1. Second-trimester cervical length as risk indicator for Cesarean delivery in women with twin pregnancy.
- Author
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van de Mheen L, Schuit E, Liem SM, Lim AC, Bekedam DJ, Goossens SM, Franssen MT, Porath MM, Oudijk MA, Bloemenkamp KW, Duvekot JJ, Woiski MD, de Graaf I, Sikkema JM, Scheepers HC, van Eijk J, de Groot CJ, van Pampus MG, and Mol BW
- Subjects
- Adult, Female, Humans, Infant, Newborn, Labor, Obstetric, Netherlands epidemiology, Predictive Value of Tests, Pregnancy, Pregnancy Trimester, Second, Randomized Controlled Trials as Topic, Reference Values, Risk Factors, Cervical Length Measurement methods, Cervical Length Measurement statistics & numerical data, Cervix Uteri diagnostic imaging, Cesarean Section statistics & numerical data, Pregnancy Complications diagnostic imaging, Pregnancy, Twin
- Abstract
Objective: To determine whether second-trimester cervical length (CL) in women with a twin pregnancy is associated with the risk of emergency Cesarean section., Methods: This was a secondary analysis of two randomized trials conducted in 57 hospitals in The Netherlands. We assessed the univariable association between risk indicators, including second-trimester CL in quartiles, and emergency Cesarean delivery using a logistic regression model. For multivariable analysis, we assessed whether adjustment for other risk indicators altered the associations found in univariable (unadjusted) analysis. Separate analyses were performed for suspected fetal distress and failure to progress in labor as indications for Cesarean section., Results: In total, 311 women with a twin pregnancy attempted vaginal delivery after 34 weeks' gestation. Emergency Cesarean delivery was performed in 111 (36%) women, of which 67 (60%) were performed owing to arrest of labor. There was no relationship between second-trimester CL and Cesarean delivery (adjusted odds ratio (aOR): 0.97 for CL 26(th) -50(th) percentiles; 0.71 for CL 51(st) - 75(th) percentiles; and 0.92 for CL > 75(th) percentile, using CL ≤ 25(th) percentile as reference). In multivariable analysis, the only variables associated with emergency Cesarean delivery were maternal age (aOR, 1.07 (95% CI, 1.00-1.13)), body mass index (BMI) (aOR, 3.99 (95% CI, 1.07-14.9) for BMI 20-23 kg/m(2) ; 5.04 (95% CI, 1.34-19.03) for BMI 24-28 kg/m(2) ; and 3.1 (95% CI, 0.65-14.78) for BMI > 28 kg/m(2) ) and induction of labor (aOR, 1.92 (95% CI, 1.05-3.5))., Conclusion: In nulliparous women with a twin pregnancy, second-trimester CL is not associated with risk of emergency Cesarean delivery., (Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.)
- Published
- 2015
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