Danielle Peress

Prediction of spontaneous preterm birth in asymptomatic twin pregnancies with the use of combined fetal fibronectin and cervical length.

OBJECTIVEnThe purpose of this study was to evaluate combined fetal fibronectin (fFN) test result and cervical length (CL) as predictors of spontaneous preterm birth in asymptomatic twin pregnancies.nnnSTUDY DESIGNnWe examined a retrospective cohort of 155 twin pregnancies with combined fFN and CL testing between 22 and 32 weeks gestation.nnnRESULTSnA positive fFN test result at 22-32 weeks or a CL <20 mm increased the risk of spontaneous preterm birth at <37, <34, <32, <30, and <28 weeks gestation. The combination of a positive fFN test result and CL<20 mm had a significantly higher positive predictive value for delivery at all gestational ages than either positive test alone. On adjusted analysis, a positive fFN test result was a stronger predictor of spontaneous preterm birth than a short CL.nnnCONCLUSIONnIn asymptomatic twin pregnancies, fFN and CL testing between 22 and 32 weeks gestation can identify pregnancies that are at significantly increased risk for preterm birth, including deliveries at <28 weeks gestation.

Weight gain in twin pregnancies and adverse outcomes: examining the 2009 Institute of Medicine guidelines.

OBJECTIVE: To estimate whether the weight gain recommendations for twin pregnancies in the 2009 Institute of Medicine (IOM) guidelines are associated with improved perinatal outcomes. METHODS: A cohort of 297 twin pregnancies was identified from a single practice with measured prepregnancy body mass index (BMI) and weight gain during pregnancy. Recommended IOM guidelines were applied to our cohort based on prepregnancy BMI categories (normal weight, overweight, obese). Pregnancy outcomes were compared between patients whose weight gain met or exceeded the IOM recommendations and patients who did not meet these recommendations. RESULTS: Patients with normal prepregnancy BMIs whose weight gain met the IOM recommendations had significantly improved outcomes compared with patients who did not meet the IOM recommendations. They were less likely to have preterm birth before 32 weeks (5.0% compared with 13.8%) and spontaneous preterm birth before 32 weeks (3.4% compared with 11.5%). They also delivered significantly larger neontates (larger twin birth weight 2,582.1±493.4 g compared with 2,370.3±586.0 g; smaller twin birth weight 2,277.0±512.1 g compared with 2,109.3±560.9 g) and were significantly more likely to have both neonates weigh more than 2,500 g (38.8% compared with 22.5%) and more than 1,000 g (97.5% compared with 91.2%) and were less likely to deliver any twin with a birth weight lower than the fifth percentile for gestational age (21.5% compared with 35.0%). CONCLUSION: In women with twin pregnancies and normal starting BMIs, weight gain during pregnancy is significantly associated with improved outcomes, including a decreased risk of prematurity and larger birth weights. LEVEL OF EVIDENCE: II

Prediction of spontaneous preterm birth in asymptomatic twin pregnancies using the change in cervical length over time.

OBJECTIVEnWe sought to evaluate the change in cervical length (CL) as a predictor of preterm birth in asymptomatic twin pregnancies.nnnSTUDY DESIGNnWe studied a historical cohort of 121 twin pregnancies with CL testing between 18-24 weeks who had a follow-up CL 2-6 weeks after the initial CL.nnnRESULTSnA total of 19 patients had their CL decrease by > or = 20% (shortened CL group) and 102 patients CL decreased by less, or not at all (stable CL group). The shortened CL group had a significantly higher rate of spontaneous preterm birth <28 weeks, <30 weeks, <32 weeks, and <34 weeks. This remained true even when excluding patients with a short CL (< or = 25 mm) on the repeated CL.nnnCONCLUSIONnIn twin pregnancies, a CL that decreases by 20% over 2 measurements is a significant predictor of very preterm birth, even in the setting of a normal CL. Serial CL measurements should be considered in twin pregnancies, starting <24 weeks.

Combined fetal fibronectin and cervical length and spontaneous preterm birth in asymptomatic triplet pregnancies

Objective: To estimate the association between fetal fibronectin (fFN), cervical length (CL), and spontaneous preterm birth (SPTB) in asymptomatic women with triplet pregnancies. Study design: A cohort of 39 consecutive women with triplet pregnancies managed in one Maternal-Fetal medicine practice from 2005–2011 was analyzed. Combined fFN and CL testing was performed every 2 weeks from 22–32 weeks. A short CL was defined as ≤20 mm. Results: A positive fFN was significantly associated with SPTB <28 weeks, <30 weeks, <32 weeks, and <34 weeks. A short CL was significantly associated with SPTB <32 weeks. On combined testing, having both tests positive was associated with the highest likelihood of SPTB at all gestational ages. As a screening test for SPTB <32 weeks, having both a positive fFN and a short CL had a sensitivity of 62.5%, specificity of 90%, positive predictive value of 62.5%, negative predictive value of 90%, positive likelihood ration of 2.98 and negative likelihood ratio of 0.88. Combined fFN and CL outperformed fFN alone, CL alone, or either test being positive alone. Conclusions: In asymptomatic women with triplet pregnancies, fFN and CL are each significantly associated with SPTB. For the prediction of SPTB, combined fFN and CL testing outperforms either test alone.

The prediction of recurrent preterm birth in patients on 17-alpha-hydroxyprogesterone caproate using serial fetal fibronectin and cervical length

OBJECTIVEnThe objective of the study was to estimate the predictive value of cervical length (CL) and fetal fibronectin (fFN) in patients being treated with 17-alpha-hydroxyprogesterone caproate (17P).nnnMETHODSnThis was a retrospective cohort of 176 patients with a prior spontaneous preterm birth being treated with weekly injections of 17P who underwent serial CL and fFN screening.nnnRESULTSnA short CL (≤25 mm) was significantly associated with an earlier gestational age at delivery and with recurrent preterm birth at less than 37, less than 35, less than 34, and less than 32 weeks. A positive fFN was not significantly associated with recurrent preterm birth. As a screening test for recurrent preterm birth, the positive and negative likelihood ratios for CL were 2.04 and 0.35, respectively, whereas for fFN they were 1.22 and 0.98, respectively, indicating that fFN did not offer any additional predictive value.nnnCONCLUSIONnIn patients being treated with 17P, cervical length at 22-32 weeks is predictive of recurrent preterm birth, but fetal fibronectin is not.

Maternal and neonatal outcomes in triplet gestations by trial of labor versus planned cesarean delivery

Abstract Objective: To determine the rate of vaginal delivery after vaginal trial of labor (TOL) among women with triplet gestations. Study design: This is a retrospective cohort study of all women delivering a viable triplet gestation between 2005 and 2016. The primary outcome was rate of vaginal delivery among all women attempting vaginal delivery. Secondary outcomes included factors associated with undergoing triplet TOL, and maternal and neonatal complications by planned delivery approach. Results: Of the 83 eligible women, 21 (25.3%) underwent TOL. A majority of these (57.1, 95% confidence interval 36.5–75.5%) achieved a vaginal delivery of all three triplets. Women who underwent TOL were more likely to be multiparous or to have spontaneous preterm labor. There were no differences in adverse maternal or neonatal outcomes by planned delivery approach. Conclusions: The rate of vaginal delivery among women with triplet gestations is higher in this institution than in reported literature, without increased morbidity.