Cervical length measurement at mid gestation to predict spontaneous preterm birth in asymptomatic triplet pregnancies

A Fichera, G Pagani, V Stagnati, S Cascella, S Faiola, C Gaini, M Lanna, L Pasquini, R Raffaelli, T Stampalija, A Tommasini, F Prefumo

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Abstract

OBJECTIVE: To assess the predictive value of cervical length (CL) measured at mid gestation for spontaneous preterm birth (PTB) in triplet pregnancies.

METHODS: Retrospective study on asymptomatic triplet pregnancies followed at five Italian tertiary referral centres, between 2002 and 2015. CL was measured transvaginally between 18-24 weeks of gestation. Pregnancies with a medically indicated PTB were excluded. Demographic and pregnancy characteristics of pregnancies complicated with PTB were analysed and the distributions of CL measurements in these patients were calculated. Logistic regression analysis was performed to assess the association between CL and PTB, adjusted for confounders. CL performance to predict PTB <28, <30 and <32 weeks of gestation was assessed.

RESULTS: A total of 120 pregnancies were included in the final analysis. Median CL was 35 mm (interquartile range [IQR] 29-40) measured at a median gestational age of 20+2(IQR 20+0-23+4) weeks. Overall, 23 (19.2%), 17 (14.2%) and 8 (6.7%) patients had a CL <25, <20 and <15 mm, respectively. Spontaneous PTB < 32 weeks occurred in 41 (34.2%) cases, <30 weeks in 23 (19.2%) and <28 weeks in 12 (10%) cases. A CL <15 mm was significantly more frequent in the group of patients delivered <28 and <30 weeks (p = 0.03 and p = 0.01), while a cervical length <20 mm was more common in triplet pregnancies delivered <32 weeks (p = 0.03). Logistic regression analysis was possible for PTB <32 weeks: after adjustment for confounders CL was not significantly associated with PTB (OR 0.97, CI 0.94 to 1.01). CL showed an area under the receiver operating characteristic curve of 0.41 (95% confidence interval [CI] 0.20 to 0.62), 0.41 (95% CI 0.26 to 0.56) and 0.42 (95% CI 0.31 to 0.54) for the prediction of PTB < 28, < 30 and < 32 weeks, respectively.

CONCLUSIONS: CL assessed at mid gestation is a poor predictor of PTB in asymptomatic triplet pregnancies.

Original languageEnglish
JournalUltrasound in Obstetrics and Gynecology
DOIs
Publication statusE-pub ahead of print - Mar 13 2017

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Cervical Length Measurement
Triplet Pregnancy
Premature Birth
Pregnancy
Confidence Intervals
Logistic Models
Regression Analysis
Tertiary Care Centers
ROC Curve
Gestational Age

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Cervical length measurement at mid gestation to predict spontaneous preterm birth in asymptomatic triplet pregnancies. / Fichera, A; Pagani, G; Stagnati, V; Cascella, S; Faiola, S; Gaini, C; Lanna, M; Pasquini, L; Raffaelli, R; Stampalija, T; Tommasini, A; Prefumo, F.

In: Ultrasound in Obstetrics and Gynecology, 13.03.2017.

Research output: Contribution to journalArticle

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title = "Cervical length measurement at mid gestation to predict spontaneous preterm birth in asymptomatic triplet pregnancies",
abstract = "OBJECTIVE: To assess the predictive value of cervical length (CL) measured at mid gestation for spontaneous preterm birth (PTB) in triplet pregnancies.METHODS: Retrospective study on asymptomatic triplet pregnancies followed at five Italian tertiary referral centres, between 2002 and 2015. CL was measured transvaginally between 18-24 weeks of gestation. Pregnancies with a medically indicated PTB were excluded. Demographic and pregnancy characteristics of pregnancies complicated with PTB were analysed and the distributions of CL measurements in these patients were calculated. Logistic regression analysis was performed to assess the association between CL and PTB, adjusted for confounders. CL performance to predict PTB <28, <30 and <32 weeks of gestation was assessed.RESULTS: A total of 120 pregnancies were included in the final analysis. Median CL was 35 mm (interquartile range [IQR] 29-40) measured at a median gestational age of 20+2(IQR 20+0-23+4) weeks. Overall, 23 (19.2{\%}), 17 (14.2{\%}) and 8 (6.7{\%}) patients had a CL <25, <20 and <15 mm, respectively. Spontaneous PTB < 32 weeks occurred in 41 (34.2{\%}) cases, <30 weeks in 23 (19.2{\%}) and <28 weeks in 12 (10{\%}) cases. A CL <15 mm was significantly more frequent in the group of patients delivered <28 and <30 weeks (p = 0.03 and p = 0.01), while a cervical length <20 mm was more common in triplet pregnancies delivered <32 weeks (p = 0.03). Logistic regression analysis was possible for PTB <32 weeks: after adjustment for confounders CL was not significantly associated with PTB (OR 0.97, CI 0.94 to 1.01). CL showed an area under the receiver operating characteristic curve of 0.41 (95{\%} confidence interval [CI] 0.20 to 0.62), 0.41 (95{\%} CI 0.26 to 0.56) and 0.42 (95{\%} CI 0.31 to 0.54) for the prediction of PTB < 28, < 30 and < 32 weeks, respectively.CONCLUSIONS: CL assessed at mid gestation is a poor predictor of PTB in asymptomatic triplet pregnancies.",
author = "A Fichera and G Pagani and V Stagnati and S Cascella and S Faiola and C Gaini and M Lanna and L Pasquini and R Raffaelli and T Stampalija and A Tommasini and F Prefumo",
note = "This article is protected by copyright. All rights reserved.",
year = "2017",
month = "3",
day = "13",
doi = "10.1002/uog.17464",
language = "English",
journal = "Ultrasound in Obstetrics and Gynecology",
issn = "0960-7692",
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TY - JOUR

