Abstract
Objective: Observe and correlate the cervical length by ultrasound and likelihood of cervical incompetence and premature delivery in multiple gestations. Materials and Methods: Retrospective study in multiple pregnancy (twin, triplet, quadruplet) delivered between 2002-2003, in King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. A total of 68 multiple pregnancies underwent routine ultrasound for fetal assessment between 16 - 32 weeks when the cervix was observed. The sonographic measurements included cervix > 2.5 cm and - 20 weeks, 21 - 24 weeks, 25 - 26 weeks, 29 - 32 weeks and >32 weeks. The gestational age at delivery was our outcome parameter. The data was analyzed statistically using Fisher’s exact test and P-value below 0.05 was considered significant. Results: Endovaginal ultrasongoraphic cervical measurement in multiple pregnancies predicted increased preterm delivery risk regardless of maternal age, previous history of preterm deliveries or presence of vaginal infection. It was found that spontaneous preterm labor > 25 mm; this majority reached > 32 weeks while the patient who had cervix Conclusion: Cervical assessment during routine ultrasound in multiple gestations seems to be useful for prediction of preterm delivery and counseling the patient without risk factors regarding cervical cerclage. Because of restricted number of patients, we suggest further study with bigger sample and prospective trial for valued conclusions.
Highlights
Risk assessment for preterm delivery remains difficult, among women with no prior history of preterm birth
Cervical assessment during routine ultrasound in multiple gestations seems to be useful for prediction of preterm delivery and counseling the patient without risk factors regarding cervical cerclage
Because of restricted number of patients, we suggest further study with bigger sample and prospective trial for valued conclusions
Summary
Risk assessment for preterm delivery remains difficult, among women with no prior history of preterm birth. We hypothesized that accurate assessment of cervical length by endovaginal ultrasonography could predict preterm delivery risk in multiple pregnancy. Several study results suggest that transvaginal ultrasound considered in multiple pregnancies, because the upper portion of the cervix is not distinguished from the lower uterine segment in early pregnancy. These assessments should not begin before 16 to 20 weeks of gestation. The aim of the present study was to describe our experience for cervical length assessment by endovaginal sonography, predict spontaneous preterm birth before 32 weeks gestation in multiple pregnancy
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