title: Outcomes of mid-trimester emergency cerclage in twin pregnancies.
abstract: BACKGROUND
  Placement of emergency cerclage at mid-trimester is controversial. At present, clinical trials comparing outcomes of mid-trimester cerclage to bed rest in twin pregnancies are lacking. Our aim was to examine the efficacy, safety and outcomes of mid-trimester cerclage in patients carrying twin gestations.
  
  
  METHODS
  We retrospectively studied the outcomes of 14 patients carrying twin gestations with significant cervical dynamics who underwent cerclage. Outcomes of patients with cervical effacement only and patients with bulging membranes through the external os were examined. The interval between cerclage and delivery and the complication rates were calculated.
  
  
  RESULTS
  The average time interval between cerclage placement and delivery was 71.1 days overall. Patients with cervical shortening or effacement only (n = 10) gave birth an average of 80.2 days after the procedure, while 4 patients with bulging membranes gave birth an average of 48.5 days after cerclage placement. The overall procedure failure rate, defined as delivery before 28 completed weeks, was 14.2%.
  
  
  CONCLUSIONS
  Patients carrying twin gestations with advanced cervical changes might benefit from therapeutic cerclage. Further studies are required to demonstrate whether there is a difference compared to bed rest alone.
authors.affiliation: Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. ilevin@post.tau.ac.il
authors.forename: Ishai
authors.initials: I
authors.lastname: Levin
authors.forename: Liat
authors.initials: L
authors.lastname: Salzer
authors.forename: Sharon
authors.initials: S
authors.lastname: Maslovitz
authors.forename: Amiram
authors.initials: A
authors.lastname: Avni
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Lessing
authors.forename: Asnat
authors.initials: A
authors.lastname: Groutz
authors.forename: Benny
authors.initials: B
authors.lastname: Almog
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical / Q000009:adverse effects*; D002584:Cervix Uteri / Q000601:surgery*; D004108:Dilatation, Pathologic / Q000601:surgery; D004638:Emergency Treatment / Q000009:adverse effects; D005321:Extraembryonic Membranes / Q000473:pathology*; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008499:Medical Records; D007752:Obstetric Labor, Premature / Q000209:etiology / Q000517:prevention & control; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D059285:Pregnancy, Twin; D011379:Prognosis; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal; D002581:Uterine Cervical Incompetence / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014621:Vagina / Q000000981:diagnostic imaging