Amer J Perinatol 2018; 35(07): 648-654
DOI: 10.1055/s-0037-1608877
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Uterocervical Angle Measurement Improves Prediction of Preterm Birth in Twin Gestation

Jordan C. Knight
1  Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
,
Emily Tenbrink
1  Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
,
Mitchell Onslow
1  Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
,
Avinash S. Patil
2  Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
3  Center for Personalized Obstetric Medicine, Valley Perinatal Services, Phoenix, Arizona
› Author Affiliations
Further Information

Publication History

06 August 2017

12 October 2017

Publication Date:
30 November 2017 (eFirst)

Abstract

Objective Twin pregnancies are associated with an increased risk of spontaneous preterm birth. Our objective was to compare the performance of uterocervical angle to cervical length as predictors of spontaneous preterm birth in this population.

Methods We conducted a retrospective cohort study of twin gestations at a single center from May 2008 to 2016 who received a transvaginal ultrasound for the evaluation of the cervix between 16 0/7 and 23 0/7 weeks. The primary outcome was prediction of preterm birth <28 and <32 weeks by uterocervical angle and cervical length.

Results Among 259 women with twin gestation, the mean gestational age at birth was 34.83 ± 3.48 weeks. Receiver operator characteristic curves demonstrated optimal prediction of spontaneous preterm birth prior to 32 weeks at a uterocervical angle >110° (80% sensitivity, 82% specificity) [odds ratio (OR), 15.7 (95% confidence interval (CI), 7.2–34.4)] versus cervical length <20 mm (53% sensitivity, 85% specificity; p < 0.001, OR, 6.4 [95% CI, 2.3–17.8]) and similarly, prior to 28 weeks at a uterocervical angle >114° (OR, 24.3 [95% CI, 6.7–88.5]) compared with cervical length <20 mm (OR, 11.4 [95% CI, 3.5–36.7]).

Conclusion Uterocervical angles >110° performed better than cervical length for the prediction of spontaneous preterm birth in twin gestations.