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Cervical Length as a Predictor of Latency to Labour in Twin Pregnancies Complicated by Preterm Pre-Labour Rupture of Membranes: A Retrospective Study

Published:April 13, 2020DOI:https://doi.org/10.1016/j.jogc.2020.03.018

      Abstract

      Objective

      Preterm pre-labour rupture of membranes (PPROM), one of the leading causes of preterm delivery, represents a serious economic and psychosocial health care burden. The unpredictability of the interval between PPROM and labour, also known as the latency period, can be unsettling for patients and clinicians alike. In singleton pregnancies, the literature supports the use of ultrasound-determined cervical length to estimate the latency period.

      Methods

      With this retrospective cohort study, we sought to determine whether a shorter cervical length (≤25 vs. >25 mm) is associated with a shorter latency period in twin pregnancies complicated by PPROM. At McMaster University Medical Centre, a tertiary care centre, we used the Better Outcomes Registry Network (BoRN) database to identify patient records that met our criteria for inclusion over a 5-year period.

      Results

      Forty-three records were included in our analysis. On average, shorter cervical length was statistically significantly associated with a 6-day shorter latency period (P = 0.035). Confounders were controlled for using ANCOVA statistical analysis. A moderate, positive correlation between cervical length and latency period was also identified (r = 0.4).

      Conclusion

      Understanding that a shorter cervical length is associated with a shorter latency period can assist clinicians in optimizing maternal counselling and patient care, including triaging transfers to tertiary care centres.

      Résumé

      Objectif

      La rupture prématurée des membranes avant terme (RPMAT), une des principales causes d'accouchement prématuré, représente un fardeau économique et psychosocial considérable en matière de soins de santé. L'imprévisibilité de l'intervalle entre la RPMAT et le travail, aussi appelé période de latence, peut s'avérer déstabilisante tant pour les patientes que pour les cliniciens. Pour les grossesses monofœtales, la littérature soutient le recours à la mesure échographique de la longueur du col pour estimer la période de latence.

      Méthodologie

      Dans le cadre de cette étude de cohorte rétrospective, nous avons cherché à déterminer si un col court (≤ 25 mm par rapport à > 25 mm) est lié à une période de latence plus courte qu'en cas de col long pour les grossesses gémellaires compliquées par une RPMAT. Au McMaster University Medical Centre, un centre de soins tertiaires, nous avons utilisé la base de données du Registre et réseau des bons résultats dès la naissance (BORN) pour repérer les dossiers de patientes répondant à nos critères d'inclusion sur une période de 5 ans.

      Résultats

      Nous avons retenu 43 dossiers pour notre analyse. Nous avons observé qu'en moyenne, un col court était lié de façon statistiquement significative à une période de latence 6 jours plus courte qu'en présence d'un col de plus de 25 mm (P = 0,035). Les facteurs de confusion ont été pris en compte pour l'utilisation de l'analyse statistique de la covariance. Une corrélation moyenne et positive entre la longueur du col et la période de latence a également été observée (r = 0,4).

      Conclusion

      Il peut être utile pour les cliniciens de savoir qu'un col court est lié à un raccourcissement de la période de latence afin d'optimiser l'accompagnement maternel et les soins prodigués aux patientes, y compris les transferts au triage vers des centres de soins tertiaires.

      Keywords

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