Twin transvaginal cervical length at 16-20 weeks and prediction of preterm birth.

OBJECTIVE: Our objective was to determine if transvaginal cervical length at 16-20 weeks is predictive of preterm birth <34 weeks in a large cohort of twin pregnancies. STUDY DESIGN: This is a secondary analysis from a randomized trial of 17 alpha-hydroxyprogesterone caproate in twins to prevent preterm birth. Transvaginal cervical length was performed at 16-20-week gestation. The inclusion criteria were non-anomalous twins with transvaginal cervical length at 16-20 weeks. Receiver-operating characteristic (ROC) curves were generated to determine the transvaginal cervical length associated with preterm birth. RESULTS: Of 655 pregnancies, 27% (N = 178) women met our inclusion criteria. The rate of spontaneous preterm birth before 34 weeks was 16% (N = 29). A receiver operator characteristic curve was generated for all preterm birth <34 weeks (spontaneous and indicated) which demonstrated an area under the curve of 0.51, 95% CI (0.41-0.61). When indicated preterm birth (n = 15) were excluded, the area under the curve was 0.59 (95% CI 0.47-0.70), indicating that transvaginal cervical length values were not a clinically useful test for the prediction of spontaneous preterm birth. A transvaginal cervical length of 30 mm from this model would produce a sensitivity of detecting spontaneous preterm birth of 95% and a specificity of 14%. CONCLUSION: In an asymptomatic twin population, a single transvaginal cervical length between 16 and 20 weeks was not predictive of spontaneous preterm birth before 34 weeks. Thus, our findings suggest that routine transvaginal cervical length screening of twins should not be performed between 16-20 weeks.

Pfannenstiel versus Vertical Skin Incision for Cesarean Delivery in Women with Class III Obesity: A Randomized Trial.

OBJECTIVE: To compare Pfannenstiel versus vertical skin incision for the prevention of cesarean wound complications in morbidly obese women. STUDY DESIGN: Women with body mass index ≥ 40 kg/m2 undergoing cesarean delivery (CD) were randomly allocated to Pfannenstiel or vertical skin incision. The primary outcome was a wound complication within 6 weeks. Due to a low consent rate, we limited enrollment to a defined time period for feasibility. We conducted a traditional frequentist analysis with log-binomial regression to obtain relative risks (RRs), and a Bayesian analysis to estimate the probability of treatment benefit. A priori, we decided that a ≥60% probability of treatment benefit for either incision type would be convincing evidence to pursue a larger trial. RESULTS: A total of 648 women were approached, 228 were consented, and 91 were randomized. The primary outcome rate was 19% in the Pfannenstiel group and 21% in the vertical group (RR: 1.18; 95% confidence interval: 0.49-2.85). Bayesian analysis revealed a 59% probability that Pfannenstiel had a lower primary outcome rate. CONCLUSION: In the first published randomized trial to compare skin incision types for obese women undergoing CD, we were unable to demonstrate differences in clinical outcomes. Our trial suggests that a larger study would have a low probability for different findings. TRIAL REGISTRATION: NCT 01897376 (www.clinicaltrials.gov).

High risk human papillomavirus at entry to prenatal care and risk of preeclampsia.

OBJECTIVE: To determine the association between high-risk human papillomavirus (HR-HPV) and preeclampsia. METHODS: Retrospective cohort study of women with HR-HPV at entry to prenatal care compared with those with at least 2 normal pap smears. Preeclampsia was defined by clinical guidelines. Unadjusted and adjusted analyses were performed. RESULTS: Three hundred fourteen women with HR-HPV matched with 628 women with normal pap smears. Exposed HR-HPV patients were younger, had lower body mass index, systolic and diastolic blood pressure at entry to care, and more likely to be nulliparous and smokers. Exposed HR-HPV patients were more likely to develop preeclampsia (10.19% vs 4.94%; P = .004; adjusted odds ratio, 2.18; 95% confidence interval, 1.31-3.65). Women with HR-HPV were also more likely to deliver prematurely at less than 37 and less than 35 weeks. CONCLUSION: HR-HPV is associated with an almost 2-fold increased risk of developing preeclampsia. This warrants a larger study, particularly when HPV infection can be prevented with vaccination.