The impact of cerclage in twin pregnancies on preterm birth rate before 32 weeks

Han, Michelle; O’Donnell, Betsy; Maykin, Melanie; González, Juan M.; Tabsh, Khalil; Gaw, Stephanie L.

doi:10.1080/14767058.2018.1427719

Cited by 27 publications

(25 citation statements)

References 21 publications

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“…Other studies have also drawn similar conclusions that cervical cerclage including EC in twin pregnancies significantly decreased the rate of spontaneous preterm births [ 8 , 19 ]. The reason for these conflicting results regarding the efficacy of cerclage in twin pregnancies might be due to different surgical techniques and management protocols used in different institutions [ 27 ]. In our study, the rate of preterm birth and the rate of VLBWI or ELBWI in twin pregnancies were not increased compared to the rates in singleton pregnancies.…”

Section: Discussionmentioning

confidence: 99%

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Effects of emergency cerclage on the neonatal outcomes of preterm twin pregnancies compared to preterm singleton pregnancies: A neonatal focus

Chun

Lee

et al. 2018

PLoS ONE

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ObjectiveTo evaluate the efficacy and safety of emergency cerclage (EC) in preterm twins by comparing neonatal outcomes of preterm twins with those of preterm singletons.Study designThis is a single-institution retrospective study of preterm infants born to women who underwent EC from 2008 to 2014. We compared various maternal and neonatal factors. The primary and secondary goals were to compare the maternal and neonatal morbidities and neonatal mortality, respectively.ResultsOne hundred fifty-three infants were included comprising 32(21%) twins and 121(79%) singletons. The mean gestational age (GA) at the time of EC and the number of days from EC to delivery were not significantly different (47.9±27.5 vs. 48.3±35.5). The rate of preterm delivery at ≤32 weeks GA (69% vs. 79%) and ≤28 weeks GA (50% vs. 55%), and other prematurity-associated morbidities were not significantly different. The survival rate during hospitalization was 75% (24/32) in twins and 88% (107/121) in singletons (P = 0.054). Death within 7 days after birth occurred in 8 twins (25%) and 7 singletons (6%) (P = 0.001). All of the infants were <1,000 g with a GA of ≤27 weeks.ConclusionCompared to EC in singleton pregnancies, EC in twin pregnancies resulted in a higher mortality rate for preterm babies. EC might be considered a salvage procedure for selective twin pregnancies with cervical insufficiency.

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Section: Discussionmentioning

confidence: 99%

“…Recent studies have shown that EC in twin pregnancies improved neonatal outcomes when compared to expectant management [ 27 – 29 ]. Another study also concluded that EC for cervical insufficiency in twin pregnancies and in singleton pregnancies contributed to a good perinatal prognosis [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of emergency cerclage on the neonatal outcomes of preterm twin pregnancies compared to preterm singleton pregnancies: A neonatal focus

Chun

Lee

et al. 2018

PLoS ONE

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“…In particular, in cases when the cervix is opened, cervical stitching is almost the only treatment option (compared to absolute bed rest). Although no randomized control trial study has been performed specifically on multiple pregnancies, the results from retrospective studies show that cervical lifecycle in multiple pregnancies helps prolong pregnancy by 7.3 days to 91 days [7] [14] [15]. In the trend of increasing fertility support, the rate of multiple pregnancies is also increasing.…”

Section: Discussionmentioning

confidence: 99%

Physical Examination Indicated Rescue Cerclage to Improve Live Birth Rate at Hung Vuong Hospital in Vietnam

Trang¹,

Tam²,

Hung³

et al. 2020

OJOG

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Emergency cerclage with advanced cervical dilatation and bulging of fetal membranes is still challenging to obstetricians. Objective: To identify the live birth rate after physical examination indicated rescue cerclage. Methods: A retrospective cohort study of 36 pregnant women, who underwent rescue cerclage at Hung Vuong hospital from January 2015 to January 2019. Selection criteria: cervical dilation 10 to 40 mm, at 20 to 30 gestational weeks. Exclusion criteria: multiple pregnancy, birth defects, pregnancy termination due to maternal or fetal indications. Results: Delivery of live infant rate was 72.22%; mean pregnancy prolongation was 42.8 ± 34.15 days. Early live birth rate was 77.78%. The percentage of delivery after 34 and 37 weeks was 44.45% and 27.78%, respectively. Live birth weight was 400 to 3600 g, with mean being 1878.06 ± 1049.04 g. No procedure-related complication was observed. Conclusions: Rescue cerclage may be an effective and safe method in prolonging pregnancy and improving neonatal outcome in women with cervical dilation 10 to 40 mm. It should be considered as a viable option for women with a dilated cervix in 20 to 30 gestational weeks. Future controlled studies are needed.

