ABSTRACT(240 words)
Objective: The purpose of this study was to develop a dynamic
nomogram model to predict
the
risk of spontaneous preterm birth at <32 weeks in twin
pregnancy.
Design: A retrospective analysis and multicentre validation
study
Setting and Population: Women with twin pregnancies
followed up in two tertiary medical centres from January 2017 to March
2019.
Methods: Data on maternal demographic characteristics,
transvaginal cervical length and funneling were extracted. The
prediction model was constructed with independent variables determined
by logistic regression analyses. The risk score was calculated according
to the dynamic nomogram model.
Main outcome measures: The risk of spontaneous preterm birth at
<32 weeks in twin pregnancy.
Results: In total, 1065 twin pregnancies were eligible for the
study, of which the data of 764 cases (92 twin preterm cases
(<32 weeks) and 672 control cases) were obtained from a
tertiary medical centre as the training group and those of 301 cases (36
twin preterm cases (<32 weeks) and 265 control cases) from the
other tertiary medical centre as the external validation group. Based on
logistic regression analyses, we built a dynamic nomogram model with
satisfactory discrimination in both the training group(C-index: 0.856,
95% CI: 0.813-0.899) and external validation group(C-index: 0.808, 95%
CI: 0.751-0.865). The restricted cubic splines and ROC curve supported
the performance of the prediction model.
Conclusions: We developed and validated a dynamic nomogram
model to predict the individual probability of preterm birth in twin
pregnancy at <32 weeks.
Funding: This research was supported by Fujian Key Laboratory
of Women and Children’s Critical Diseases Research [Fujian Maternity
and Child Health Hospital], along with funds from Fujian Maternity and
Child Health Hospital Innovation Project under Contract No.YCXZ18-21.
Keywords: Twin pregnancy, spontaneous preterm birth, dynamic
nomogram, risk score, cervical length, cervical funneling
Tweetable Abstract: We developed a reliable and user-friendly
prediction model for spontaneous preterm birth at <32 weeks in
twin pregnancy. It can assists the counselling and decision-making of
clinical treatment for twin pregnancy with differing risks of PTB.