title: Cervical cerclage in twin pregnancies.
abstract: OBJECTIVE
  To evaluate the outcomes of cervical cerclage (CC) in twin pregnancies.
  
  
  METHODS
  Retrospective analysis of twin pregnancies undergoing CC between January 2001 and December 2009 at our Institution. CC was offered in case of a cervical length measurement ≤ 20 mm (ultrasound-indicated CC) or in case of cervical dilatation with membranes at or beyond the external cervical os (physical examination-indicated CC). Cervicovaginal and rectal swabs were obtained preoperatively. Perioperative antibiotics and tocolysis were administered.
  
  
  RESULTS
  There were 28 cases of ultrasound-indicated and 14 of physical examination-indicated CC. Positive swab cultures were observed in 21 % of cases. The incidence of preterm delivery <34 weeks was 32 % [95 % confidence interval (CI) 16-52 %] and 50 % (95 % CI 23-77 %) in the ultrasound-indicated and physical examination-indicated CC group, respectively. The incidence of premature rupture of membranes <34 weeks was 21 % (95 % CI 8-41 %) and 29 % (95 % CI 8-58 %) in the ultrasound-indicated and physical examination-indicated CC group, respectively. Perinatal survival was 96 % (95 % CI 88-100 %) in the ultrasound-indicated CC group, and 86 % (95 % CI 67-96 %) in the physical examination-indicated CC group.
  
  
  CONCLUSIONS
  We showed a high-risk of preterm delivery in both groups, but with a high overall perinatal survival. Our data stress the importance of re-evaluating the efficacy of CC in twin pregnancies by properly designed clinical trials, particularly if it is physical examination indicated.
authors: Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy. zanardini.cristina@gmail.com
authors: Cristina
authors: C
authors: Zanardini
authors: Giorgio
authors: G
authors: Pagani
authors: Anna
authors: A
authors: Fichera
authors: Federico
authors: F
authors: Prefumo
authors: Tiziana
authors: T
authors: Frusca
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D023802:Cerclage, Cervical; D002584:Cervix Uteri / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000382:microbiology; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use; D010808:Physical Examination; D011247:Pregnancy; D011256:Pregnancy Outcome; D059285:Pregnancy, Twin; D047928:Premature Birth / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D015145:Tocolysis; D015149:Tocolytic Agents / Q000627:therapeutic use; D014463:Ultrasonography; D002581:Uterine Cervical Incompetence / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D014621:Vagina / Q000382:microbiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D015149:Tocolytic Agents; D007213:Indomethacin