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The impact of cerclage in twin pregnancies on preterm birth rate before 32 weeks
| Content Provider | Scilit |
|---|---|
| Author | O’Donnell, Betsy E. Han, Michelle N. Maykin, Melanie M. Gonzalez, Juan M. Tabsh, Khalil Gaw, Stephanie L. |
| Copyright Year | 2018 |
| Description | Journal: The Journal of Maternal-Fetal & Neonatal Medicine |
| Abstract | Purpose: To evaluate whether cerclage in twins reduces the rate of spontaneous preterm birth <32 weeks when compared to expectant management. Methods: This is a retrospective cohort study of twin pregnancies with the following indications for cerclage from two institutions: history of prior preterm birth, ultrasound-identified short cervix ≤2.5 cm, and cervical dilation ≥1.0 cm. The “cerclage” cohort received a cerclage from a single provider at a single institution from 2003–2016. The “no cerclage” group included all patients with similar indications that were expectantly managed from 2010–2015, at a second institution where cerclages are routinely not performed in twin pregnancies. The primary outcome was the rate of spontaneous preterm birth at <32 weeks. Secondary outcomes were the rates of spontaneous and overall (including medically indicated) preterm births at <32 weeks, < 34 weeks, and <36 weeks, chorioamnionitis, birth weight, and neonatal mortality within 30 days of life. We also performed a planned subgroup analysis stratified by cerclage indication. Results: In all, 135 women were included in two cohorts: cerclage (n = 96) or no cerclage (n = 39). The rates of spontaneous preterm birth <32 weeks were 10.4% (n = 10) with cerclage versus 28.2% (n = 11) without cerclage (OR 0.23, CI 0.08–0.70, p = .017). After adjusting for cerclage indication, clinical history, age, chorionicity, insurance type, race, BMI, in-vitro fertilization, and multifetal reduction, there remained a significant reduction in the cerclage group of spontaneous preterm birth <32 weeks (adjusted odds ratio (aOR) 0.24, CI 0.06–0.90, p = .035), spontaneous preterm birth <36 weeks (aOR 0.34, CI 0.04–0.81, p = .013) as well as in overall preterm birth <32 weeks (aOR 0.31, CI 0.1–0.86, p = .018), and overall preterm birth <36 weeks (aOR 0.37, CI 0.10–0.84, p = .030). When stratified by short cervix or cervical dilation in the cerclage versus no cerclage groups, there was a significant decrease in spontaneous preterm birth <32 weeks in the cerclage group with cervical dilation (11.1 versus 41.2%, p = .01) but not in the cerclage group with short cervix only, even for cervical length <1.5 cm. Pregnancy latency was 91 days in the cerclage group versus 57 days in the no cerclage group (p = .001), with a median gestational age at delivery of 35 versus 32 weeks (p = .002). There was no increase in chorioamnionitis in the cerclage group. Furthermore, there was a significant increase in birth weight (median 2278 versus 1665 g, p < .001) and decrease in perinatal death <30 days (1.6 versus 12.9%, p = .001). Conclusions: Cerclage in twin pregnancies significantly decreased the rate of spontaneous preterm birth <32 weeks compared to expectant management. However, when stratified by cerclage indication, this decrease in primary outcome only remained significant in the group with cervical dilation. |
| Related Links | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6251764/pdf |
| Ending Page | 2151 |
| Page Count | 9 |
| Starting Page | 2143 |
| ISSN | 14767058 |
| e-ISSN | 14764954 |
| DOI | 10.1080/14767058.2018.1427719 |
| Journal | The Journal of Maternal-Fetal & Neonatal Medicine |
| Issue Number | 13 |
| Volume Number | 32 |
| Language | English |
| Publisher | Informa UK Limited |
| Publisher Date | 2019-07-03 |
| Access Restriction | Open |
| Subject Keyword | Journal: The Journal of Maternal-Fetal & Neonatal Medicine Obstetrics and Gynecology Multiple Gestation Short Cervix Cervical Insufficiency |
| Content Type | Text |
| Subject | Pediatrics, Perinatology and Child Health Obstetrics and Gynecology |
