The effect of gestational age and cervical length measurements in the prediction of spontaneous preterm birth in twin pregnancies: an individual patient level meta-analysis

L M Kindinger; L C Poon; S Cacciatore; D A MacIntyre; N S Fox; E Schuit; B W Mol; S Liem; A C Lim; V Serra; A Perales; F Hermans; A Darzi; P Bennett; K H Nicolaides; T G Teoh

doi:10.1111/1471-0528.13575

The effect of gestational age and cervical length measurements in the prediction of spontaneous preterm birth in twin pregnancies: an individual patient level meta-analysis

L M Kindinger, L C Poon, S Cacciatore, D A MacIntyre, N S Fox, E Schuit, B W Mol, S Liem, A C Lim, V Serra, A Perales, F Hermans, A Darzi, P Bennett, K H Nicolaides, T G Teoh

Julius Center, dept. Epidemiology & Health Economics

Research output: Contribution to journal › Article › Academic › peer-review

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: Asymptomatic twin pregnancy.

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 MEASURES: 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 12 studies. Both GA at screening and CL had a significant and non-linear effect on GA at birth. The best prediction of birth at ≤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). Negative prediction value of 100% for birth at ≤28(+0) weeks is achieved at CL 65 mm and 43 mm at ultrasound GA at ≤18(+0) weeks and at 22(+1) to 24(+0) weeks, respectively.

CONCLUSION: In twin pregnancies, prediction of preterm birth depends on both CL and the GA at screening. When CL is <30 mm, screening at ≤18(+0) weeks is most predictive for birth at ≤28(+0) weeks. Later screening at >22(+0) weeks is most predictive of delivery at 28(+1) to 36(+0) weeks. In twins, we recommend CL screening in twins to commence from ≤18(+0) weeks.

TWEETABLE ABSTRACT: An individual patient meta-analysis assessing gestation and CL in the prediction of preterm birth in twins.

Original language	English
Pages (from-to)	877-884
Number of pages	8
Journal	BJOG - An International Journal of Obstetrics and Gynaecology
Volume	123
Issue number	6
DOIs	https://doi.org/10.1111/1471-0528.13575
Publication status	Published - 2016

Keywords

Cervical Length Measurement
Cervix Uteri
Female
Gestational Age
Humans
Predictive Value of Tests
Pregnancy
Pregnancy, Twin
Premature Birth

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10.1111/1471-0528.13575

Cite this

Kindinger, L. M., Poon, L. C., Cacciatore, S., MacIntyre, D. A., Fox, N. S., Schuit, E., Mol, B. W., Liem, S., Lim, A. C., Serra, V., Perales, A., Hermans, F., Darzi, A., Bennett, P., Nicolaides, K. H., & Teoh, T. G. (2016). The effect of gestational age and cervical length measurements in the prediction of spontaneous preterm birth in twin pregnancies: an individual patient level meta-analysis. BJOG - An International Journal of Obstetrics and Gynaecology, 123(6), 877-884. https://doi.org/10.1111/1471-0528.13575

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title = "The effect of gestational age and cervical length measurements in the prediction of spontaneous preterm birth in twin pregnancies: an individual patient level meta-analysis",

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: Asymptomatic twin pregnancy.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 MEASURES: 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 12 studies. Both GA at screening and CL had a significant and non-linear effect on GA at birth. The best prediction of birth at ≤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). Negative prediction value of 100% for birth at ≤28(+0) weeks is achieved at CL 65 mm and 43 mm at ultrasound GA at ≤18(+0) weeks and at 22(+1) to 24(+0) weeks, respectively.CONCLUSION: In twin pregnancies, prediction of preterm birth depends on both CL and the GA at screening. When CL is <30 mm, screening at ≤18(+0) weeks is most predictive for birth at ≤28(+0) weeks. Later screening at >22(+0) weeks is most predictive of delivery at 28(+1) to 36(+0) weeks. In twins, we recommend CL screening in twins to commence from ≤18(+0) weeks.TWEETABLE ABSTRACT: An individual patient meta-analysis assessing gestation and CL in the prediction of preterm birth in twins.",

keywords = "Cervical Length Measurement, Cervix Uteri, Female, Gestational Age, Humans, Predictive Value of Tests, Pregnancy, Pregnancy, Twin, Premature Birth",

author = "Kindinger, {L M} and Poon, {L C} and S Cacciatore and MacIntyre, {D A} and Fox, {N S} and E Schuit and Mol, {B W} and S Liem and Lim, {A C} and V Serra and A Perales and F Hermans and A Darzi and P Bennett and Nicolaides, {K H} and Teoh, {T G}",

