Document Type

Capstone Experience

Graduation Date

5-2018

Degree Name

Master of Public Health

Department

Health Promotion

First Committee Member

Martha Goedert

Second Committee Member

Joshua Dahlke

Third Committee Member

Carl Smith

Fourth Committee Member

Tiffany Moore

Abstract

Strategies to prevent preterm birth in multifetal gestation remain a high-priority in the United States. In women with a history of spontaneous preterm birth (sPTB) and singleton gestation, transvaginal cervical length (TVCL) surveillance and subsequent treatment is associated with a reduction in spontaneous preterm birth, however, there is limited data on the role of TVCL surveillance in twin gestation. The goal of this study is to determine if an association exists between TVCL and spontaneous preterm birth in twin gestations. Additionally, our research will assess whether TVCL surveillance impacts the timing of antenatal corticosteroids (ACS), magnesium sulfate administration, and maternal and neonatal outcomes in multiple gestations. We performed a retrospective cohort study of women with twin gestations born at Methodist Women’s Hospital between January 1st, 2013 and April 30th, 2016. Patients having six or more TVCL measurements during their twin gestation were compared to those with less than six TVCL measurements. Women without TVCL measurement, monochorionic-monoamniotic twins, or monochorionic-diamniotic twins with twin-twin transfusion syndrome were excluded from statistical analysis. We hypothesized that women who experience spontaneous preterm birth will demonstrate shorter TVCL measurements throughout their surveillance. We also hypothesized that those with more frequent TVCL surveillance would result in optimized timing of ACS within seven days of delivery, increased exposure to magnesium sulfate in those born before 32 0/7 weeks and improved neonatal and maternal outcomes. Our study found no association between TVCL frequency and spontaneous preterm birth, exposure to magnesium sulfate for neuroprotection, or maternal or neonatal outcomes. Twins whom delivered at/7 weeks were more likely to receive first course ACS (55% vs 31%, p=0.03) within 7 days of delivery in the

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