Efficacy of physical examination-indicated cerclage in twin pregnancies compared with singleton pregnancies: a systematic review and meta-analysis.

Abstract

INTRODUCTION To compare the pregnancy outcomes of physical examination-indicated cerclage (PEIC) between twin and singleton pregnancies with acute cervical insufficiency. EVIDENCE ACQUISITION We searched Medline, Ovid, Scopus, EBSCO, ClinicalTrials.gov and the Cochrane Central Register of Controlled Trials from their commencement until Dec 2019 for relevant studies. Patient-level data abstraction and analysis were done by two independent authors. EVIDENCE SYNTHESIS A total of five studies with 786 women were included in the final analysis. The pooled outcomes showed that PEIC was associated with a similar reduction in preterm birth (PTB) at <32 [Risk ratio (RR) 0.93, 95% CI 0.79- 1.11, I2 = 0%, P = 0.43], and 28 (RR 1.03, 95% CI 0.82-1.29, I2 = 0%, P = 0.81) weeks of gestation; however, a much higher frequency of PTB was observed at <36 (RR 0.74, 95% CI 0.66-0.83, I2 = 0%, P < 0.000), and 34 (RR 0.80, 95% CI 0.68- 0.93, I2 = 0%, P = 0.004) weeks of gestation in twin pregnancies than in singleton pregnancies. No significant differences in perinatal outcomes, including neonatal death (RR 1.03, 95% CI 0.64-1.67, I2 = 52%, P = 0.900), stillbirth (RR 0.73, 95% CI 0.37-1.44, I2=0%, P=0.360), perinatal mortality (RR 0.94, 95% CI 0.65-1.38, P = 0.760) and neonatal complications were found between twin and singleton pregnancies. CONCLUSIONS Our meta-analysis indicated that PEIC achieved good perinatal prognosis in both singleton and twin pregnancies. However, because the available evidence is insufficient to attain a strong conclusion, so further high-quality trials are needed to confirm our findings.