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Cervical cerclage in twin pregnancies
Cristina Zanardini1, Giorgio Pagani, Anna Fichera
1Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy. zanardini.cristina@gmail.com
Archives of Gynecology and Obstetrics
|February 23, 2013
Summary
Cervical cerclage (CC) in twin pregnancies shows high risk for preterm birth but good perinatal survival. Further trials are needed to confirm CC efficacy, especially for physical examination-indicated cases.
Area of Science:
- Maternal-Fetal Medicine
- Perinatology
- Obstetrics
Background:
- Twin pregnancies face increased risks of preterm birth.
- Cervical cerclage (CC) is a procedure to prevent preterm delivery.
- The efficacy of CC in twin gestations requires further investigation.
Purpose of the Study:
- To evaluate the outcomes of cervical cerclage (CC) in twin pregnancies.
- To compare outcomes between ultrasound-indicated and physical examination-indicated CC.
Main Methods:
- Retrospective analysis of twin pregnancies undergoing CC (2001-2009).
- CC offered for cervical length ≤ 20 mm or dilatation with membranes present.
- Preoperative swabs, perioperative antibiotics, and tocolysis were administered.
Main Results:
- 32% preterm delivery (<34 weeks) for ultrasound-indicated CC vs. 50% for physical examination-indicated CC.
- Perinatal survival was 96% (ultrasound-indicated) and 86% (physical examination-indicated).
- Positive swab cultures occurred in 21% of cases.
Conclusions:
- Twin pregnancies undergoing CC have a high risk of preterm delivery but high perinatal survival.
- The study highlights the need for well-designed trials to re-evaluate CC efficacy in twin pregnancies.
- Physical examination-indicated CC warrants particular attention in future research.
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