note = "{\textcopyright} 2015 Royal College of Obstetricians and Gynaecologists.",

year = "2016",

doi = "10.1111/1471-0528.13575",

language = "English",

volume = "123",

pages = "877--884",

journal = "BJOG - An International Journal of Obstetrics and Gynaecology",

issn = "1470-0328",

publisher = "Wiley-Blackwell",

number = "6",

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Kindinger, LM, Poon, LC, Cacciatore, S, MacIntyre, DA, Fox, NS, Schuit, E, Mol, BW, Liem, S, Lim, AC, Serra, V, Perales, A, Hermans, F, Darzi, A, Bennett, P, Nicolaides, KH & Teoh, TG 2016, 'The effect of gestational age and cervical length measurements in the prediction of spontaneous preterm birth in twin pregnancies: an individual patient level meta-analysis', BJOG - An International Journal of Obstetrics and Gynaecology, vol. 123, no. 6, pp. 877-884. https://doi.org/10.1111/1471-0528.13575

The effect of gestational age and cervical length measurements in the prediction of spontaneous preterm birth in twin pregnancies: an individual patient level meta-analysis. / Kindinger, L M; Poon, L C; Cacciatore, S et al.
In: BJOG - An International Journal of Obstetrics and Gynaecology, Vol. 123, No. 6, 2016, p. 877-884.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - The effect of gestational age and cervical length measurements in the prediction of spontaneous preterm birth in twin pregnancies

T2 - an individual patient level meta-analysis

AU - Kindinger, L M

AU - Poon, L C

AU - Cacciatore, S

AU - MacIntyre, D A

AU - Fox, N S

AU - Schuit, E

AU - Mol, B W

AU - Liem, S

AU - Lim, A C

AU - Serra, V

AU - Perales, A

AU - Hermans, F

AU - Darzi, A

AU - Bennett, P

AU - Nicolaides, K H

AU - Teoh, T G

PY - 2016

Y1 - 2016

N2 - 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: Asymptomatic twin pregnancy.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 MEASURES: 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 12 studies. Both GA at screening and CL had a significant and non-linear effect on GA at birth. The best prediction of birth at ≤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). Negative prediction value of 100% for birth at ≤28(+0) weeks is achieved at CL 65 mm and 43 mm at ultrasound GA at ≤18(+0) weeks and at 22(+1) to 24(+0) weeks, respectively.CONCLUSION: In twin pregnancies, prediction of preterm birth depends on both CL and the GA at screening. When CL is <30 mm, screening at ≤18(+0) weeks is most predictive for birth at ≤28(+0) weeks. Later screening at >22(+0) weeks is most predictive of delivery at 28(+1) to 36(+0) weeks. In twins, we recommend CL screening in twins to commence from ≤18(+0) weeks.TWEETABLE ABSTRACT: An individual patient meta-analysis assessing gestation and CL in the prediction of preterm birth in twins.

AB - 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: Asymptomatic twin pregnancy.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 MEASURES: 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 12 studies. Both GA at screening and CL had a significant and non-linear effect on GA at birth. The best prediction of birth at ≤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). Negative prediction value of 100% for birth at ≤28(+0) weeks is achieved at CL 65 mm and 43 mm at ultrasound GA at ≤18(+0) weeks and at 22(+1) to 24(+0) weeks, respectively.CONCLUSION: In twin pregnancies, prediction of preterm birth depends on both CL and the GA at screening. When CL is <30 mm, screening at ≤18(+0) weeks is most predictive for birth at ≤28(+0) weeks. Later screening at >22(+0) weeks is most predictive of delivery at 28(+1) to 36(+0) weeks. In twins, we recommend CL screening in twins to commence from ≤18(+0) weeks.TWEETABLE ABSTRACT: An individual patient meta-analysis assessing gestation and CL in the prediction of preterm birth in twins.

KW - Cervical Length Measurement

KW - Cervix Uteri

KW - Female

KW - Gestational Age

KW - Humans

KW - Predictive Value of Tests

KW - Pregnancy

KW - Pregnancy, Twin

KW - Premature Birth

U2 - 10.1111/1471-0528.13575

DO - 10.1111/1471-0528.13575

M3 - Article

C2 - 26333191

SN - 1470-0328

VL - 123

SP - 877

EP - 884

JO - BJOG - An International Journal of Obstetrics and Gynaecology

JF - BJOG - An International Journal of Obstetrics and Gynaecology

IS - 6

ER -

The effect of gestational age and cervical length measurements in the prediction of spontaneous preterm birth in twin pregnancies: an individual patient level meta-analysis

Abstract

Keywords

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