Abstract
Objective To determine if prophylactic cerclage improves pregnancy outcomes in women with twin
pregnancies without a history of cervical insufficiency.
Study Design Women with twin pregnancies who received outpatient preterm labor surveillance services
between January 1990 and May 2004 for ≥1 day beginning at < 28.0 weeks' gestation
were identified from a database. Patients with previous preterm delivery or a diagnosis
of cervical incompetence in a previous or in the index pregnancy were excluded. Twin
pregnancies managed with prophylactic cerclage were compared with twin pregnancies
in which cerclage was not placed. The primary outcome was incidence of preterm birth
prior to 32 weeks. Groups were compared using Fisher exact and Mann-Whitney U test statistics.
Results Overall, 8,218 twin pregnancies met inclusion criteria, of which 146 women (1.8%)
received prophylactic cerclage. Patients who received prophylactic cerclage had a
significantly higher incidence of preterm birth before 32 weeks and infants with lower
mean birth weight and longer nursery stays. No significant difference was seen in
mean gestational age at delivery. This study had 80% power to detect a 7% reduction
in the primary outcome.
Conclusion Prophylactic cerclage was not associated with a lower risk of preterm birth and adverse
neonatal outcomes in twin pregnancies without history of cervical insufficiency.
Keywords
twin - cerclage - preterm birth - multiple gestation
