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Xu W, Ni X, Liu Y, Meng L, Ru P, Gu Z, Yan Y, Yuan W, Su X, Liu M, Duan T. Transvaginal cerclage for prevention of preterm birth in twin pregnancies with cervical dilatation or shortening: A prospective observational study. Int J Gynaecol Obstet 2024; 164:942-950. [PMID: 37621196 DOI: 10.1002/ijgo.15061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE To investigate the efficacy of transvaginal cerclage in twin pregnancies with cervical shortening, and to narrow the threshold cervical length for transvaginal cerclage. METHODS This is a prospective cohort study and 177 twin pregnancies with asymptomatic cervical dilatation or cervical length of 15 mm or less between 16+0 and 25+6 weeks of pregnancy were included. Patients independently chose either transvaginal cerclage (n = 129) or no cerclage treatment (n = 48) after being consulted on the risk and potential benefit of transvaginal cerclage. The primary outcome measures were gestational age at delivery and neonatal survival rate. RESULTS Compared with the no cerclage group, the cerclage group exhibited a higher gestational age at delivery (32.1 ± 4.5 vs 28.3 ± 6.2 weeks, P < 0.001) and a higher neonatal survival rate (86.4% vs 47.9%, P < 0.001). Subgroup analysis showed that in twin pregnancies with cervical dilatation or cervical length less than 10 mm, the cerclage group had significantly higher gestational age at delivery (31.3 ± 4.6 vs 23.4 ± 4.3 weeks, P < 0.001) and a higher neonatal survival rate (123 [85.4%] vs 4 [9.1%], P < 0.001) than the no cerclage group, but in twins when cervical length was 10-15 mm, the two measures were similar between the two groups. CONCLUSION Transvaginal cerclage may provide benefits for twins when cervical dilatation or cervical length is less than 10 mm, but its efficacy might not extend to twins when the cervical length is 10-15 mm. Further evidence is needed to confirm the efficacy of transvaginal cerclage for twin pregnancies with a short cervix.
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Affiliation(s)
- Wenyi Xu
- Department of Obstetrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaotian Ni
- Department of Obstetrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yun Liu
- Department of Obstetrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lulu Meng
- Department of Obstetrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ping Ru
- Department of Obstetrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhuorong Gu
- Department of Obstetrics and Gynecology, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Yan
- Department of Obstetrics and Gynecology, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wenjun Yuan
- Department of Obstetrics and Gynecology, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiujuan Su
- Clinical Research Center, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ming Liu
- Department of Obstetrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tao Duan
- Department of Obstetrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
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