Transvaginal sonographic cervical length for the prediction of spontaneous preterm birth in twin pregnancies: a systematic review and metaanalysis

Am J Obstet Gynecol. 2010 Aug;203(2):128.e1-12. doi: 10.1016/j.ajog.2010.02.064. Epub 2010 Jun 23.


Objective: To assess the accuracy of transvaginal sonographic cervical length (CL) in predicting spontaneous preterm birth in women with twin pregnancies.

Study design: Systematic review and metaanalysis of predictive test accuracy.

Results: Twenty-one studies (16 in asymptomatic women and 5 in symptomatic women) with a total of 3523 women met the inclusion criteria. Among asymptomatic women, a CL <or=20 mm at 20-24 weeks' gestation was the most accurate in predicting preterm birth <32 and <34 weeks' gestation (pooled sensitivities, specificities, and positive and negative likelihood ratios of 39% and 29%, 96% and 97%, 10.1 and 9.0, and 0.64 and 0.74, respectively). A CL <or=25 mm at 20-24 weeks' gestation had a pooled positive likelihood ratio of 9.6 to predict preterm birth <28 weeks' gestation. The predictive accuracy of CL for preterm birth was low in symptomatic women.

Conclusion: Transvaginal sonographic CL at 20-24 weeks' gestation is a good predictor of spontaneous preterm birth in asymptomatic women with twin pregnancies.

Publication types

  • Meta-Analysis
  • Research Support, N.I.H., Intramural
  • Review
  • Systematic Review

MeSH terms

  • Cervix Uteri / anatomy & histology
  • Cervix Uteri / diagnostic imaging*
  • Female
  • Gestational Age
  • Humans
  • Incidence
  • Infant, Newborn
  • Predictive Value of Tests
  • Pregnancy
  • Pregnancy Outcome
  • Pregnancy, Multiple*
  • Premature Birth / diagnostic imaging*
  • Premature Birth / epidemiology
  • Risk Assessment
  • Twins
  • Ultrasonography, Prenatal*