The effectiveness of cervical cerclage in twin pregnancies with a mid-trimester short cervix: A retrospective cohort study.

Autor: Ferro J; Unidad de Medicina Materno-Fetal, Instituto Universitario IVI Valencia, IVIRMA Global, Valencia, Spain., Diago V; Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Departamento de Pediatría, Obstetricia y Ginecología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain., Diago DM; Servicio de Obstetricia, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain., Pellicer N; Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain., Olmo I; Unidad de Medicina Materno-Fetal, Instituto Universitario IVI Valencia, IVIRMA Global, Valencia, Spain; Departamento de Pediatría, Obstetricia y Ginecología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain., Vázquez S; Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain., Lara C; Unidad de Medicina Materno-Fetal, Instituto Universitario IVI Valencia, IVIRMA Global, Valencia, Spain., Perales A; Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Departamento de Pediatría, Obstetricia y Ginecología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain., Serra V; Unidad de Medicina Materno-Fetal, Instituto Universitario IVI Valencia, IVIRMA Global, Valencia, Spain; Departamento de Pediatría, Obstetricia y Ginecología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain. Electronic address: vicente.serra-serra@uv.es.
Jazyk: angličtina
Zdroj: European journal of obstetrics, gynecology, and reproductive biology [Eur J Obstet Gynecol Reprod Biol] 2024 Mar; Vol. 294, pp. 33-38. Date of Electronic Publication: 2023 Dec 21.
DOI: 10.1016/j.ejogrb.2023.12.029
Abstrakt: Objective: To analyze the effectiveness of cerclage in twin pregnancies with a short cervix.
Study Design: Retrospective cohort study performed in two University Institutions in Valencia (Spain) with two different protocols for the management of asymptomatic dichorionic diamniotic twin pregnancies with mid-trimester cervical length ≤ 25 mm: treatment with indomethacin, antibiotics and cerclage (cerclage group) (N = 43) versus expectant management (control group) (N = 37).
Results: The initial cervical length was similar in both groups but detection of a short cervix was performed earlier in the cerclage group (21.6 vs 24.1 weeks, p < 0.001). Women with cerclage had a greater pregnancy latency (12.5 vs. 7.7 weeks, p < 0.001); higher gestational age at delivery (34.1 vs. 31.8 weeks, p < 0.04); less spontaneous preterm birth (SPB) < 28 weeks (11.6 % vs 37.8 %, p < 0.009); higher birthweight (2145 vs 1733 g, p < 0.001); lower birthweight < 1500 g (12.5 % vs 40.0 %, p < 0.001); less admissions to the neonatal intensive care unit (NICU) (24.1 % vs 43.3 %, p < 0.03); shorter stay at NICU (25.6 vs 49.4 days, p < 0.02); lower respiratory distress requiring mechanical ventilation (14.9 % vs 36.5 %, p < 0.02); fewer patent ductus arteriosus (8.9 % vs 26.9 %, p < 0.008); and lower composite adverse neonatal outcome (26.6 % vs. 44.8 %, p < 0.03). Cerclage and gestational age at diagnosis were the only independent predictors of SPB < 32 and < 28 weeks by multivariate analysis. The cumulative data in the literature show promising beneficial effects of cerclage.
Conclusion: Our data suggest that cerclage in asymptomatic twin pregnancies with a short cervix may reduce the earliest SPB and may improve neonatal outcome.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2023 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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