Clinically meaningful improvements of less blood loss, fewer transfusions, and higher intraoperative MAPs suggest that MDT cases were more stable intraoperatively, which over a larger number of patients, should translate into improved outcomes.
OBJECTIVE: To evaluate whether cerclage in twins reduces the rate of spontaneous preterm birth (sPTB) < 32 weeks compared to expectant management. STUDY DESIGN: This is a retrospective cohort study of twin pregnancies with the following potential indications for cerclage: history of cervical insufficiency or PTB, short cervix 25mm at 13-26 weeks, or cervical dilation 1cm at 14-27 weeks. The "cerclage" cohort (from UCLA Medical Center) received a cerclage from a single provider from 2003-2015. The "no cerclage" group (from UCSF Medical Center, where cerclages are not performed for twins) included all patients with similar cerclage indications that were expectantly managed from 2010-2015. Exclusion criteria were: major fetal anomaly, monochorionic-monoamniotic twins, and cerclage for delayed interval delivery. Primary outcome was the rate of sPTB <32 weeks. Secondary outcome was the rate of overall PTB <32 week for all indications. RESULTS: In all, 129 women were included in two cohorts: cerclage (n¼89) or no cerclage (n¼40). Cerclages were placed for history of cervical insufficiency (n¼16, 18%), short cervix 25mm (n¼23, 25.8%), or cervical dilation 1cm (n¼50, 56.2%). Compared to controls, patients in the cerclage group were older (32.2 vs 35.6, p¼0.003), less likely to have short cervix (67.5 vs 25.8%, p<0.001), and more likely to have cervical dilation (12.1 vs 46.1%, p<0.001). Gravidity and parity were not significantly different between the two groups. The rates of sPTB <32 weeks were 11.2% (n¼10) with cerclage vs. 27.5% (n¼11) without cerclage (p¼0.02). The rates of overall PTB <32 weeks were 16.9% (n¼15) vs 32.5% (n¼40), respectively (p¼0.05). After adjusting for maternal age, cerclage indication, parity, and history of PTB, there was a significant reduction in sPTB <32 weeks in the cerclage group (RR 0.20, CI 0.08-0.46, p<0.001), and in overall PTB < 32 weeks (RR 0.24, CI 0.12-0.48, p<0.001). CONCLUSION: Cerclage in twin pregnancies significantly decreased the rate of sPTB <32 weeks by 80%, and overall PTB <32weeks by 76%, compared to expectant management. Randomized controlled trials are needed to further evaluate the efficacy of cerclage in twins.
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