Cervical stitch (cerclage) for preventing preterm birth in multiple pregnancy

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Neonatology

Background:

• Cervical cerclage involves a surgical stitch to prevent premature cervical dilation and reduce preterm birth risk.
• Its efficacy and safety in multiple gestations (twins, triplets) remain controversial and require further investigation.

Purpose of the Study:

• To evaluate if cervical cerclage improves obstetrical and perinatal outcomes in multiple gestations.
• Assess outcomes for history-indicated, ultrasound-indicated, and physical exam-indicated cerclage compared to no cerclage.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) identified through the Cochrane Pregnancy and Childbirth Group's Trials Register.
• Included studies compared cervical cerclage versus no cerclage in multiple pregnancies; data extraction and risk of bias assessment were performed independently.

Main Results:

• Five trials involving 128 women (122 twins, 6 triplets) were analyzed.
• No statistically significant differences were found in perinatal deaths, serious neonatal morbidity, or composite outcomes between cerclage and no cerclage groups.
• Ultrasound-indicated cerclage showed a potential increased risk for low birthweight and respiratory distress syndrome, but data interpretation requires caution due to small sample sizes and heterogeneity.

Conclusions:

• Limited data from five small, average-to-above-average quality studies suggest no evidence that cervical cerclage is effective in preventing preterm birth or reducing perinatal mortality/morbidity in multiple gestations.
• Further research is needed, particularly on long-term infant neurodevelopmental outcomes.