Abstract
Objective: Our aim was to determine the accuracy of cervical length and funneling of the internal
os in the prediction of the spontaneous very preterm birth of twin pregnancies. Study design: In a prospective study at 13 centers, routine transvaginal ultrasound scanning was
used to examine 251 women with twin pregnancies at 22 weeks of gestation and 215 women
at 27 weeks of gestation; cervical length, spontaneous cervical funneling, and funneling
after transfundal pressure were evaluated. Receiver operating characteristic curve
analysis was used to determine the best cervical length for the prediction of spontaneous
preterm birth before 32 and 35 weeks of gestation. We calculated the sensitivity,
specificity, and predictive values for cervical length and for funneling. Results: The median gestational age at delivery was 36 weeks in both populations. Of the population
that was included at 22 weeks of gestation, 5.2% (13 women) gave birth spontaneously
before 32 weeks of gestation, and 13.2% (33 women) gave birth spontaneously before
35 weeks of gestation; the median cervical length was 40 mm. The receiver operating
characteristic curve showed no clear best cutoff point for cervical length. For spontaneous
delivery before 32 and 35 weeks of gestation, the sensitivity of cervical length ≤30
mm was 46% and 27%, respectively; the specificity was 89% and 90%, respectively. The
sensitivity of funneling was 54% and 33%, and its specificity 89% and 91%, respectively.
After multivariate analysis, only funneling remained significant for delivery before
both 32 and 35 weeks of gestation. Of the population that was included at 27 weeks,
3.3% (7 women) gave birth spontaneously before 32 weeks of gestation, and 12.4% (26
women) gave birth spontaneously before 35 weeks of gestation; the median cervical
length was 35 mm. The receiver operating characteristic curve showed 25 mm to be the
best cutoff point for cervical length. For spontaneous delivery before 32 and 35 weeks
of gestation, the sensitivity of cervical length ≤25 mm was 100% and 54%, respectively,
and the specificity was 84% and 87%, respectively. The sensitivity of funneling was
86% and 54%, and the specificity 78% and 82%, respectively. After multivariate analysis,
both indicators remained significant for delivery before 35 weeks of gestation. Funneling
after transfundal pressure at 22 or 27 weeks did not predict very preterm delivery.
Conclusion: Cervical length and funneling both predict the very preterm birth of twins. Although
cervical length is the predictor of choice at 27 weeks of gestation, at 22 weeks of
gestation the diagnostic values of both parameters are close. (Am J Obstet Gynecol
2002;187:1596-1604.)
Keywords
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Article Info
Publication History
Accepted:
June 6,
2002
Received in revised form:
April 12,
2002
Received:
October 26,
2001
Footnotes
☆Reprint requests: Christophe Vayssière, MD, the Department of Obstetrics and Gynecology, Centre Medico-Chirurgical et Obstetrical (SIHCUS), Louis Pasteur University, 19 rue Louis Pasteur 67303 Schiltigheim. E-mail: [email protected]
Identification
Copyright
© 2002 Published by Elsevier Inc.
