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407: The predictive value of sonographic cervical length in triplet pregnancies
Poster Session II
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labor at term. Primiparous vs multiparous patients were compared. CL vs time to delivery was also analyzed. RESULTS: Seventy-seven patients met criteria for analysis; 48/77 (62%) patients were in true labor. The median (range) CL was 1.7cm (1.2-5.0cm). Area under the ROC curve showed a concordance of 0.8(P<0.0001) (Figure). CL cutoff of 1.5 cm to predict true labor produces specificity of 84%, positive predictive value (PPV) of 85%, disciminant ability of 77 and false positive rate (FPR) of 5% (Table), with no difference based on parity. CL was positively correlated with time to delivery. Preliminary results (30 cases) were previously reported. CONCLUSION: In differentiating true vs false labor at term, CL of 1.5cm is the most clinically optimal cutoff with the highest specificity, PPV and the lowest FPR. Its use to decide admission in patients at term may prevent unnecessary admissions, obstetrical interventions, resource utilization and cost.
conditions were excluded: gestational age at delivery <24 weeks, stillbirth of one or both fetuses, genetic or structural anomalies, or cervical cerclage. The predictive accuracy of CL was determined at 4 time periods along gestation: 18-20 (period 1), 21-24 (period 2), 2527 (period 3) and 28-32 weeks (period 4). RESULTS: 1) Overall 442 measurements of CL obtained from 86 women with triplets were analyzed. 2) The rate of CL shortening was faster in triplets compared with twins (Figure), as well as among triplets that delivered before 34, 32 or 30 weeks compared with those who did not (Figure). 3) The correlation between CL and GA at delivery was highest during periods 3 and 4 (r¼0.57-0.58) compared with periods 1 and 2 (r¼0.19 and 0.34, respectively). 4) CL at period 1 was not predictive of PTB. 5) CL at>¼ 25 weeks had the highest predictive value for PTB, with a PPV of 78-87% and NPV of 54-68%. CONCLUSION: Sonographic cervical length in triplet pregnancies is predictive of PTB only when performed after 20 weeks of gestation, and has the greatest predictive accuracy at >¼25 weeks.
Diagnostic accuracy of CL cutoffs in differentiating true vs false labor at term <1.5cm
<2cm
<2.5cm
<3cm
Sensitivity
62
82
89
96
Specificity
84
65
44
23
FPR
5
11
18
25
PPV
85
76
69
63
NPV
61
71
74
79
Discriminant ability
77
74
71
68
408 Systolic to diastolic time index in assessment of cardiac function in Twin Twin Transfusion Syndrome cardiomyopathy Lisa Howley1,2, Sonali S. Patel1,2, Michael Zaretsky1,2, Elizabeth Weisenborn1, Timothy Crombleholme1,2, Bettina Cuneo1,2, Henry L. Galan1,2 1
Children’s Hospital Colorado, Aurora, CO, 2University of Colorado, Aurora, CO
OBJECTIVE: To evaluate right (RV) and left ventricular (LV) function
407 The predictive value of sonographic cervical length in triplet pregnancies Nir Melamed1, Hadar Rosen1, Rania Okby1, Howie Freeman1, Ori Nevo1, Jon Barrett1 1
Sunnybrook Health Sciences Center, Toronto, ON, Canada
OBJECTIVE: While sonographic cervical length (CL) at mid-trimester
have been shown to predict preterm birth (PTB) in singleton the twin pregnancies, data regarding the predictive value of CL in triplets is limited. Our aim was to assess the predictive accuracy of CL in triplet pregnancies. STUDY DESIGN: Retrospective study of women with triplet and twin pregnancies followed in a tertiary referral center who underwent serial sonographic measurement of CL between 16-32 weeks. The change in CL along gestation in triplets was compared to that observed in twins. Pregnancies complicated by any of the following
in fetuses with Twin Twin Transfusion Syndrome (TTTS) cardiomyopathy using the systolic to diastolic time index (SDI) to determine if functional changes result from differences in myocardial relaxation or systolic performance. STUDY DESIGN: Echocardiograms from 72 donor twins and 78 recipient twins performed before and after selective fetoscopic laser therapy were retrospectively compared to echocardiograms of 66 age-matched normal controls (366 total echocardiograms). Spectral Doppler signals obtained from the RV and LV inflows were analyzed. The SDI was calculated as the ratio of the ejection time (ET) plus isovolumic contraction and relaxation times to the diastolic filling time (FT). RV and LV Tei indices were also calculated. Group differences were identified using Kruskal-Wallis testing. Spearman correlation coefficients were used to estimate the relationship between SDI and Tei indices. RESULTS: Prior to laser, both the RV and LV SDIs were significantly longer in recipients and shorter in donors when compared to controls (Table). Pre-laser differences in SDI were the result of changes
S224 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2016
ajog.org
labor at term. Primiparous vs multiparous patients were compared. CL vs time to delivery was also analyzed. RESULTS: Seventy-seven patients met criteria for analysis; 48/77 (62%) patients were in true labor. The median (range) CL was 1.7cm (1.2-5.0cm). Area under the ROC curve showed a concordance of 0.8(P<0.0001) (Figure). CL cutoff of 1.5 cm to predict true labor produces specificity of 84%, positive predictive value (PPV) of 85%, disciminant ability of 77 and false positive rate (FPR) of 5% (Table), with no difference based on parity. CL was positively correlated with time to delivery. Preliminary results (30 cases) were previously reported. CONCLUSION: In differentiating true vs false labor at term, CL of 1.5cm is the most clinically optimal cutoff with the highest specificity, PPV and the lowest FPR. Its use to decide admission in patients at term may prevent unnecessary admissions, obstetrical interventions, resource utilization and cost.
