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Transvaginal cerclage for prevention of preterm birth in twin pregnancies with short cervix: a prospective cohort study
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  • Ming Liu,
  • Wenyi Xu,
  • Xiaotian Ni,
  • Yun Liu,
  • Lulu Meng,
  • Ping Ru,
  • Zhuorong Gu,
  • Yan Yan,
  • Wenjun Yuan,
  • xiujuan su,
  • Junyao Shi,
  • Tao Duan
Ming Liu
Tongji University Dongfang Hospital

Corresponding Author:2105059@tongji.edu.cn

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Wenyi Xu
Tongji University Dongfang Hospital
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Xiaotian Ni
Tongji University Dongfang Hospital
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Yun Liu
Tongji University Dongfang Hospital
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Lulu Meng
Tongji University Shanghai First Maternal and Infant Hospital
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Ping Ru
Tongji University Dongfang Hospital
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Zhuorong Gu
Tongren Hospital Shanghai Jiaotong University School of Medicine
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Yan Yan
Tongren Hospital Shanghai Jiaotong University School of Medicine
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Wenjun Yuan
Tongren Hospital Shanghai Jiaotong University School of Medicine
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xiujuan su
Tongji University Shanghai First Maternal and Infant Hospital
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Junyao Shi
Shanghai Pudong Center for women and children’s health
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Tao Duan
Tongji University Dongfang Hospital
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Abstract

Objective: To evaluate the efficacy of transvaginal cerclage for twins with cervical dilation or short cervix and to explore the indicated cervical length for transvaginal cerclage. Design: Prospective cohort study. Setting: Two tertiary hospitals in Shanghai, China. Population: A total of 177 twins with asymptomatic cervical dilation or cervical length ≤15 mm between 16 0/7 and 25 6/7 weeks. Methods: The logistic regression model and generalized estimation equation were used to compare the pregnancy outcomes between no-cerclage group and cerclage group followed by subgroup analysis of different cervical length. NNT and Kaplan‒Meier curves were used to estimate the efficacy of cerclage for twins in different groups. Main Outcome Measures: The primary outcome was gestational age at delivery and the neonatal survival rate within 3 months after birth. The secondary outcomes were the gestational latency from diagnosis to delivery and the risk of preterm birth before 26, 28, 32 and 34 weeks of gestation. Results: Compared with no-cerclage group, the gestational age at delivery (32.09±4.50 vs. 28.29±6.20 weeks, p<0.000) and the gestational latency from diagnosis to delivery (10.86 [7.14,13.86] vs. 3.00 [0.50,10.29] weeks, p<0.000) were longer in the cerclage group. The rate of neonatal survival (86.43% [223/258] vs. 47.92% [46/96], p<0.000) in the cerclage group was significantly higher. In the subgroup of twins with cervical dilation or cervical length <10 mm, twins in the cerclage group had significantly longer gestational age at delivery (31.33±4.63 vs. 23.44±4.25 weeks, p<0.001) and gestational latency from diagnosis to delivery (9.07 [6.29-13.57] vs. 0.43 [0.29-1.71] weeks, p<0.001). For twins with cervical length of 10-15mm, although the gestational latency (12 [9.14-13.86] vs. 9.93 [6.29-12.29] weeks, p=0.037) was significantly longer, there was no difference in gestational age at delivery (33.05±4.16 vs. 32.40±4.33 weeks, p=0.300) or neonatal survival rate (87.72% [100/114] vs. 80.77% [42/52], p=0.238) between the two groups. Conclusion: Cerclage was associated with improved maternal and neonatal outcomes in twins with cervical dilation or cervical length <15 mm. More evidence is needed to confirm the efficacy of transvaginal cerclage for twins with cervical length of 10 - 15 mm.