Does cervical cerclage decrease preterm birth in twin pregnancies with a short cervix?
OBJECTIVE
To determine if use of cerclage in twin gestations with mid-trimester short cervix is associated with decreased preterm birth rate.


METHODS
This is a retrospective cohort of twin gestations identified with cervical length of ≤2.5 cm before 24 weeks of gestation through the perinatal ultrasound database of two institutions from 2008 to 2014. Patients with and without cerclage were compared for a primary outcome of preterm birth at <35 weeks. A pre-planned sub-group analysis of patients with cervical length ≤1.5 cm was also performed.


RESULTS
Eighty-two patients were included; 43 received cerclage, 39 did not. Mean gestational age at cerclage placement was 20.8 weeks. There was no significant difference in rate of preterm birth <35 weeks between the groups (34.9% versus 48.7%, respectively). In the sub-group analysis of patients with cervical length ≤1.5 cm, there was a significant decreased risk of preterm birth <35 weeks [37% versus 71.4%; adjusted RR 0.49 (0.26-0.93)].


CONCLUSIONS
Cerclage placement for cervical length ≤2.5 cm in twin gestations did not decrease the rate of preterm birth at <35 weeks; however, cerclage placement for cervical length ≤1.5 cm was associated with a significantly decreased rate of preterm birth <35 weeks when compared to patients managed without cerclage.
a Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , Winthrop University Hospital , Mineola , NY , USA.|b Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , Stony Brook University Medical Center , Stony Brook , NY , USA.
Tracy M
TM
Adams
a Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , Winthrop University Hospital , Mineola , NY , USA.
Timothy J
TJ
Rafael
a Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , Winthrop University Hospital , Mineola , NY , USA.|b Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , Stony Brook University Medical Center , Stony Brook , NY , USA.
Nadia B
NB
Kunzier
c Stony Brook University Health Sciences Center School of Medicine , Stony Brook , NY , USA.
Supriya
S
Mishra
d Department of Biostatistics , Winthrop University Hospital , Mineola , NY , USA.
Rose
http://orcid.org/0000-0002-2020-5906
R
Calixte
a Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , Winthrop University Hospital , Mineola , NY , USA.
Anthony M
AM
Vintzileos
D000328:Adult; D023802:Cerclage, Cervical; D005260:Female; D006801:Humans; D011247:Pregnancy; D059285:Pregnancy, Twin; D047928:Premature Birth / Q000517:prevention & control*; D012189:Retrospective Studies; D055815:Young Adult
Cerclage; cervical length; multiple gestation; pessary; preterm birth; progesterone