Risk prediction of spontaneous preterm birth in twin pregnancy: a nomogram

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Abstract

Preterm birth remains a leading cause of perinatal morbidity and mortality in twin pregnancy.

Objective. To improve perinatal outcomes in twin pregnancies by creating a nomogram to predict the risks of spontaneous preterm births.

Materials and methods. The study included 839 patients with twin pregnancies. Based on pregnancy outcomes, the patients were divided into two groups. Group 1 consisted of women (n=175) whose pregnancies ended in term births. Group 2 included women (n=664) whose pregnancies ended in preterm births. A nomogram for the risk of preterm birth was constructed based on significant predictors, and its predictive performance was evaluated using ROC analysis.

Results. Multivariate analysis identified that independent predictors of preterm birth were twin growth discordance (OR=1.044; 95% CI 1.024–1.064; p< 0.001) and twin chorionicity (monochorionic diamniotic twins: OR=2.993; 95% CI 1.677–5.340; p< 0.001). The nomogram model included these predictors, and was developed to estimate the individual preterm birth risk. ROC curve analysis confirmed satisfactory predictive performance of the model (AUC=0.766).

Conclusion. The risk of spontaneous preterm birth in twin pregnancy is primarily associated with twin chorionicity and twin growth discordance, that is important for personalized high-risk patient management.

About the authors

Kristina A. Gladkova

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Author for correspondence.
Email: k_gladkova@oparina4.ru
ORCID iD: 0000-0001-8131-4682

PhD, Senior Researcher at the Department of Fetal Medicine, Institute of Obstetrics, Head of the 1st Obstetric Department of Pregnancy Pathology

Russian Federation, Moscow

Anastasia O. Kiryanova

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: anastasia.kiryanova2002@gmail.com

6th year student at N.V. Sklifosovsky Institute of Clinical Medicine

Russian Federation, Moscow

Victoria A. Sakalo

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: v_sakalo@oparina4.ru
ORCID iD: 0000-0002-5870-4655

PhD, Researcher at the Department of Obstetrics and Extragenital Pathology, Institute of Obstetrics, obstetrician-gynecologist at the 1st Obstetric Department of Pregnancy Pathology

Russian Federation, Moscow

Valentina V. Vtorushina

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: v_vtorushina@oparina4.ru

PhD, Doctor of Clinical Laboratory Diagnostics at the Laboratory of Clinical Immunology

Russian Federation, Moscow

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