T1 - Cervical length measurement at mid gestation to predict spontaneous preterm birth in asymptomatic triplet pregnancies

AU - Fichera, A

AU - Pagani, G

AU - Stagnati, V

AU - Cascella, S

AU - Faiola, S

AU - Gaini, C

AU - Lanna, M

AU - Pasquini, L

AU - Raffaelli, R

AU - Stampalija, T

AU - Tommasini, A

AU - Prefumo, F

N1 - This article is protected by copyright. All rights reserved.

PY - 2017/3/13

Y1 - 2017/3/13

N2 - OBJECTIVE: To assess the predictive value of cervical length (CL) measured at mid gestation for spontaneous preterm birth (PTB) in triplet pregnancies.METHODS: Retrospective study on asymptomatic triplet pregnancies followed at five Italian tertiary referral centres, between 2002 and 2015. CL was measured transvaginally between 18-24 weeks of gestation. Pregnancies with a medically indicated PTB were excluded. Demographic and pregnancy characteristics of pregnancies complicated with PTB were analysed and the distributions of CL measurements in these patients were calculated. Logistic regression analysis was performed to assess the association between CL and PTB, adjusted for confounders. CL performance to predict PTB <28, <30 and <32 weeks of gestation was assessed.RESULTS: A total of 120 pregnancies were included in the final analysis. Median CL was 35 mm (interquartile range [IQR] 29-40) measured at a median gestational age of 20+2(IQR 20+0-23+4) weeks. Overall, 23 (19.2%), 17 (14.2%) and 8 (6.7%) patients had a CL <25, <20 and <15 mm, respectively. Spontaneous PTB < 32 weeks occurred in 41 (34.2%) cases, <30 weeks in 23 (19.2%) and <28 weeks in 12 (10%) cases. A CL <15 mm was significantly more frequent in the group of patients delivered <28 and <30 weeks (p = 0.03 and p = 0.01), while a cervical length <20 mm was more common in triplet pregnancies delivered <32 weeks (p = 0.03). Logistic regression analysis was possible for PTB <32 weeks: after adjustment for confounders CL was not significantly associated with PTB (OR 0.97, CI 0.94 to 1.01). CL showed an area under the receiver operating characteristic curve of 0.41 (95% confidence interval [CI] 0.20 to 0.62), 0.41 (95% CI 0.26 to 0.56) and 0.42 (95% CI 0.31 to 0.54) for the prediction of PTB < 28, < 30 and < 32 weeks, respectively.CONCLUSIONS: CL assessed at mid gestation is a poor predictor of PTB in asymptomatic triplet pregnancies.

AB - OBJECTIVE: To assess the predictive value of cervical length (CL) measured at mid gestation for spontaneous preterm birth (PTB) in triplet pregnancies.METHODS: Retrospective study on asymptomatic triplet pregnancies followed at five Italian tertiary referral centres, between 2002 and 2015. CL was measured transvaginally between 18-24 weeks of gestation. Pregnancies with a medically indicated PTB were excluded. Demographic and pregnancy characteristics of pregnancies complicated with PTB were analysed and the distributions of CL measurements in these patients were calculated. Logistic regression analysis was performed to assess the association between CL and PTB, adjusted for confounders. CL performance to predict PTB <28, <30 and <32 weeks of gestation was assessed.RESULTS: A total of 120 pregnancies were included in the final analysis. Median CL was 35 mm (interquartile range [IQR] 29-40) measured at a median gestational age of 20+2(IQR 20+0-23+4) weeks. Overall, 23 (19.2%), 17 (14.2%) and 8 (6.7%) patients had a CL <25, <20 and <15 mm, respectively. Spontaneous PTB < 32 weeks occurred in 41 (34.2%) cases, <30 weeks in 23 (19.2%) and <28 weeks in 12 (10%) cases. A CL <15 mm was significantly more frequent in the group of patients delivered <28 and <30 weeks (p = 0.03 and p = 0.01), while a cervical length <20 mm was more common in triplet pregnancies delivered <32 weeks (p = 0.03). Logistic regression analysis was possible for PTB <32 weeks: after adjustment for confounders CL was not significantly associated with PTB (OR 0.97, CI 0.94 to 1.01). CL showed an area under the receiver operating characteristic curve of 0.41 (95% confidence interval [CI] 0.20 to 0.62), 0.41 (95% CI 0.26 to 0.56) and 0.42 (95% CI 0.31 to 0.54) for the prediction of PTB < 28, < 30 and < 32 weeks, respectively.CONCLUSIONS: CL assessed at mid gestation is a poor predictor of PTB in asymptomatic triplet pregnancies.

U2 - 10.1002/uog.17464

DO - 10.1002/uog.17464

M3 - Article

C2 - 28295801

JO - Ultrasound in Obstetrics and Gynecology

JF - Ultrasound in Obstetrics and Gynecology

SN - 0960-7692

ER -