Factors associated with preterm labour and changes in the cervix before labour in twin pregnancy

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Abstract
A total of 132 twin pregnancies in black African women were studied prospectively after 30 wk gestation. Delivery occurred before 37 wk in 32%. There was a trend (0.1 > P > 0.05) towards a higher preterm delivery rate in nullipara (57%), in women under the age of 20 yr (60%) and in those with a height/weight ratio of > 2.5 (50%). The cervix was assessed with a score based on the length of the canal minus the dilatation of the internal os. In both term and preterm labor, there was a significant relation between a cervical score of 0 or a decrease in cervical score and the onset of labor within the subsequent 14 days (P < 0.001). By these criteria to predict impending labor, 60% of all labors that ensued within 14 days of the assessment were predicted with a 20% false-positive rate. When nulliparae were excluded, the predictive value of cervical assessment for preterm labor was 80% with a false-positive rate of < 5%. Plasma estriol levels were significantly higher in the preterm labor group but had no clinical prognostic value.

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