Second-trimester cervical length as risk indicator for Cesarean delivery in women with twin pregnancy

L. Van De Mheen, E. Schuit, S. M S Liem, A. C. Lim, D. J. Bekedam, S. M T A Goossens, M. T M Franssen, M. M. Porath, M. A. Oudijk, K. W M Bloemenkamp, J. J. Duvekot, M. D. Woiski, I. De Graaf, J. M. Sikkema, H. C J Scheepers, J. Van Eijk, C. J M De Groot, M. G. Van Pampus, B. W J Mol

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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 26th-50th percentiles; 0.71 for CL 51st-75th percentiles; and 0.92 for CL > 75th percentile, using CL ≤ 25th 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/m2; 5.04 (95% CI, 1.34-19.03) for BMI 24-28 kg/m2; and 3.1 (95% CI, 0.65-14.78) for BMI > 28 kg/m2) 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.

LanguageEnglish
Pages579-584
Number of pages6
JournalUltrasound in Obstetrics and Gynecology
Volume46
Issue number5
DOIs
Publication statusPublished - 1 Jan 2015

Keywords

  • Cesarean delivery
  • cervical-length measurement
  • twin pregnancy

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Reproductive Medicine
  • Radiology Nuclear Medicine and imaging
  • Obstetrics and Gynaecology

Cite this

Van De Mheen, L., Schuit, E., Liem, S. M. S., Lim, A. C., Bekedam, D. J., Goossens, S. M. T. A., ... Mol, B. W. J. (2015). Second-trimester cervical length as risk indicator for Cesarean delivery in women with twin pregnancy. Ultrasound in Obstetrics and Gynecology, 46(5), 579-584. https://doi.org/10.1002/uog.14727