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A comparison of pregnancy outcome of emergency modified transvaginal cervicoisthmic cerclage performed in twin and singleton pregnancies

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To compare the pregnancy outcome of emergency cerclage performed in twin and singleton pregnancies.

Methods

A retrospective trial was carried out in the Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital in Zhejiang, China, from January 2013 to December 2018. A total of 89 women with acute cervical incompetence underwent the emergency cerclage. Main outcome measures were gestational age at delivery and the fetal outcome.

Results

There were 31 twin and 58 singleton pregnancies that underwent emergency cerclage. In singleton pregnancies, gestational age at delivery (31.57 ± 6.11 vs 28.81 ± 4.34, p = 0.016), and prolongation of pregnancy (8.69 ± 6.13 vs 5.41 ± 3.72, p < 0.001) were greater, and the preterm delivery rate before 34 weeks was lower (53.4% vs 80.6%, p = 0.011) compared with twin pregnancies. Fetal weight was greater in singletons than in twins (2377.3 ± 862.1 vs 1630.3 ± 557.6, p < 0.001), but the fetal survival rate was similar. The proportion of twin gestations was significantly higher in the group with preterm delivery before 34 weeks (44.6% vs 18.2%, p = 0.011) and the proportion of previous term delivery was higher in the group with delivery at or after 34 weeks (30.3% vs 12.5%, p = 0.039). The group with preterm delivery before 34 weeks had a significantly larger size of visible membranes at cerclage than the group with delivery at or after 34 weeks (2.23 ± 0.86 vs 1.64 ± 0.80, p = 0.001). In binary logistic regression analysis, twin gestations and a larger size of visible membranes were associated with an increased risk of preterm delivery.

Conclusion

The pregnancy outcome of emergency cerclage appears to have a better prognosis in singleton pregnancies than in twin pregnancies, and twin pregnancy is a risk factor for preterm delivery.

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Acknowledgements

We thank Ellen Knapp, PhD, from Liwen Bianji, Edanz Group China (https://www.liwenbianji.cn/ac), for editing the English text of a draft of this manuscript.

Funding

This study was sponsored by Key Research and Development Program of Zhejiang Province Grant 2017C03022.

Author information

Authors and Affiliations

  1. Center of Reproductive Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3# Qingchun East Road, Hangzhou, 310016, People’s Republic of China

    Minling Wei, Yang Yang, Xiaoying Jin, Jingyan Yang, Dong Huang & Songying Zhang

  2. Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou, 310016, People’s Republic of China

    Minling Wei, Yang Yang, Xiaoying Jin, Jingyan Yang, Dong Huang & Songying Zhang

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  1. Minling Wei
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Contributions

MW: data collection, data analysis, and manuscript writing. YY: data collection. XJ: data collection. JY: operation performed. DH: operation performed. SZ: project management and manuscript editing.

Corresponding author

Correspondence to Songying Zhang.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the Ethics Committee of Sir Run Run Shaw Hospital (Ethics Approval Number: 20200302-34).

Informed consent

All patients had signed the informed consent statement for cerclage before the operation. The study was exempted from signing the informed consent for clinical trials because of the characteristic of the retrospective study.

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Wei, M., Yang, Y., Jin, X. et al. A comparison of pregnancy outcome of emergency modified transvaginal cervicoisthmic cerclage performed in twin and singleton pregnancies. Arch Gynecol Obstet 303, 1197–1205 (2021). https://doi.org/10.1007/s00404-020-05852-4

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  • DOI: https://doi.org/10.1007/s00404-020-05852-4

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