Abstract
Objective. The aim of this study was to assess whether cervical length measurement (CL) could predict preterm birth (PTB) in symptomatic women with a twin pregnancy. Methods. We searched MEDLINE and EMBASE to identify studies investigating the accuracy of CL measurement in predicting PTB in symptomatic women with a twin pregnancy. We extracted data to construct two-by-two tables and used bivariate meta-analysis to generate point estimates of sensitivity and specificity. Results. Five studies (N = 226) were included. Variation in definition of PTB and cut-off points for CL was strong. One study investigated delivery within seven days, demonstrating a sensitivity of 1.0 (95% CI: 0.83–1.0) and a specificity of 0.31 (95% CI 0.2–0.43) for a CL cutoff at 25 mm. Three studies reported on predicting PTB < 37 weeks at a CL cutoff of 30 mm, with sROC point estimates of 0.76 (95% CI: 0.66 to 0.84) and 0.37 (95% CI: 0.21 to 0.56) for sensitivity and specificity, respectively. For preterm birth <34 weeks, no pooled estimates could be estimated since only 2 studies with large heterogeneity were identified. Conclusions. There is limited evidence on the accuracy of cervical length measurement testing the prediction of preterm birth in symptomatic women with a twin pregnancy, especially on the most important outcome, that is, delivery within 7 days.
Highlights
Twin pregnancies are related to a significant higher rate of perinatal morbidity and mortality compared to singleton pregnancies [1, 2]
Obstetrics and Gynecology International truly deliver and those who will not. Correct identification of these women might be effective in reducing perinatal morbidity and mortality by providing needed interventions such as tocolysis, antenatal corticosteroid administration, and transfer to a tertiary care center in time
We only identified 5 studies with relative small sample sizes that could be included in this review on the predictive capacity of cervical length measurement for preterm birth in symptomatic women with a twin pregnancy
Summary
Twin pregnancies are related to a significant higher rate of perinatal morbidity and mortality compared to singleton pregnancies [1, 2]. Preterm birth is the major contributing factor to this problem. In The Netherlands, approximately 50% of women with a multiple pregnancy deliver before 37 weeks of gestation, of whom 9% even prior to 32 weeks [3]. In the United States, these rates are 60% and 12%, respectively. Among women with a singleton pregnancy, 6%–10% delivers before 37 weeks’ gestation and 1% prior to 32 weeks [3, 4]. Efforts in reducing the risk of preterm birth in twins have until now been unsuccessful
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