Outcomes following rescue cerclage in twin pregnancies

Objective: Our aim was to compare perinatal outcomes in twin pregnancies complicated by premature asymptomatic cervical dilatation treated with rescue cerclage and expectant management.Methods: A retrospective cohort study was conducted at a single tertiary referral center between 2003 and 2014 and included all women with twins found to have a dilated cervix with intact membranes before 25-week gestation. Pregnancy outcomes were compared between women with rescue cerclage and those managed expectantly. A total of 36 women were eligible for the study, 27 (75.0%) of whom had a rescue cerclage compared to 9 (25.0%) women managed expectantly. Student's t-test was used to compare continuous variables between the groups and the chi-square and Fisher's exact tests were used for categorical variables as appropriate. Statistical analysis was performed with the SPSS v21.0 software (IBM Corp; Armonk, NY). Differences were considered significant when the p value was less than .05.Results: Among the 27 women with a rescue cerclage, the mean gestational age at time of cerclage insertion was 21.52.6 weeks. The intervention and control groups were similar with respect to the degree of cervical dilatation at presentation (2.6 +/- 1.3 versus 3.0 +/- 1.5cm, p=.5). Women in the cerclage group gave birth at a more advanced gestation (28.9 +/- 6.1 versus 24.2 +/- 2.6weeks, respectively, p=.03) and were less likely to give birth at <34 and <28weeks (66.7 versus 100.0%, p=.046, and 59.3 versus 100.0%, p=.02, respectively). The mean latency from the placement of cerclage to delivery was 7.3 +/- 5.5 weeks. Similar findings were observed when analysis was limited to women with cervical dilatation of 3cm at presentation.Conclusions: In asymptomatic women with twin pregnancies and cervical dilatation before 25weeks of gestation, rescue cerclage can prolong pregnancy and improve perinatal outcomes when compared to expectant management.