Abstract
Objective: Observe and correlate the funneling of upper cervical canal by ultrasound and likelihood of cervical incompetence and premature delivery in twin pregnancy. Materials and methods: Retrospective study in twin pregnancies deliveries in 1997, in king Faisal specialist hospital and research center, Riyadh, Saudi Arabia. A total of 67 twin pregnancies underwent routine ultrasound for fetal assessment, when the cervix closed, long; and short, funneling. The time of ultrasound was divided in three groups by gestational age: from 18 to 22 weeks; from 22 to 26 weeks and from 26 to 30 weeks. The gestational age at delivery was our outcome parameter and subdivided the patients in 4 groups, group 1: patients delivered before 24 weeks (n = 4); group 2: delivered between 24 and 34 weeks (n = 16); group 3: delivered between 34 weeks and 36 weeks and 6 days (n = 18); and group 4: delivered with gestational age equal or above 37 weeks (n = 29). The data was analyzed statistically using Pearson chi square method and p value below 0.05 was considered significant. Results: There was no significant difference among the 4 subgroups in maternal age, body mass index, parity, previous history of preterm delivery or presence of urinary/vaginal infection in actual pregnancy. There was stronger history of mid trimester abortion in patients delivered before 34 weeks of gestational age. Considering the cervical sonographic findings, the diagnosis of funneling between 18 - 22 weeks was higher among the group delivered before 34 weeks of gestational age (1 and 2) comparing to other groups (3 and 4) with p value equal to 0.016. The finding in ultrasound justifies the results of higher aggressive management in patients from groups 1 and 2 comparing with groups 3 and 4; admission to hospital (p = 0.007); emergency cerclage (p = 0.04), complete hospital bed rest (p = 0.002). Conclusion: Cervical assessment during routine ultrasound in twins pregnancy 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, especially group 1 (11 = 4), we suggest further study with bigger sample and prospective trial for valued conclusion.
Highlights
1% of all pregnancies have two fetuses and approximately 2% of all newborns are twins [1]-[6]
There was no significant difference among the 4 subgroups in maternal age, body mass index, parity, previous history of preterm delivery or presence of urinary/vaginal infection in actual pregnancy
To evaluate the role of the ultrasonographic diagnosis of cervical incompetence further, we suggest that the method should be subjected to a randomized trial in pregnant women with presence of cervical funneling in twin pregnancy without cerclage comparing to selective cervical suture insertion
Summary
1% of all pregnancies have two fetuses and approximately 2% of all newborns are twins [1]-[6] These 2% of all births account for approximately 12% of all preterm births and an even higher proportion (15%) of neonatal mortality [2]. Account for a disproportionate share of preterm births and neonatal morbidity and mortality [1] [2]. Twins are such a powerful risk factor for preterm birth that it is not clear if the usual risk factor for preterm birth such as black race, maternal thinness, prior preterm birth, various types of pelvic infection, and various demographic characteristics such as age, marital status, and educational level, is important risk factors in the face of a twin pregnancy. We have observed that funneling of the upper cervical canal is associated with an increased likelihood of cervical incompetence whereas shortening of the cervical canal without funneling is not specific for incompetent cervix [5]
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