Ultrasound-indicated and physical examination-indicated cervical cerclage in twin versus singleton gestations

Abstract

Aim

To compare the safety and efficacy of ultrasound- and physical examination-indicated cervical cerclage in twin versus singleton gestations.

Methods

A retrospective cohort study of all ultrasound-indicated (cervical length ≤ 25 mm) and physical examination-indicated cerclage cases performed over a 9-year period. The primary outcome was the time interval from cerclage placement to delivery.

Results

The study cohort included 94 singleton and 16 twin pregnancies. The time interval from cerclage placement to delivery was comparable in singleton and twin gestations (14.77 vs. 12.07 weeks, p = 0.11), as were the rates of preterm births before 28 and 32 weeks. The rate of alive newborns >24 weeks was lower in the twin group (71.9% vs. 88.3%, p = 0.028). Regression analysis identified that cervical dilation, but not twin gestation, was the only factor independently associated with an increased risk for birth before 32 weeks.

Conclusion

Ultrasound-indicated and physical examination-indicated cerclage had comparable efficacy in prolonging pregnancy in twin and singleton gestations, though live birth rates were lower in twins.