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Physical examination-indicated cerclage in twin pregnancy: a retrospective cohort study

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

Abstract

Purpose

This study aimed to evaluate the efficacy of physical examination–indicated cerclage in twin pregnancies and compare it with those that received conservative management.

Methods

We used a retrospective cohort study design of asymptomatic twin pregnancies identified with physical examination indications at 14–26 weeks from 2015 through 2019 at Fujian Maternity and Child Health Hospital. The primary outcomes were gestational age (GA) at delivery and the incidence of spontaneous preterm birth (SPTB) at < 34 weeks, < 32 weeks, < 28 weeks, and < 24 weeks. The main secondary outcomes were latency period from diagnosis to delivery, composite neonatal adverse outcome and neonatal survival at discharge.

Results

Thirty–one women with twin pregnancies were managed with physical examination-indicated cerclage, and another 31 received expectant management. The demographic characteristics of the two groups were not significantly different. GA at delivery was significantly later in the cerclage group than in the controls: 32.53 ± 4.78 vs. 27.53 ± 4.15 weeks, with a mean difference of 5.00 weeks [95% confidence interval (CI), 2.73–7.28]. There were significant decreases in the incidence of spontaneous preterm birth (SPTB) at < 34 weeks, < 32 weeks, < 28 weeks, and < 24 weeks in the cerclage group. The interval from diagnosis to delivery was increased with cerclage by a mean difference of 4.37 weeks (95% CI, 1.96–7.06). Regarding neonatal outcome, the perinatal mortality rate in the cerclage group was significantly reduced compared to that in the control group [8/62 (12.9%) vs. 26/62 (41.9%); P < 0001]. Likewise, the neonatal intensive care unit (NICU) admissions, length of stay in the NICU, and composite adverse neonatal outcome in the cerclage group were significantly reduced.

Conclusion

Physical examination–indicated cerclage was associated with significantly later GA at delivery, longer latency period from diagnosis to delivery, decreased incidence of SPTB at any given GA, and improved perinatal outcome compared with the corresponding measures in controls treated conservatively.

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Acknowledgements

We thank Xiaoxiao Wang, MD (Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital) for her help in revising the manuscript.

Funding

This research was supported by Fujian Key Laboratory of Women and Children's Critical Diseases Research [Fujian Maternity and Child Health Hospital]; and, with funds from Fujian Maternity and Child Health Hospital Innovation Project under Contract No.YCXZ18-21.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350108, Fujian, China

    Mian Pan, Jun Zhang, Xiaoxiang Jiang & Danlin Yang

  2. Department of Neonatology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350108, Fujian, China

    Xia Ouyang

  3. School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China

    Wenqiang Zhan

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  1. Mian Pan
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Contributions

MP: Data Collection, project development, data management and analysis, manuscript writing. JZ: Project development, management and analysis, manuscript writing and editing. WZ: Data collection, management and analysis. XO: Data analysis, manuscript editing. XJ: Data collection and analysis. DY: Data collection and analysis.

Corresponding author

Correspondence to Jun 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 approved by the Fujian Maternity and Child Health Hospital of China Ethics Committee (Ethical approval number: 2019-014), and are in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Because our study was retrospective and all clinical data were anonymized, consent for participation was not required.

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Pan, M., Zhang, J., Zhan, W. et al. Physical examination-indicated cerclage in twin pregnancy: a retrospective cohort study. Arch Gynecol Obstet 303, 665–676 (2021). https://doi.org/10.1007/s00404-020-05777-y

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  • DOI: https://doi.org/10.1007/s00404-020-05777-y

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