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Obstetrics and Gynecology International
Volume 2013, Article ID 125897, 7 pages
Review Article

Cervical Length Measurement for the Prediction of Preterm Birth in Symptomatic Women with a Twin Pregnancy: A Systematic Review and Meta-Analysis

1Department of Obstetrics and Gynecology, Academic Medical Center, P.O. Box 22770, 1100 DE Amsterdam, The Netherlands
2Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, Amsterdam, The Netherlands
3Clinical Research Unit, Academic Medical Center, P.O. Box 22770, Amsterdam, The Netherlands

Received 6 November 2012; Accepted 1 April 2013

Academic Editor: Jyh Kae Nien

Copyright © 2013 S. M. S. Liem et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective. The aim of this study was to assess whether cervical length measurement (CL) could predict preterm birth (PTB) in symptomatic women with a twin pregnancy. Methods. We searched MEDLINE and EMBASE to identify studies investigating the accuracy of CL measurement in predicting PTB in symptomatic women with a twin pregnancy. We extracted data to construct two-by-two tables and used bivariate meta-analysis to generate point estimates of sensitivity and specificity. Results. Five studies ( ) were included. Variation in definition of PTB and cut-off points for CL was strong. One study investigated delivery within seven days, demonstrating a sensitivity of 1.0 (95% CI: 0.83–1.0) and a specificity of 0.31 (95% CI 0.2–0.43) for a CL cutoff at 25 mm. Three studies reported on predicting PTB < 37 weeks at a CL cutoff of 30 mm, with sROC point estimates of 0.76 (95% CI: 0.66 to 0.84) and 0.37 (95% CI: 0.21 to 0.56) for sensitivity and specificity, respectively. For preterm birth <34 weeks, no pooled estimates could be estimated since only 2 studies with large heterogeneity were identified. Conclusions. There is limited evidence on the accuracy of cervical length measurement testing the prediction of preterm birth in symptomatic women with a twin pregnancy, especially on the most important outcome, that is, delivery within 7 days.