Use of cervical ultrasonography in prediction of spontaneous preterm birthin triplet gestations

OBJECTIVE: The aim of this study was to assess the role of cervical ultraso nography in the prediction of spontaneous preterm birth in triplet gestatio ns and to compare various ultrasonographic cervical parameters with respect to predictive ability. STUDY DESIGN: This prospective cohort study included 51 triplet gestations longitudinally evaluated between 15 and 28 weeks' gestation on 274 occasion s with transvaginal cervical ultrasonography and transfundal pressure. The cervical parameters obtained were funnel width and length, cervical length, percentage of funneling, and cervical index. RESULTS: Receiver operating characteristic curve analyses showed that cervi cal lengths of less than or equal to2.5 cm and less than or equal to2.0 cm between 15 and 24 weeks' gestation and between 25 and 28 weeks' gestation, respectively were at least as good as other ultrasonographic cervical param eters for the prediction of spontaneous preterm birth. A cervical length of less than or equal to2.5 cm between 15 and 20 weeks' gestation had both a specificity and a positive predictive value of 100% for delivery at <28 wee ks' gestation, and the sensitivities and negative predictive values ranged from 25% to 50% and from 72% to 91%, respectively for deliveries at <28, <3 0, and <32 weeks' gestation. A cervical length of less than or equal to2.5 cm between 21 and 24 weeks' gestation had an 86% sensitivity for prediction of spontaneous delivery at <28 weeks' gestation. A cervical length of <les s than or equal to>2.0 cm between 25 and 28 weeks' gestation had both a sen sitivity and a negative predictive value of 100% for delivery at both <28 a nd <30 weeks' gestation. CONCLUSIONS: In triplet gestations cervical lengths of less than or equal t o2.5 cm between 15 and 24 weeks' gestation and less than or equal to2.0 cm between 25 and 28 weeks' gestation were at least as good as other ultrasono graphic cervical parameters for the prediction of spontaneous preterm birth .