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“…preterm birth,Emergency cervical cerclage reduces preterm birth, provides prolonged gestational weeks, and reduces neonatal mortality and loss rates. SOGC [4] recommends emergency cervical cerclage in a singleton pregnant cervix less than 4cm without contractions.The Han et al [5] retrospective study analyzed the prolonged pregnancy interval of 5-7 weeks after cervical dilation> 1cm compared to the conservative treated group.Emergency cervical cerclage is an active treatment that extends gestational weeks and increases neonatal survival, However,premature fetal membrane rupture occurs in 4%-9% postoperative cases,when the amniotic cavity intrauterine infection is present, the effect of cerclage decreases signi cantly [6].Several studies have shown that the amniotic sac is located beyond external os and that the cervix dilation of 1.5cm is an independent risk factor for failure after cerclage [7],The Baryk M et al [8] study evaluated emergency cervical cerclage with less than 28 weeks of premature birth at 75/252 (29.7%),In this study, 106 patients underwent emergency cervical dilation and amniotic protrusion, and 39 had sPTB less than 28 weeks with an incidence of 36.8%,Higher than the above study may be related to a higher proportion of cervical expansion greater than 4cm (18 cases). Emergency cervical cerclage has a positive effect on pregnancy outcome with cervical dilation> 4cm, less than spontaneous prematurity of 18/37 (46.2%) at 28 weeks, prolonged gestational interval of 4.43 (3.43,7.00)…”

Section: Tablementioning

confidence: 99%

To Identify Risk Factors Predicting Spontaneous Preterm Labor Less Than 28 Weeks After Emergency Cerclage in the Second Trimester of Pregnancy

Zhucan

2021

Preprint

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Purpose To identify risk factors predicting spontaneous preterm labor (sPTB) less than 28 weeks after emergency cerclage in the second trimester of pregnancy.Methods 106 cases with Prolapsed membranes in the second trimester of pregnancy who underwent emergency cerclage were collected from July 2019-July 2021 .39 cases who happened sPTB less than 28 weeks were in case group. 67 cases were in control group.Univariate analysis and logistic regression analysis were used to identify the risk factors for sPTB less than 28 weeks after emergency cerclage.Results Among the 106 cases,37cases developed sPTB less than 28 weeks, and the incidence was 36.8%, Univariate analysis showed that positive cervical culture,cervical dilatation,the location of amniotic membranes and histologic chorioamnionitis were related with sPTB(P<0.05). Logistic regression analysis showed that histologic chorioamnionitis was the risk factors for sPTB after emergency cerclage in patients with Prolapsed membranes in the second trimester of pregnancy[relative risk14.603 ,95% confidence interval(CI)2.621-81.369,P<0.05].Amniotic membrane is an independent risk factor for less than 28 weeks of sPTB after emergency cerclage in middle pregnancy [relative risk11.993 ,95% confidence interval(CI)3.825-37.607,P<0.05].Conclusion The independent risk factors of sPTB less than 28 weeks after emergency cerclage with prolapsed membranes in the second trimester of pregnancy was histologic chorioamnionitis and Amniotic membrane.

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The impact of cerclage in twin pregnancies on preterm birth rate before 32 weeks

Abstract: 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.

Cited by 27 publications

References 21 publications

Effects of emergency cerclage on the neonatal outcomes of preterm twin pregnancies compared to preterm singleton pregnancies: A neonatal focus

Effects of emergency cerclage on the neonatal outcomes of preterm twin pregnancies compared to preterm singleton pregnancies: A neonatal focus

Physical Examination Indicated Rescue Cerclage to Improve Live Birth Rate at Hung Vuong Hospital in Vietnam

To Identify Risk Factors Predicting Spontaneous Preterm Labor Less Than 28 Weeks After Emergency Cerclage in the Second Trimester of Pregnancy

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