Abstract
Objective: To 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.
Design: Individual patient data (IPD) meta-analysis
Setting: International multicentre study
Population: Twin pregnancies
Methods: MEDLINE 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 measure: Predicted probabilities for preterm birth at ≤28+0, 28+1 to 32+0, and 32+1 to 36+0.
Results: A total of 6188 CL measurements were performed on 4409 twin pregnancies in twelve studies. Both GA at screening and CL had a significant and non-linear effect on GA at birth. The best prediction of birth ≤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).
Conclusion: In twin pregnancies, prediction of preterm birth depends on both CL and the GA at screening. Screening ≤18+0 weeks is most predictive for birth at ≤28+0 weeks.
Design: Individual patient data (IPD) meta-analysis
Setting: International multicentre study
Population: Twin pregnancies
Methods: MEDLINE 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 measure: Predicted probabilities for preterm birth at ≤28+0, 28+1 to 32+0, and 32+1 to 36+0.
Results: A total of 6188 CL measurements were performed on 4409 twin pregnancies in twelve studies. Both GA at screening and CL had a significant and non-linear effect on GA at birth. The best prediction of birth ≤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).
Conclusion: In twin pregnancies, prediction of preterm birth depends on both CL and the GA at screening. Screening ≤18+0 weeks is most predictive for birth at ≤28+0 weeks.
Original language | English |
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Number of pages | 8 |
Journal | British Journal of Obstetrics and Gynaecology |
DOIs | |
Publication status | E-pub ahead of print - 1 Sept 2015 |