Prediction of spontaneous preterm delivery in asymptomatic twin pregnancies using cervical length and granulocyte elastase.

OBJECTIVE: The purpose of this study was to evaluate sonographic cervical length (CL) and granulocyte elastase (GE) in cervical secretion as predictors of preterm delivery in asymptomatic twin pregnancies.

MATERIALS AND METHODS: This study prospectively enrolled asymptomatic twin pregnancies with CL < 25 mm at 22-29 weeks of gestation. All women were hospitalized for preterm labor, and the cervical secretion was obtained for GE testing on admission. The results of CL measurement and GE testing were reviewed, and the relationship between each variables and preterm delivery prior to 34 weeks of gestation was assessed.

RESULTS: Overall, we included 54 women with twin pregnancies, of which 12 (22.2%) had preterm deliveries prior to 34 weeks of gestation. A CL of <20 mm was significantly associated with preterm delivery with an odds ratio of 4.88 (95% confidence limit, 1.15-20.73). GE was not an independent predictive marker for preterm delivery. We also performed a subgroup analysis on the combination of CL and GE for predicting preterm delivery. Among the patients with GE(-), CL < 20 mm markedly increased the risk of preterm delivery with an odds ratio of 10.89 (95% confidence limit, 1.40-77.10). CL was not associated with preterm delivery among those with GE(+). Those with negative GE and shorter CL demonstrated the shortest duration of pregnancy after admission.

CONCLUSION: The combination of sonographic CL and GE of cervical secretion is useful to predict the risk of preterm delivery in asymptomatic twin pregnancies.