Emergency cerclage in cases of twin-to-twin transfusion syndrome with a short cervix at the time of surgery and relationship to perinatal outcome

Objective To evaluate the impact of emergency cerclage on perinatal outcome in cases presenting with cervical length less than fifth centile at the time of laser surgery. Population and Methods Observational study of severe twin-to-twin transfusion syndrome (TTTS) cases diagnosed before 26 weeks of gestation and treated by fetoscopic selective laser coagulation (FSLC). Transvaginal sonographic measurement of cervical length prior to treatment identified cases with cervical length less than fifth centile (15 mm). Expectant management was followed in these cases prior to 2004, and a McDonald suture was performed immediately after laser surgery from 2004 onwards. Outcome was compared in patients with and without cerclage. Results Cervical length was a strong predictor for gestational age (GA) at delivery (p = 0.005). Mean GA at laser therapy was comparable [22.4 (+/- 2.1) and 22.1 (+/- 2) in patients with (n = 9) and without cerclage (n = 5), respectively, (p = 0.8)], whereas mean (SD) GA at delivery was 30.5 (+/- 4.3) and 23.1 (+/- 2.6) weeks in patients with and without cerclage, respectively, (P = 0.004). There were 16 (89%) and 4 (40%) surviving twins in cases with and without cerclage, respectively (p = 0.01). Conclusions In TTTS treated by laser, cervical length before treatment is significantly associated with GA at delivery. In cases with cervix <15 mm, emergency cerclage may prolong the pregnancy and allow for better outcome. Copyright (C) 2008 John Wiley & Sons, Ltd.