Pregnancy outcomes and factors affecting the clinical effects of emergency cerclage in twin pregnancies with cervical dilation and prolapsed membranes

Objective To determine the effect of mid-trimester emergency cerclage in women with twin pregnancies with cervical dilation and prolapsed membranes, and to identify risk factors predicting spontaneous preterm birth (sPTB) before 28 weeks, after cerclage. Methods Retrospective analysis of twin gestations with cervical dilation and prolapsed membranes treated with emergency cerclage or expectant management (2015-2020). The primary outcomes were the rate of sPTB before 28 weeks and the gestational latency. Multiple logistic regression analysis was used to determine the factors associated with sPTB before 28 weeks, after cerclage. Results Ninety-seven women were included, cerclage (n = 58) or no cerclage (n = 39). Cerclage placement was associated with significantly lower incidence of sPTB before 28 weeks of pregnancy (34.5% vs 82.1%) and prolongation of the gestational latency (46.71 +/- 27.52 vs 10.95 +/- 11.71 days). Positive cervical culture (odds ratio [OR] 10.69, 95% confidence interval [CI] 1.82-62.95), pregnancy duration at diagnosis less than 22 weeks (OR 9.42; 95% CI 1.69-52.69) and cervical dilation at least 4 cm (OR 7.92; 95% CI 1.40-44.71) were found to be independent risk factors for sPTB before 28 weeks, after cerclage. Conclusion Emergency cerclage in women with twin pregnancies with cervical dilation and prolapsed membranes was associated with an overall 40% decrease in sPTB before 28 weeks and a prolongation of latency by 5 weeks. The strongest predictor of sPTB before 28 weeks after cerclage was a positive cervical culture.

Automated summary

Emergency cerclage in women with twin pregnancies with cervical dilation and prolapsed membranes significantly reduces the rate of sPTB before 28 weeks and extends gestational latency. Positive cervical culture, pregnancy duration at diagnosis less than 22 weeks, and cervical dilation of at least 4 cm were identified as independent risk factors for sPTB before 28 weeks after cerclage.