Multifetal pregnancies are associated with poor outcomes. The goal of this study was to compare perinatal outcomes, in twin pregnancies complicated by short cervix managed with cerclage placement, to those managed expectantly.METHODS:
We performed a retrospective cohort study of twin pregnancies complicated with short cervix (defined as <2.5cm) diagnosed before 24 weeks of gestation, at our institution between 2010 and 2015. Neonatal and pregnancy outcomes of patients who had cerclage placed were compared to those who did not. Independent t-test and Pearson’s chi-square test was used for the data analysis.RESULTS:
835 twin pregnancies were reviewed. 33 patients (3.9%) had short cervix before 24 weeks of gestation. Fourteen (42.4%) of these patients had a cerclage placed. Of those whose pregnancies reached viability (75%), 15 (62.5%) did not have a cerclage in place, while nine (37.5%) did. Mean gestational age at delivery was significantly earlier in those who had a cerclage placed as compared to those who did not (27 versus 32 weeks; p = 0.03). Admission to the neonatal intensive care unit (NICU) was significantly higher in those who had a cerclage placed (9 vs. 12; p= 0.03). Birth weight was significantly lower, with a mean of 1010 grams in the cerclage group as compared to 1748 grams for those without a cerclage (p = 0.01).CONCLUSION:
Consistent with other meta-analyses, our study demonstrates that cerclage placement in twin pregnancies complicated by short cervix is associated with poorer outcomes. Cerclage placement should be used with caution, after performing a detailed risk-benefit analysis.