ResearchObstetricsTransvaginal sonographic cervical length for the prediction of spontaneous preterm birth in twin pregnancies: a systematic review and metaanalysis
Section snippets
Materials and Methods
This systematic review was conducted following a prospectively prepared protocol and reported using recently recommended guidelines for systematic reviews of diagnostic test accuracy.6
Results
The searches produced 1027 citations of which 314 were considered relevant (Figure 1). In all, 293 studies were excluded, the main reasons being the inclusion of only singleton pregnancies (37%), not a test accuracy study (27%), and the lack of original data (24%). A total of 21 studies, including 3523 women with twin pregnancies,18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38 met the inclusion criteria of which 15 (3001 women) provided data for metaanalyses.
Comment
This systematic review and metaanalysis gives the strongest evidence to date that transvaginal sonographic measurement of CL at 20-24 weeks of gestation is a good predictor of spontaneous preterm birth in asymptomatic women with twin pregnancies. A CL ≤20 mm predicts spontaneous preterm birth at <32 and <34 weeks of gestation, whereas a CL ≤25 mm predicts preterm birth at <28 weeks of gestation. A “normal” CL, however, was less accurate in predicting the absence of preterm birth because the
Acknowledgments
We are very grateful to Dr Percy Pacora for his assistance in obtaining the articles. We would like to thank Dr Nathan Fox for assistance in providing unpublished data from his study and for clarification of other queries.
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This research was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services.
Reprints not available from the authors.
Cite this article as: 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;203:128.e1-12.