title: Cerclage for cervical shortening at fetoscopic laser photocoagulation in twin-twin transfusion syndrome.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the benefit of cervical cerclage for cervical length ≤ 25 mm at the time of fetoscopic laser photocoagulation (FLP) for twin-twin transfusion syndrome.
  
  
  METHODS
  A multicenter, retrospective cohort study was conducted with 163 patients with a short cervix before FLP for twin-twin transfusion syndrome. Seventy-nine of the patients (48%) had cerclage placement at the surgeon's discretion. The outcome measures that were compared were gestational age at delivery and perinatal mortality rates for patients with cerclage and those who were treated conservatively. Outcomes were evaluated with the use of comparative statistics.
  
  
  RESULTS
  There were no differences in the preoperative variables, except cerclage was performed more frequently for a cervical length of ≤ 15 mm (P < .001). There were no differences in the gestational age at delivery (28.8 ± 5.4 vs 29.1 ± 5.6 weeks with and without cerclage, respectively; P = .15); perinatal mortality rates were similar between the 2 groups.
  
  
  CONCLUSIONS
  The benefit of cerclage for patients with short cervix before FLP remains questionable.
authors.affiliation: Section of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06520, USA. rpapanna@gmail.com
authors.forename: Ramesha
authors.initials: R
authors.lastname: Papanna
authors.forename: Mounira
authors.initials: M
authors.lastname: Habli
authors.forename: Ahmet A
authors.initials: AA
authors.lastname: Baschat
authors.forename: Michael
authors.initials: M
authors.lastname: Bebbington
authors.forename: Lovepreet K
authors.initials: LK
authors.lastname: Mann
authors.forename: Anthony
authors.initials: A
authors.lastname: Johnson
authors.forename: Greg
authors.initials: G
authors.lastname: Ryan
authors.forename: Martin
authors.initials: M
authors.lastname: Walker
authors.forename: David
authors.initials: D
authors.lastname: Lewis
authors.forename: Christopher
authors.initials: C
authors.lastname: Harman
authors.forename: Timothy
authors.initials: T
authors.lastname: Crombleholme
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Moise
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical; D015331:Cohort Studies; D005260:Female; D005330:Fetofetal Transfusion / Q000601:surgery*; D005332:Fetoscopy; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D017075:Laser Coagulation; D054238:Perinatal Mortality; D011247:Pregnancy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D002581:Uterine Cervical Incompetence / Q000601:surgery*