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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, MD, FRCOG, Joachim W.

Ed. by Bancalari, Eduardo / Chappelle, Joseph / Chervenak, Frank A. / D'Addario , Vincenzo / Genc, Mehmet R. / Greenough, Anne / Grunebaum, Amos / Konje, Justin C. / Kurjak M.D., Asim / Romero, Roberto / Zalud, MD PhD, Ivica


IMPACT FACTOR 2018: 1.361
5-year IMPACT FACTOR: 1.578

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1619-3997
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Volume 46, Issue 7

Issues

Mid-pregnancy cervical length as a risk factor for cesarean section in women with twin pregnancies

Su Jin Sung
  • Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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/ Seung Mi Lee
  • Corresponding author
  • Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
  • Email
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/ Sohee Oh
  • Department of Biostatistics, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
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/ Joo Hee Choi
  • Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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/ Jee Yoon Park
  • Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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/ Byoung Jae Kim
  • Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
  • Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
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/ Joon Ho Lee
  • Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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/ Chan-Wook Park
  • Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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/ Joong Shin Park
  • Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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/ Jong Kwan Jun
  • Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Published Online: 2018-02-20 | DOI: https://doi.org/10.1515/jpm-2017-0302

Abstract

Objective:

It is well known that a short cervix at mid-pregnancy is a risk factor for spontaneous preterm birth in both singleton and twin gestations. Recent evidence also suggests that a long cervix at mid-pregnancy is a predictor of the risk of cesarean section (C/S) in singleton gestation. The purpose of this study was to determine whether a long cervix at mid-pregnancy was associated with an increased risk of C/S in women with twin pregnancies.

Methods:

We enrolled 746 women pregnant with twins whose cervical length was measured by trans-vaginal ultrasonography at a mean of 22 weeks of gestation and who delivered in our institution. Cases with a short cervix [cervical length (CL) <15 mm] were excluded. Cases were divided into four groups according to the quartile of CL.

Results:

The rate of C/S increased according to the quartile of CL (47% in the 1st quartile, 51% in the 2nd quartile, 56% in the 3rd quartile and 62% in the 4th quartile, P<0.005, χ2 for trend). CL was an independent risk factor for C/S even after adjustment for confounding variables. When confining analysis to women who delivered after a trial of labor (n=418), to nulliparous women (n=633) or to those who delivered at late preterm or full term (n=666), the rate of C/S also increased according to the quartile of CL, and the relationship between CL and the risk of C/S remained significant after adjustment in each group.

Conclusion:

In women pregnant with twins, long CL at mid-pregnancy was a risk factor for C/S.

Keywords: Cervical length; cesarean section; twin

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About the article

Corresponding author: Seung Mi Lee, MD, PhD, Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 110-744, Korea, Tel.: 82-2-2072-4857, Fax: 82-2-762-3599


Received: 2017-09-23

Accepted: 2018-01-18

Published Online: 2018-02-20

Published in Print: 2018-09-25


Author’s statement

Conflict of interest: Authors state no conflict of interest.

Material and methods: Informed consent: Informed consent has been obtained from all individuals included in this study.

Ethical approval: The research related to human subject use has complied with all the relevant national regulations, and institutional policies, and is in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional review board or equivalent committee.


Citation Information: Journal of Perinatal Medicine, Volume 46, Issue 7, Pages 780–785, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: https://doi.org/10.1515/jpm-2017-0302.

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