MONITORAGE ECHOGRAPHIQUE DE LA LONGUEUR DU COL UTERIN EN CAS DE GROSSESSE GEMELLAIRE.

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Published Dec 7, 2017
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Vol. 95 No. 3 (2017): Issue Mar 2017

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Kaouther Dimassi
Ines Bouriel
Amel Triki
Ali Mrabet
Mohamed Faouzi Gara

Abstract


Background: Preterm delivery is the major cause of adverse outcomes in twin pregnancy.  A shortened cervix at 20-24 weeks of amenorrhea is a good predictor of preterm birth in
asymptomatic patients. However, there are no recommendations for serial cervical length
measurements for these high risk pregnancies.
Objectives: To evaluate the benefits from monthly cervical length monitoring in asymptomatic
twin pregnancies.
Methods: This was a prospective study. We compared two groups of twin pregnancies (groupe 1: patients with a monthly and systematic transvaginal ultrasound measurement of the cervical length and groupe2 : patients without monitoring of cervical length) in terms of premature labor screening, mean gestational age at the diagnosis of preterm labor, time saved by tocolysis in case of preterm labor and  mean gestational age at delivery.
Results: Ninety nine twin pregnancies were included: 35 patients had a systematic, monthly
cervical length (group1) and 64 women had a traditional prenatal care without monitoring of
cervical length (group2). A significant relationship between a cervical length measured
between 22 and 24 weeks of amenorrhea inferior to 30 mm and preterm labor with a high
specificity (100%) and a high positive predictive value (100%). The sensitivity remains
average (45%).A significant benefit was demonstrated through this systematic ultrasound
measurement of cervical length for the screening of preterm labor (p=0.018), the time saved
by tocolysis (p=0.023), as well as the medium gestational age at birth (p=0.046).
Conclusion: Serial cervical length measurements seems to be a significant predictor of early
preterm birth in asymptomatic twin pregnancies.

Keywords:

Twin pregnancy, ultrasound monitoring, cervical length.

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References

  1. Assunção RA, Liao AW, BrizotMde L, Krebs VL, Zugaib M. Perinatal outcome of twin pregnancies delivered in a teaching hospital. Rev Assoc Med Bras. 2010;56(4):447-51.
  2. Martin JA, Hamilton BE, Sutton PD, et al. Births: final data for 2006. Natl vital Stat Rep. 2009;57:1-102.
  3. Goldenberg RL, Lams JD, Miodovnik M, et al. The preterm prediction study: risk factors in twin gestations. National institute of child health and human Development Maternal-Fetal Medicine Units Network. Am J Obstet Gynecol. 1996;175:1047-53.
  4. Guzman ER, Walters C, O Reilly-Green C, et al. Use of cervical ultrasonography in prediction of spontaneous preterm birth in twin gestations. Am J Obstet Gynecol. 2000;183:1103-7.
  5. Lams Jd, Goldenberg RL, Meis PJ, et al. The length of the cervix and the risk of spontaneous preterm delivery. N Engl J Med. 1996;334 :567-72.
  6. Yost NP, Bloom SL, Twickler DM, Levano KJ. Pitfalls in ultrasound cervical length measurements for predicting preterm birth. ObstetGynecol. 1999;93:510-6.
  7. Berghella V, Odibo AO, To MS, Rust OA, Althuisius SM. Cerclage for short cervix on ultrasonography : meta-analysis of trials using individual patient-level data. Obstet Gynecol. 2005;106:181-9.
  8. Christophe V, Guillaume B, Blondel B, et al. Twin pregnancies: guidelines for clinical practice from the French College of Gynaecologistes and Obstetricians (CNGOF). Eur J ObstetGynecolReprod Biol. 2011;156(1):12-7
  9. Simpson LL. Ultrasound in twins: dichorionic and monochorionic. SeminPerinatol. 2013;37(5):348-58.
  10. Conde-Agudelo A, Romero R, Hassan SS, Yeo L. Transvaginal sonographiccervicallength for the prediction of spontaneous preterm birth in twin pregnancies: a systematic review and meta-analysis. Am J ObstetGynecol.2010;203:128-32
  11. To MS, Skentou C, Souka A, Nicolaides KH. Cervical assessment at the routine 23-weeks scan: problems with transabdominal sonography. UltasoundObstet Gynecol. 2000;15:292-6.
  12. Andersen HF, Ansbacher R. Ultrasound: a new approach to the evaluation of cervical ripening. SeminPerinatol. 1991,15:140-8.
  13. Owen J, Neely C, Northen A. Transperineal versus endovaginalultrasonographic examination of the cervix in the midtrimester: a blinded comparison. Am J Obstet Gynecol. 1999,181:780-3.
  14. Gibson JL, Macara LM, Owen P, Young D, Macauley J, Mackenzie F. Prediction of preterm delivery in twin pregnancy: a prospective, observational study of cervical length and fetal fibronectin testing. UltrasoundObstet Gynecol. 2004,23:561-6.
  15. Crane JM, Hutchens D. Transvaginal sonographic measurement of cervical length to predict preterm birth in asymptomatic women at increased risk: a systematic review.Ultrasound Obstet Gynecol. 2008;31(5):579-87.
  16. To MS, Fonseca EB, Molina FS, Cacho AM, Nicolaides KH. Maternal characteristics and cervical length in the prediction of spontaneous preterm delivery in twins. Am J ObstetGynecol. 2006;194:1360-5.
  17. Vayssiere C, Favre R, Audibert F, et al. Cervical length and funneling at 22 and 27 weeks to predict spontaneous birth before 32 weeks in twin pregnancies: a French prospective multicenter study. Am J Obstet Gynecol. 2002;187:1596-604.
  18. Fox NS, RebarberA, Klauser CK, et al.Prediction of spontaneous preterm birth in asymptomatic twin pregnancies using the change in cervical length over time. Am J Obstet Gynecol. 2010;202(2):155.e1-4.