title: Outcomes of emergency or physical examination-indicated cerclage in twin pregnancies compared to singleton pregnancies.
abstract: OBJECTIVE
  To report the obstetrical outcomes in patients with twin pregnancies who underwent an emergency/physical exam-indicated cerclage and to compare them to patients with singleton pregnancies undergoing the same procedure.
  
  
  METHODS
  Patients who underwent emergency/physical exam-indicated cerclage in the second trimester in one maternal-fetal medicine practice from July 1997 to March 2012 were reviewed. We defined an emergency/physical exam-indicated cerclage as any cerclage placed in a patient with a dilated cervix on examination or membranes visible at the external cervical os on speculum examination. We compared outcomes between patients with singleton and twin pregnancies using non-parametric testing.
  
  
  RESULTS
  There were 43 patients (12 twin and 31 singleton pregnancies) who underwent emergency/physical exam-indicated cerclage placement. The median gestational age at cerclage placement, cervical dilation, maternal age, and cerclage type were similar between the groups. Comparing twins to singletons, the median time from cerclage placement to delivery was similar (92 vs. 106 days, p=0.330), as was the median gestational age at delivery (33.5 vs. 35.0 weeks, p=0.244). The likelihood of delivery at >32 weeks (75.0% vs. 71.0%, p>0.999) and the likelihood of neonatal survival to discharge (83.3% vs. 83.9%, p>0.999) were also similar.
  
  
  CONCLUSIONS
  Emergency/physical exam-indicated cerclage in twin pregnancies can be associated with favorable outcomes, including a high likelihood of delivery at >32 weeks and a high likelihood of survival. Their outcomes appear similar to singleton pregnancies. Cerclage should be considered an option for patients with twin pregnancies and a dilated cervix in the second trimester.
authors: Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai School of Medicine, United States; Maternal Fetal Medicine Associates, PLLC, United States; Department of Obstetrics and Gynecology, NYU School of Medicine, New York, NY, United States.
authors: Andrei
authors: A
authors: Rebarber
authors: Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai School of Medicine, United States; Maternal Fetal Medicine Associates, PLLC, United States.
authors: Samuel
authors: S
authors: Bender
authors: Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai School of Medicine, United States; Maternal Fetal Medicine Associates, PLLC, United States.
authors: Michael
authors: M
authors: Silverstein
authors: Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai School of Medicine, United States; Maternal Fetal Medicine Associates, PLLC, United States; Department of Obstetrics and Gynecology, NYU School of Medicine, New York, NY, United States.
authors: Daniel H
authors: DH
authors: Saltzman
authors: Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai School of Medicine, United States; Maternal Fetal Medicine Associates, PLLC, United States; Department of Obstetrics and Gynecology, NYU School of Medicine, New York, NY, United States.
authors: Chad K
authors: CK
authors: Klauser
authors: Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai School of Medicine, United States; Maternal Fetal Medicine Associates, PLLC, United States; Department of Obstetrics and Gynecology, NYU School of Medicine, New York, NY, United States. Electronic address: nfox@mfmnyc.com.
authors: Nathan S
authors: NS
authors: Fox
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical; D005260:Female; D006801:Humans; D010808:Physical Examination; D011247:Pregnancy; D011256:Pregnancy Outcome; D059285:Pregnancy, Twin; D012189:Retrospective Studies; D016896:Treatment Outcome; D002581:Uterine Cervical Incompetence / Q000601:surgery*
keywords: Cerclage; Emergency; Physical examination; Preterm birth; Shirodkar; Twin