Ultrasound-indicated and physical examination-indicated cervical cerclage in twin versus singleton gestations

Abstract

Aim: To compare the safety and efficacy of ultrasound- and physical examination-indicated cervical cerclage in twin versus singleton gestations. Methods: A retrospective cohort study of all ultrasound-indicated (cervical length ≤ 25 mm) and physical examination-indicated cerclage cases performed over a 9-year period. The primary outcome was the time interval from cerclage placement to delivery. Results: The study cohort included 94 singleton and 16 twin pregnancies. The time interval from cerclage placement to delivery was comparable in singleton and twin gestations (14.77 vs. 12.07 weeks, p = 0.11), as were the rates of preterm births before 28 and 32 weeks. The rate of alive newborns >24 weeks was lower in the twin group (71.9% vs. 88.3%, p = 0.028). Regression analysis identified that cervical dilation, but not twin gestation, was the only factor independently associated with an increased risk for birth before 32 weeks. Conclusion: Ultrasound-indicated and physical examination-indicated cerclage had comparable efficacy in prolonging pregnancy in twin and singleton gestations, though live birth rates were lower in twins.