TITLE:
Sonography Cervical Assessment in Twin Pregnancy Correlation with Gestational Age at Delivery
AUTHORS:
Mahrous Areej, Wesam Kurdi, Mylene Martins Lavado
KEYWORDS:
Cervix, Twin Pregnancy, Ultrasonography, Cervical Assessment, Delivery
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.12 No.2,
February
24,
2022
ABSTRACT: Objective: Observe and correlate the funneling of upper
cervical canal by ultrasound and likelihood of cervical incompetence and
premature delivery in twin pregnancy. Materials and methods: Retrospective
study in twin pregnancies deliveries in 1997, in king Faisal specialist
hospital and research center, Riyadh, Saudi Arabia. A total of 67 twin
pregnancies underwent routine ultrasound for fetal assessment, when the cervix
closed, long; and short, funneling. The time of ultrasound was divided in three
groups by gestational age: from 18 to 22 weeks; from 22 to 26 weeks and from 26
to 30 weeks. The gestational age at delivery was our outcome parameter and
subdivided the patients in 4 groups, group 1: patients delivered before 24
weeks (n = 4); group 2: delivered between 24 and 34 weeks (n = 16); group 3:
delivered between 34 weeks and 36 weeks and 6 days (n = 18); and group 4:
delivered with gestational age equal or above 37 weeks (n = 29). The data was
analyzed statistically using Pearson chi square method and p value below 0.05
was considered significant. Results: There was no significant difference
among the 4 subgroups in maternal age, body mass index, parity, previous
history of preterm delivery or presence of urinary/vaginal infection in actual
pregnancy. There was stronger history of mid trimester abortion in patients
delivered before 34 weeks of gestational
age. Considering the cervical sonographic findings, the diagnosis of
funneling between 18 - 22 weeks was higher among the group delivered before 34 weeks of
gestational age (1 and 2) comparing to other groups (3 and 4) with p value
equal to 0.016. The finding in ultrasound justifies the results of higher
aggressive management in patients from groups 1 and 2 comparing with groups 3
and 4; admission to hospital (p = 0.007); emergency cerclage (p = 0.04),
complete hospital bed rest (p = 0.002). Conclusion: Cervical
assessment during routine ultrasound in twins pregnancy seems to be useful for
prediction of preterm delivery and counseling the patient without risk factors
regarding cervical cerclage. Because of restricted number of patients,
especially group 1 (11 = 4), we suggest further study with bigger sample and
prospective trial for valued conclusion.