Tracy M Adams1,2, Timothy J Rafael1, Nadia B Kunzier1,2, Supriya Mishra3, Rose Calixte4, Anthony M Vintzileos1. 1. a Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , Winthrop University Hospital , Mineola , NY , USA. 2. b Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , Stony Brook University Medical Center , Stony Brook , NY , USA. 3. c Stony Brook University Health Sciences Center School of Medicine , Stony Brook , NY , USA. 4. d Department of Biostatistics , Winthrop University Hospital , Mineola , NY , USA.
Abstract
PURPOSE: To determine if use of cerclage in twin gestations with mid-trimester short cervix is associated with decreased preterm birth rate. STUDY DESIGN: 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)]. CONCLUSION: 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.
PURPOSE: To determine if use of cerclage in twin gestations with mid-trimester short cervix is associated with decreased preterm birth rate. STUDY DESIGN: 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)]. CONCLUSION: 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.
Authors: Michelle N Han; Betsy E O'Donnell; Melanie M Maykin; Juan M Gonzalez; Khalil Tabsh; Stephanie L Gaw Journal: J Matern Fetal Neonatal Med Date: 2018-01-23
Authors: Vinh Q Dang; Yen Tn He; Ha Nh Pham; Tuyen Tt Trieu; Trung Q Bui; Nhu T Vuong; Loc Mt Nguyen; Diem Tn Nguyen; Thanh V Le; Wentao Li; Cam H Le; Ben W Mol; Lan N Vuong Journal: BMJ Open Date: 2020-06-16 Impact factor: 2.692