title: Routine cervical cerclage in higher order multiple gestation -- does it prolong the pregnancy?
abstract: Preterm birth following cervical dilatation is the greatest threat to infants of a multiple pregnancy. Lacking reliable data concerning the effect of prophylactic cerclage, we compared a study group to controls for maternal and perinatal outcome. Sixteen of 94 triplet-, 9 of 18 quadruplet/quintuplet-pregnancies, treated with prophylactic cerclage, were retrospectively compared to those without cervical cerclage respectively. Kruskal-Wallis test and Mann-Whitney-U test were performed as non-parametric one way analysis of variance. For the analysis of frequencies Chi Square test or Fisher's exact test were performed. Odds ratio with 95% confidence interval was used to compare the need for intravenous tocolysis as well as perinatal morbidity and mortality. Gestational age at delivery was not different from the controls in all studied groups. Birth weight revealed a 200 g dominance for the "no cerclage-triplets", while this significant difference was inverted for quadruplets/quintuplets (1245 g vs. 1069 g). With respect to gestational age at birth, need for hospitalisation or medical intervention no benefit was achieved. Moreover, perinatal outcome analysed by arterial pH, APGAR-Score and perinatal mortality was not altered by a prophylactic cerclage. Perinatal morbidity for quadruplets and quintuplets was even higher in cerclage pregnancies. Therefore, these retrospective results disclaim a positive impact of cervical cerclage on pregnancy management or perinatal outcome in multifetal pregnancies.
authors.affiliation: Department of Obstetrics and Gynecology - Grosshadern, University of Munich, Germany. Alexander.Strauss@helios.med.uni-muechen.de
authors.forename: Alexander
authors.initials: A
authors.lastname: Strauss
authors.forename: Ivo M
authors.initials: IM
authors.lastname: Heer
authors.forename: Udo
authors.initials: U
authors.lastname: Janssen
authors.forename: Christian
authors.initials: C
authors.lastname: Dannecker
authors.forename: Peter
authors.initials: P
authors.lastname: Hillemanns
authors.forename: Susanne
authors.initials: S
authors.lastname: Müller-Egloff
mesh_terms: D001034:Apgar Score; D023802:Cerclage, Cervical; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007752:Obstetric Labor, Premature / Q000517:prevention & control*; D016017:Odds Ratio; D011247:Pregnancy; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple / Q000502:physiology; D011783:Quadruplets; D011811:Quintuplets; D012189:Retrospective Studies; D014310:Triplets