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Vaginal progesterone in women with twin gestations complicated by short cervix: a retrospective cohort study
Author(s) -
Brubaker SG,
Pessel C,
Zork N,
GyamfiBannerman C,
Ananth CV
Publication year - 2015
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.13188
Subject(s) - medicine , gestation , hazard ratio , obstetrics , propensity score matching , gynecology , confounding , retrospective cohort study , proportional hazards model , cohort study , pregnancy , population , confidence interval , genetics , biology , environmental health
Objective To determine whether the use of vaginal progesterone in twin gestations with a cervical length ( CL ) of ≤2.5 cm is associated with a reduced risk of preterm delivery. Design Retrospective cohort study. Setting Tertiary‐care medical centre in New York City. Population Women with twin gestations undergoing sonographic cervical length screening. Methods Women with twin gestations with a CL of ≤2.5 cm between 16 and 32 weeks of gestation, and who delivered at our centre between 2010 and 2013, were included. We evaluated the impact of vaginal progesterone on the risk of preterm delivery using a Cox proportional hazard model, adjusted for potential confounding factors. We then performed a propensity score analysis using inverse probability of treatment weights to account for treatment selection bias and confounding. Main outcome measure Delivery prior to 35 weeks of gestation. Results Of the 167 twin pregnancies analysed, 61 (35.7%) were treated with vaginal progesterone. The hazard ratio ( HR ) of delivery prior to 35 weeks of gestation in the vaginal progesterone group, compared with the no vaginal progesterone group, was 1.8 (95% confidence interval, 95% CI 1.5–3.1) in the unadjusted analysis, 1.4 (95% CI 0.7–3.2) following multivariable adjustment for confounding factors, and 1.5 (95% CI 1.1–2.3) using propensity score methods. Conclusion Women with more risk factors for preterm delivery were more likely to be treated with vaginal progesterone. After statistically correcting for this with propensity score methods, we found that vaginal progesterone therapy in twin pregnancies with a CL ≤2.5 cm was associated with an increased risk of preterm delivery.