The effect of gestational age and cervical length measurements in the prediction of spontaneous preterm birth in twin pregnancies: an individual patient level meta-analysis

Autors de IIS La Fe

• Vicente Serra Serra

  Autor

• Alfredo José Perales Marín

  Autor

Autors aliens a IIS La Fe

• Kindinger LM
• Poon LC
• Cacciatore S
• MacIntyre DA
• Fox NS
• Schuit E
• Mol BW
• Liem S
• Lim AC
• Hermans F
• Darzi A
• Bennett P
• Nicolaides KH
• Teoh TG

Grups d'Investigació

• Medicina Reproductiva

  

  Investigador Principal

  José Morales Roselló

Abstract

ObjectiveTo assess the effect of gestational age (GA) and cervical length (CL) measurements at transvaginal ultrasound (TVUS) in the prediction of preterm birth in twin pregnancy. DesignIndividual patient data (IPD) meta-analysis. SettingInternational multicentre study. PopulationAsymptomatic twin pregnancy. MethodsMEDLINE and EMBASE searches were performed and IPD obtained from authors of relevant studies. Multinomial logistic regression analysis determined probabilities for birth at 28(+0), 28(+1) to 32(+0), 32(+1) to 36(+0), and 36(+1)weeks as a function of GA at screening and CL measurements. Main outcome measuresPredicted probabilities for preterm birth at 28(+0), 28(+1) to 32(+0), and 32(+1) to 36(+0). ResultsA total of 6188 CL measurements were performed on 4409 twin pregnancies in 12 studies. Both GA at screening and CL had a significant and non-linear effect on GA at birth. The best prediction of birth at 28(+0)weeks was provided by screening at 18(+0)weeks (P<0.001), whereas the best prediction of birth between 28(+1) and 36(+0)weeks was provided by screening at 24(+0)weeks (P<0.001). Negative prediction value of 100% for birth at 28(+0)weeks is achieved at CL 65mm and 43mm at ultrasound GA at 18(+0)weeks and at 22(+1) to 24(+0)weeks, respectively. ConclusionIn twin pregnancies, prediction of preterm birth depends on both CL and the GA at screening. When CL is <30mm, screening at 18(+0)weeks is most predictive for birth at 28(+0)weeks. Later screening at >22(+0)weeks is most predictive of delivery at 28(+1) to 36(+0)weeks. In twins, we recommend CL screening in twins to commence from 18(+0)weeks. Tweetable abstractAn individual patient meta-analysis assessing gestation and CL in the prediction of preterm birth in twins. Tweetable abstract An individual patient meta-analysis assessing gestation and CL in the prediction of preterm birth in twins.

Keywords

• Cervical length; individual patient meta-analysis; prematurity; preterm birth; twin pregnancy