conditions were excluded: gestational age at delivery <24 weeks, stillbirth of one or both fetuses, genetic or structural anomalies, or cervical cerclage. The predictive accuracy of CL was determined at 4 time periods along gestation: 18-20 (period 1), 21-24 (period 2), 2527 (period 3) and 28-32 weeks (period 4). RESULTS: 1) Overall 442 measurements of CL obtained from 86 women with triplets were analyzed. 2) The rate of CL shortening was faster in triplets compared with twins (Figure), as well as among triplets that delivered before 34, 32 or 30 weeks compared with those who did not (Figure). 3) The correlation between CL and GA at delivery was highest during periods 3 and 4 (r¼0.57-0.58) compared with periods 1 and 2 (r¼0.19 and 0.34, respectively). 4) CL at period 1 was not predictive of PTB. 5) CL at>¼ 25 weeks had the highest predictive value for PTB, with a PPV of 78-87% and NPV of 54-68%. CONCLUSION: Sonographic cervical length in triplet pregnancies is predictive of PTB only when performed after 20 weeks of gestation, and has the greatest predictive accuracy at >¼25 weeks.
Diagnostic accuracy of CL cutoffs in differentiating true vs false labor at term <1.5cm
<2cm
<2.5cm
<3cm
Sensitivity
62
82
89
96
Specificity
84
65
44
23
FPR
5
11
18
25
PPV
85
76
69
63
NPV
61
71
74
79
Discriminant ability
77
74
71
68
408 Systolic to diastolic time index in assessment of cardiac function in Twin Twin Transfusion Syndrome cardiomyopathy Lisa Howley1,2, Sonali S. Patel1,2, Michael Zaretsky1,2, Elizabeth Weisenborn1, Timothy Crombleholme1,2, Bettina Cuneo1,2, Henry L. Galan1,2 1
Children’s Hospital Colorado, Aurora, CO, 2University of Colorado, Aurora, CO
OBJECTIVE: To evaluate right (RV) and left ventricular (LV) function
407 The predictive value of sonographic cervical length in triplet pregnancies Nir Melamed1, Hadar Rosen1, Rania Okby1, Howie Freeman1, Ori Nevo1, Jon Barrett1 1
Sunnybrook Health Sciences Center, Toronto, ON, Canada
OBJECTIVE: While sonographic cervical length (CL) at mid-trimester
have been shown to predict preterm birth (PTB) in singleton the twin pregnancies, data regarding the predictive value of CL in triplets is limited. Our aim was to assess the predictive accuracy of CL in triplet pregnancies. STUDY DESIGN: Retrospective study of women with triplet and twin pregnancies followed in a tertiary referral center who underwent serial sonographic measurement of CL between 16-32 weeks. The change in CL along gestation in triplets was compared to that observed in twins. Pregnancies complicated by any of the following
in fetuses with Twin Twin Transfusion Syndrome (TTTS) cardiomyopathy using the systolic to diastolic time index (SDI) to determine if functional changes result from differences in myocardial relaxation or systolic performance. STUDY DESIGN: Echocardiograms from 72 donor twins and 78 recipient twins performed before and after selective fetoscopic laser therapy were retrospectively compared to echocardiograms of 66 age-matched normal controls (366 total echocardiograms). Spectral Doppler signals obtained from the RV and LV inflows were analyzed. The SDI was calculated as the ratio of the ejection time (ET) plus isovolumic contraction and relaxation times to the diastolic filling time (FT). RV and LV Tei indices were also calculated. Group differences were identified using Kruskal-Wallis testing. Spearman correlation coefficients were used to estimate the relationship between SDI and Tei indices. RESULTS: Prior to laser, both the RV and LV SDIs were significantly longer in recipients and shorter in donors when compared to controls (Table). Pre-laser differences in SDI were the result of changes
S224 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2016