Efficacy of emergency cervical cerclage in twin pregnancies and factors affecting the clinical effects of emergency cerclage

Abstract

Objectives

To estimate clinical effects of emergency cervical cerclage in twin pregnancies with cervical dilation ≥1.0 cm in mid-trimester of gestation and to identify risk factors after cerclage.

Methods

This retrospective cohort study included 99 twin pregnancies with cervical dilation ≥1cm in the mid-trimester of gestation at three institutions, from December 2015 through December 2021. The cases were treated with emergency cervical cerclage (52 cases) or expectant management (47 cases). Compare the pregnancy and neonatal outcomes of the two groups. Multiple logistic regression analysis was used to determine the independent risk factors associated with cerclage.

Results

Cerclage placement was associated with significantly longer gestation age and prolongation of the gestational latency (p < .05). In the cases, compared to expectant treatments, spontaneous preterm birth (sPTB) at <26, <28, <30, <32 weeks was significantly less frequent (p < .05). Pre-operation WBC > 11.55 × 10⁹/L, CRP > 10.1 and cervical dilation >3.5 cm were found to be independent risk factors for delivery 28 weeks after cerclage.

Conclusions

Cervical cerclage in twin pregnancies with cervical dilation ≥1.0 cm in mid-trimester of gestation may prolong pregnancy and gestation age, and improve pregnancy and neonatal outcomes compared with expectant management. The strongest predictor of sPTB before 28 weeks after ECC were pre-operation WBC >11.55 × 10^9/L, CRP > 10.1 and cervical dilation >3.5 cm.

Keywords:

• Emergency cervical cerclage
• cervical dilation
• twin pregnancy
• pregnancy outcomes
• risk factors

Acknowledgements

The authors thank the Staff at Women’s Hospital, Zhejiang University for technical assistance and facility support.

Ethical statement

The study protocol was approved by the Ethical Committee of Women Hospital, 293 Zhejiang University, School of Medicine in Hangzhou (IRB-20200044-R on May 21, 294 2020) and has been carried out according to the declaration of Helsinki.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The study is funded by the National Key Research and Development Program of China(No. 2018YFC1004603). The sponsors or funders play no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. .