No large studies have evaluated whether the presence of fibroids affects cervical length in twin gestations. The objective of this study was to determine whether uterine fibroids identified on second-trimester ultrasound increase the risk for short cervix and adverse pregnancy outcomes in twin pregnancies.METHODS:
This retrospective cohort study evaluated all women with twin gestations who had a routine second-trimester ultrasound at 17-23 weeks gestational age from 2010-2016. When fibroids were noted, their presence, number, location and size were recorded. Exclusion criteria included a history of cervical conization or loop electrosurgical excision procedure (LEEP) and uterine anomalies. The primary variable of interest was short cervix (<25 mm). Secondary variables of interest included gestational age at delivery, mode of delivery, indication for cesarean, birth weight and Apgar scores.RESULTS:
Fibroids were identified in 127/1,260 patients (10.1%). Short cervix was increased in women with fibroids compared to women without fibroids (14.2% vs. 8.2%, OR 1.85, 95% CI 1.07-3.18, P<.03). Women with fibroids were older in age, lower in parity and more likely to have had pregnancies resulting from assisted reproductive technology. There was no difference in the gestational age at delivery, indication for primary cesarean, newborn birth weight or Apgar scores in twin gestations with fibroids compared to those without fibroids. The size and number of fibroids did not affect the frequency of short cervix.CONCLUSION:
Women with twin gestations and uterine fibroids may be at higher risk for a short cervix. Fibroids are not associated with adverse obstetric and neonatal outcomes in twin pregnancies.