Routine cervical cerclage in higher order multiple gestation -- does it prolong the pregnancy?

Area of Science:

• Maternal-Fetal Medicine
• Perinatology
• Obstetrics

Background:

• Preterm birth due to cervical dilatation poses a significant risk to infants in multiple pregnancies.
• Limited data exists on the efficacy of prophylactic cerclage in managing these high-risk pregnancies.

Purpose of the Study:

• To evaluate the impact of prophylactic cervical cerclage on maternal and perinatal outcomes in triplet, quadruplet, and quintuplet pregnancies.
• To compare outcomes between women who received prophylactic cerclage and those who did not.

Main Methods:

• Retrospective comparison of 94 triplet and 18 quadruplet/quintuplet pregnancies with and without prophylactic cerclage.
• Non-parametric statistical tests (Kruskal-Wallis, Mann-Whitney-U) and frequency analysis (Chi Square, Fisher's exact test) were employed.
• Odds ratios were calculated to assess intravenous tocolysis, perinatal morbidity, and mortality.

Main Results:

• No significant difference in gestational age at delivery was observed between cerclage and non-cerclage groups.
• Birth weight showed a slight advantage for non-cerclage triplets but favored cerclage in quadruplets/quintuplets.
• Perinatal outcomes, including arterial pH, APGAR scores, and mortality, were not improved; quadruplet/quintuplet morbidity was higher with cerclage.

Conclusions:

• Prophylactic cervical cerclage does not demonstrate a positive impact on pregnancy management or perinatal outcomes in multifetal pregnancies.
• The procedure did not improve gestational age, hospitalisation rates, or medical interventions.
• Results suggest that cervical cerclage should not be routinely recommended for multifetal pregnancies based on this data.