant management (EM), cervical cerclage (CC) and vaginal progesterone (VP) in decreasing the rate of spontaneous preterm birth in twin gestations with midtrimester cervical shortening.This is a retrospective cohort study comparing pregnancy outcomes of twin gestations with midtrimester cervical shortening, defined as a cervical length (CL) on routine transvaginal ultrasound between 15 weeks 0 days and 24 weeks 6 days gestation of2.5 cm, managed with either EM, CC or VP. Women were categorized by final management strategy. Primary outcome was gestational age at delivery. Secondary outcomes included latency period (defined as number of weeks between a diagnosis of cervical shortening and delivery), gestational age at delivery32 weeks, mode of delivery, perinatal death, neonatal birthweight and rate of chorioamnionitis. Subanalysis of women with a CL1.5 cm was also performed. Logistic regression was used to identify predictors of delivery32 weeks, controlling for potential confounders.Between January 2006 and July 2016, 64 pairs of twins with midtrimester cervical shortening were identified, 18 managed with EM (28.1%), 29 CC (45.3%), and 17 VP (26.6%), 52 of which had information regarding delivery outcomes. 90.4% of women delivered prematurely (37 weeks). Women in the CC group were diagnosed with cervical shortening at a significantly earlier mean gestational age (CC 20.6 ± 1.7 weeks versus EM 22.2 ± 2.9 weeks and VP 22.2 ± 2.0 weeks,Twin pregnancies with midtrimester cervical shortening are at high risk for preterm delivery, and outcomes were similar regardless of management strategy. Large prospective trials are needed to evaluate the effect of different management strategies for cervical shortening in twins. |
| Databáze: | OpenAIRE |
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