Objective: Our aim was to compare perinatal outcomes in twin pregnancies complicated by premature asymptomatic cervical dilatation treated with rescue cerclage and expectant management.
Methods: A retrospective cohort study was conducted at a single tertiary referral center between 2003 and 2014 and included all women with twins found to have a dilated cervix with intact membranes before 25-week gestation. Pregnancy outcomes were compared between women with rescue cerclage and those managed expectantly. A total of 36 women were eligible for the study, 27 (75.0%) of whom had a rescue cerclage compared to 9 (25.0%) women managed expectantly. Student's t-test was used to compare continuous variables between the groups and the chi-square and Fisher's exact tests were used for categorical variables as appropriate. Statistical analysis was performed with the SPSS v21.0 software (IBM Corp; Armonk, NY). Differences were considered significant when the p value was less than .05.
Results: Among the 27 women with a rescue cerclage, the mean gestational age at time of cerclage insertion was 21.5 ± 2.6 weeks. The intervention and control groups were similar with respect to the degree of cervical dilatation at presentation (2.6 ± 1.3 versus 3.0 ± 1.5 cm, p = .5). Women in the cerclage group gave birth at a more advanced gestation (28.9 ± 6.1 versus 24.2 ± 2.6 weeks, respectively, p = .03) and were less likely to give birth at <34 and <28 weeks (66.7 versus 100.0%, p = .046, and 59.3 versus 100.0%, p = .02, respectively). The mean latency from the placement of cerclage to delivery was 7.3 ± 5.5 weeks. Similar findings were observed when analysis was limited to women with cervical dilatation of ≤3 cm at presentation.
Conclusions: In asymptomatic women with twin pregnancies and cervical dilatation before 25 weeks of gestation, rescue cerclage can prolong pregnancy and improve perinatal outcomes when compared to expectant management.
Keywords: Multiple gestations; preterm birth; rescue cerclage; twins.