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To determine the utility of frequent cervical length measurement in the prediction of spontaneous preterm delivery at less than 32 weeks (PTD<32) in twin pregnancy.
Retrospective review of twin pregnancies managed at a tertiary care center between 2005-2009. Cervical length was measured by transvaginal sonography every two weeks from 18-32 week. Delivery outcomes were correlated with cervical length data.
154 twin pregnancies were studied; monoamniotic twins were excluded. 72 subjects were excluded from the analysis because they had indicated delivery <32 weeks. An average of 6 cervical length assessments were made in the remaining patients. PTD<32 occurred in 20 patients [24%]. A cervical length <2 cm at 24 weeks was associated with a likelihood ratio (LR) of PTD<32 of 10 [PPV 71%, NPV 86%]. Beyond 24 weeks, a cervical length of less than 2 cm was associated with a LR of PTD<32 of 3 [PPV 33%, NPV 90%]. There were no significant differences in these values between measurements made at 26-30 weeks.
A cervical length less than 2 cm at 24 weeks is highly predictive of PTD<32 in uncomplicated twin pregnancies. A cervical length greater than 2 cm at 24 weeks has a high negative predictive value for PTD<32 . Beyond 26 weeks, a cervical length of less than 2 cm is a common finding and the association with PTD<32 is not as robust.