Prophylactic cerclage in the management of triplet pregnancies.
OBJECTIVE
The purpose of this study was to determine if prophylactic cerclage improves pregnancy outcome in women with triplet pregnancies without a history of cervical insufficiency.


METHODS
Triplet pregnancies with > or = 1 day of outpatient surveillance beginning before 32 weeks' gestation were identified from a database of women in the US who received outpatient preterm labor surveillance services between January 1990 and May 2004. Triplet pregnancies managed with prophylactic cerclage were compared with triplet pregnancies in which cerclage was not placed. Patients with a diagnosis of cervical insufficiency in a previous or in the index pregnancy were excluded from analysis. The primary outcome was incidence of preterm birth before 32 weeks. Groups were compared using Fisher exact test, and Student t test with 2-sided P values < .05 considered statistically significant.


RESULTS
Three thousand two hundred seventy-eight triplet pregnancies met criteria for inclusion, of which 248 women (7.6%) received prophylactic cerclage. No significant differences were seen in mean gestational age at delivery, incidence of preterm birth before 32 weeks, birth weight, or neonatal days in the hospital. This study had 80% power to detect a 30% reduction in the primary outcome.


CONCLUSIONS
Prophylactic cerclage did not result in improved pregnancy or neonatal outcomes in triplet pregnancies without a history of cervical insufficiency.
Rebarber
Andrei
A
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU School of Medicine, New York, NY, USA.
Roman
Ashley S
AS
Istwan
Niki
N
Rhea
Debbie
D
Stanziano
Gary
G
D000328:Adult; D023802:Cerclage, Cervical; D005260:Female; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple; D047928:Premature Birth / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D014310:Triplets