The Place for Prophylactic Cerclage in the Infertile Patient With Established Cervical Incompetence [9D]

Abstract

IntroductionIt is well known that cervical incompetence and associated preterm birth confers greater morbidity and mortality on birth outcomes, with an additional increased risk of cervical incompetence in higher order gestations. While the pathophysiology of cervical incompetence has yet to be elucidated, research has identified risk factors and assessed outcomes of numerous interventions. Cervical cerclage has been shown, in certain situations involving singleton pregnancies, to improve outcomes. Conversely, rescue cerclage increases the risk of preterm birth in twin gestations. However, these studies did not consider the unique situation of infertile patients, with known cervical incompetence, who have utilized assisted reproductive technologies to attain pregnancy. This study aims to describe the outcomes of infertile patients with known cervical incompetence, carrying twin gestation, who have undergone cervical cerclage.MethodsThis case series includes eight infertile patients who have cervical incompetence resulting in fetal loss between 20-24 weeks after in vitro fertilization embryo transfer (IVF-ET). These patients continued with IVF treatments and subsequently conceived twins. All patients underwent prophylactic cervical cerclage placement before 12 weeks. The outcomes of these pregnancies are reviewed.ResultsAll pregnancies resulted in the delivery of viable twins. Six of the eight pregnancies (75%) were carried beyond 34 weeks. One pregnancy delivered at 31 weeks and one pregnancy delivered at 25 weeks after placental abruption.ConclusionsThis data suggest that the use of prophylactic cervical cerclage may be beneficial in improving reproductive outcomes in infertile patients with known cervical incompetence that subsequently conceived twin gestations via IVF-ET treatment.

Effect of cervical incompetence in patients with polycystic ovary syndrome enduring second- trimester abortion during the frozen-embryo transfer cycle: A retrospective study

“…The nal favorable outcome of a twin pregnancy with prophylactic cervical cerclage has indeed resulted in a twin delivery, indicating that the number of embryos transferred differs from one individual to another. It is not always possible to transfer one embryo in order to achieve a favorable pregnancy outcome [22]. Therefore, customized transplantation protocols have been developed based on the individual needs of the patient.…”

Combined fetal reduction and cervical cerclage in twin pregnancies complicated by cervical insufficiency: Effects on perinatal outcomes

“…Cervical cerclage has been proposed as an effective surgical method for preventing preterm birth in singleton pregnancies complicated by CI [6]. Increasing evidence suggests that cervical cerclage is also bene cial in twin pregnancies complicated with CI [7][8][9].…”