Ultrasound-Indicated Cervical Cerclage Efficacy Between 16 and 28 Weeks of Gestation in Twin Pregnancy: Retrospective Cohort Study

Abstract

Li-Ping Yao,1,2,* Qing Yang,1,2,* Jin-Dan Pei,3 Yue-Lin Wu,3 Sheng Wan,3 Zhi-Qin Chen,4 Xiao-Lin Hua1,3 1Shanghai Key Laboratory of Maternal Fetal Medicine, Department of Ultrasound, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China; 2Department of Ultrasound, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 200092, People’s Republic of China; 3Department of Obstetrics, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China; 4Department of Assisted Reproduction, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiao-Lin Hua Department of Obstetrics, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, No. 2699 of West Gaoke Road, PuDong New District, Shanghai, 200092, People’s Republic of China Tel [phone] Fax [phone] Email [email protected] Zhi-Qin Chen Department of Assisted Reproduction, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, No. 536 of Changle Road, JingAn District, Shanghai, 200092, People’s Republic of China Tel [phone] Fax [phone] Email [email protected]: The aim of this study is to determine if cervical cerclage administration reduces the preterm birth (PTB) rate at a gestational age (GA) of 16– 28 weeks in women with twin pregnancy.Methods: This is a retrospective cohort study on asymptomatic twin pregnancy with an ultrasound-identified cervix length (CL) of ≦25 mm. The patients were divided into two groups: ultrasound-indicated cerclage (UIC) group and control (expectant management) group. The primary outcome was a PTB rate at < 34 weeks. A logistic regression was also performed, and a subgroup analysis stratified by CL and GA at first short cervix diagnosis was planned.Results: In all 320 women, there were no differences in the overall < 34-week PTB rates and neonatal outcomes between the UIC group and control group. After performing a multivariate logistic regression analysis, the subgroup analyses were planned. In patients with a CL of ≦15 mm, the < 34-week PTB rate was significantly decreased in the UIC subgroup compared with the control subgroup (60.78% vs 78.26%; odds ratio (OR) = 0.43, confidence interval (CI) = 95% [0.22– 0.86]; and p = 0.020). In patients with a first short cervix diagnosis GA of ≦24 weeks, the < 34-week PTB rate was significantly decreased in the UIC subgroup when compared with the control subgroup (61.54% vs 84.75%; OR = 0.29; CI = 95% [0.13– 0.63]; and p = 0.001). Furthermore, compared with the control groups, the UIC groups had higher mean birth weight, lower perinatal mortality, and lower NICU admission, and the differences were statistically significant.Conclusion: UIC could significantly reduce the < 34-week PTB rate and improve perinatal outcomes in patients with a CL of ≦15mm or first short cervix diagnosis GA of ≦24 weeks with asymptomatic twin pregnancy during the second trimester.Keywords: twin pregnancy, ultrasound-indicated cerclage, cervical length, preterm birth

Keywords

• twin pregnancy
• ultrasound-indicated cerclage
• cervical length
• preterm birth