Cerclage placement in twin pregnancies with cervical dilation: a systematic review and meta-analysis

Abstract

Objective

Existing guidelines and studies on the benefits of cerclage in twin pregnancies with a dilated cervix have low reliability and inconsistent conclusions. New randomized control trials and cohort studies focusing on twin pregnancies with cervical insufficiency were published recently. Therefore, this meta-analysis aimed to compare outcomes of cerclage placement and expectant treatment in twin pregnancies with a dilated cervix using recent data.

Methods

We screened the PubMed, Web of Science, ClinicalTrials.gov, and Cochrane Library databases to identify randomized controlled trials and cohort studies comparing maternal and perinatal outcomes of twin pregnancies with cervical dilation, with and without cerclage placement, published until December 2020. Estimates were pooled using random-effects or fixed-effect models depending on the heterogeneity. Mean difference, 95% confidence interval, and relative risk were used to compare the outcomes. The risk of bias was assessed using the Cochrane Handbook and the Newcastle-Ottawa Scale. The meta-analyses followed the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard and the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines for systematic reviews of observational studies.

Results

Five studies, comprising 275 twin pregnancies, met the inclusion criteria; of those, 167 underwent cerclage and 108 were expectantly managed. Cerclage placement significantly prolonged the interval from the time of diagnosis to delivery and reduced the incidence of preterm delivery, perinatal death, and complications. The fetal outcomes improved significantly in cases managed with cerclage.

Conclusion

Therefore, emergent cerclage is a potential option for managing twin pregnancies with cervical dilation of at least 1 cm.

Keywords:

• Cervical cerclage
• twin pregnancy
• cervical dilation
• preterm birth
• meta-analysis

Acknowledgments

The authors would like to express their appreciation to Dr. Ma Yubo from the Department of Epidemiology and Biostatistics, Anhui Medical University, for providing valuable guidance on literature review and data analysis.

Ethical approval

Because the meta-analysis does not detail work directly involving humans, the requirement of informed consent and ethical approval was waived due to the study’s nature.

Disclosure statement

The authors repgort no conflict of interest.

Data availability statement

The datasets used and analyzed in this study are available from the corresponding author upon reasonable request.

Additional information

Funding

This work was funded by National Natural Science Foundation of China (No. 82071679), Natural Science Foundation of Anhui Province (2008085MH286), and Basic and Clinical Cooperative Research Promotion Program of Anhui Medical University (No. 2019xkjT020). All the foundations sponsored the analysis and interpretation of the data. The funding did not play additional roles in the study.