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New Approach to Risk Assessment in Twins.
VAIL, COLO. -- A major emerging theme in the management of twin pregnancies is early identification of those likely to get into trouble while sparing others the aggravation and expense of intensive management, according to Dr. John C. Hobbins.
"In the next few years, there'll be a lot more light shed on the concept of empirically doing something for those at risk for preterm birth and [intrauterine growth retardation], leaving the others alone to have a singleton-type birth," Dr. Hobbins predicted at a conference on obstetrics and gynecology sponsored by the University of Colorado.
Ultrasound assessment of cervical length, the presence or absence of twin-to-twin discordance with regard to growth restriction, and evaluation of placental health each can help indicate a problematic twin pregnancy said Dr. Hobbins, professor of ob.gyn. and chief of obstetrics at the University of Colorado Health Sciences Center, Denver.
"It looks like your best bang for the buck in predicting preterm birth and trouble with [intrauterine growth retardation] is going to be doing an ultrasound exam between 20 and 24 weeks' gestation, although it may not be a bad idea to increase your surveillance by doing another one at about 30 weeks' gestation," he said.
The finding of a shortened cervix and/or cervical funneling on transvaginal ultrasound has had a checkered history as a predictor of preterm birth. Dr. Hobbins said that's because until just a few years ago studies typically employed overly broad definitions of what constitutes a shortened cervix.
The past couple of years have brought two clinical trials totalling nearly 10,000 singleton pregnancies in which a shortened cervix was defined as 1.5 cm or less in length before 24 weeks. In both studies, women found to have a shortened cervix had a one-in-two chance of spontaneous delivery before 32 weeks' gestation.
There is a widely held--and in Dr. Hobbins' view, misguided--perception that twin pregnancies are different and that a cervical length of 2.5 cm or less in this setting is associated with a high risk of preterm birth. This stance is based chiefly upon the outcome of a study of 215 twin pregnancies from King's College Medical School, London.
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Source: HighBeam Research, New Approach to Risk Assessment in Twins.