Vol 88, No 11 (2017)
Review paper
Published online: 2017-11-30

open access

Page views 4193
Article views/downloads 3670
Get Citation

Connect on Social Media

Connect on Social Media

Short cervix in twin pregnancies: current state of knowledge and the proposed scheme of treatment

Hubert Huras1, Jarosław Kalinka2, Romuald Dębski3
Pubmed: 29303217
Ginekol Pol 2017;88(11):626-632.

Abstract

Short cervical length (SCL) should be defined as cervical length (CL) less than 25 mm between 18 and 22 weeks of gestation. This definition of SCL is fully applicable for singleton pregnancies but is not entirely correct for twin pregnancies. So far there are no explicit guidelines on the treatment of twin pregnancy with SCL. The use of progesterone in the treatment of SCL and preterm birth (PTB) prophylaxis is one of the interventions recommended by the Polish Ministry of Health for cervical shortening in singleton pregnancies. In twin pregnancies attention should be paid to the potential benefits of using vaginal progesterone in reduction of neonatal mortality and incidence of neonatal complications in a group of patients with twin pregnancies and CL less than 25 mm or below the 10th percentile for the gestational age, measured between 18 and 22 weeks of gestation. It is still difficult to identify the benefits of using pessaries in the prevention of PTB in twin pregnancies. The usage of pessaries appears to be beneficial only in selected subpopulations of patients with asymptomatic CL less than 25 mm or 10th percentile for gestational age. The use of cervical cerclage in PTB prevention in twin pregnancies is limited to cases where the external cervical dilation is >1 cm and <4 cm between 16 and 24 weeks of gestation. Considering the necessity for screening for asymptomatic shortening of the cervix twin pregnancies establishing a practice directions in case of positive screening result seems to be crucial.

Article available in PDF format

View PDF Download PDF file

References

  1. Norman JE. Preterm labour. Cervical function and prematurity. Best Pract Res Clin Obstet Gynaecol. 2007; 21(5): 791–806.
  2. Shennan A, Jones B. The cervix and prematurity: aetiology, prediction and prevention. Semin Fetal Neonatal Med. 2004; 9(6): 471–479.
  3. Vyas NA, Vink JS, Ghidini A, et al. Risk factors for cervical insufficiency after term delivery. Am J Obstet Gynecol. 2006; 195(3): 787–791.
  4. Iams JD, Johnson FF, Sonek J, et al. Cervical competence as a continuum: a study of ultrasonographic cervical length and obstetric performance. Am J Obstet Gynecol. 1995; 172(4 Pt 1): 1097–103; discussion 1104.
  5. ROZPORZĄDZENIE MINISTRA ZDROWIA z dnia 9 listopada 2015 r. w sprawie standardów postępowania medycznego przy udzielaniu świadczeń zdrowotnych w dziedzinie położnictwa i ginekologii z zakresu okołoporodowej opieki położniczo-ginekologicznej, sprawowanej nad kobietą w okresie ciąży, porodu, połogu, w przypadkach występowania określonych powikłań oraz opieki nad kobietą w sytuacji niepowodzeń położniczych.
  6. Iams J, Goldenberg R, Meis P, et al. The Length of the Cervix and the Risk of Spontaneous Premature Delivery. New England Journal of Medicine. 1996; 334(9): 567–573.
  7. Pun TC, Lee CP, Lao TT. The Preterm Prediction Study: Recurrence risk of spontaneous preterm birth. American Journal of Obstetrics and Gynecology. 1998; 178(5): 1104–1105.
  8. van der Ven J, van Os MA, Kazemier BM, et al. The capacity of mid-pregnancy cervical length to predict preterm birth in low-risk women: a national cohort study. Acta Obstet Gynecol Scand. 2015; 94(11): 1223–1234.
  9. Goldenberg R, Iams J, Miodovnik M, et al. The preterm prediction study: Risk factors in twin gestations. American Journal of Obstetrics and Gynecology. 1996; 175(4): 1047–1053.
  10. Conde-Agudelo A, Romero R, Hassan SS, et al. Transvaginal sonographic cervical length for the prediction of spontaneous preterm birth in twin pregnancies: a systematic review and metaanalysis. Am J Obstet Gynecol. 2010; 203(2): 128.e1–128.12.
  11. Melamed N, Pittini A, Hiersch L, et al. Do serial measurements of cervical length improve the prediction of preterm birth in asymptomatic women with twin gestations? Am J Obstet Gynecol. 2016; 215(5): 616.e1–616.e14.
  12. Vayssière C, Favre R, Audibert F, et al. Cervical length and funneling at 22 and 27 weeks to predict spontaneous birth before 32 weeks in twin pregnancies: a French prospective multicenter study. Am J Obstet Gynecol. 2002; 187(6): 1596–1604.
  13. Yoshimatsu K, Sekiya T, Ishihara K, et al. Detection of the cervical gland area in threatened preterm labor using transvaginal sonography in the assessment of cervical maturation and the outcome of pregnancy. Gynecol Obstet Invest. 2002; 53(3): 149–156.
  14. Romero, Roberto, "Vaginal progesterone in women with an asymptomatic sonographic short cervix in the mid-trimester decreases preterm delivery and neonatal morbidity: a systematic review and meta-analysis of individual patient data. " American journal of obstetrics and gynecology 206. 2012; 2: 124–e1.
  15. Schuit E, Stock S, Rode L, et al. Effectiveness of progestogens to improve perinatal outcome in twin pregnancies: an individual participant data meta-analysis. BJOG: An International Journal of Obstetrics & Gynaecology. 2014; 122(1): 27–37.
  16. Serra, V., "Increased doses of vaginal progesterone for the prevention of preterm birth in twin pregnancies: a randomised controlled double‐blind multi-centre trial. " BJOG: An International Journal of Obstetrics & Gynaecology 120. 2013; 1: 50–57.
  17. Liem S, Schuit E, Hegeman M, et al. Cervical pessaries for prevention of preterm birth in women with a multiple pregnancy (ProTWIN): a multicentre, open-label randomised controlled trial. The Lancet. 2013; 382(9901): 1341–1349.
  18. Goya M, Cabero L, Nicolaides KH, et al. Cervical pessary placement for prevention of preterm birth in unselected twin pregnancies: a randomized controlled trial. Am J Obstet Gynecol. 2016; 214(1): 3.e1–3.e9.
  19. Goya M, Calle Md, Pratcorona L, et al. Cervical pessary to prevent preterm birth in women with twin gestation and sonographic short cervix: a multicenter randomized controlled trial (PECEP-Twins). American Journal of Obstetrics and Gynecology. 2016; 214(2): 145–152.
  20. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No.142: Cerclage for the management of cervical insufficiency. Obstet Gynecol. 2014; 123(2 Pt 1): 372–379.
  21. Brown R, Gagnon R, Delisle MF, et al. MATERNAL FETAL MEDICINE COMMITTEE. Cervical insufficiency and cervical cerclage. J Obstet Gynaecol Can. 2013; 35(12): 1115–1127.
  22. Royal College of Obstetricians & Gynaecologists. "Cervical cerclage. Green–top Guideline No 60. 2015.
  23. Berghella, Vincenzo, "Cerclage for short cervix on ultrasonography: meta-analysis of trials using individual patient-level data. " Obstetrics & Gynecology 106. 2005; 1: 181–189.
  24. Roman A, Rochelson B, Martinelli P, et al. Cerclage in twin pregnancy with dilated cervix between 16 to 24 weeks of gestation: retrospective cohort study. Am J Obstet Gynecol. 2016; 215(1): 98.e1–98.e11.