The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians · 2026
Comparison of two strategies to prevent preterm birth in twins complicated by cervical insufficiency: a retrospective cohort study.
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Liu Yun, Meng Lulu, Ni Xiaotian, Ru Ping, Xu Wenyi, Gu Zhuorong, Shi Junyao, Wang Ling, Su Xiujuan, Liu Ming, Duan Tao
Аннотация
OBJECTIVE: The strategies of preventing preterm birth in twin pregnancies complicated by cervical insufficiency is controversial. We compared the efficacy of fetal reduction combined with prophylactic cervical cerclage and prophylactic cervical cerclage alone in preventing preterm birth in this population.
METHODS: A retrospective cohort study was conducted in two tertiary hospitals in China. A total of 82 twins complicated by cervical insufficiency who received either fetal reduction combined with cervical cerclage treatment (reduction group, n = 40) or only prophylactic cervical cerclage (ongoing group, n = 42) were included in this study. The primary outcome is gestational age at delivery. The secondary outcomes included series of maternal and neonatal outcomes.
RESULTS: Compared with the ongoing group, twins in the reduction group had a higher median gestational age (38.1 vs. 35.0 weeks, p < 0.001) and lower rates of preterm birth of <24 weeks (0% vs. 14.3%, p = 0.03), <28 weeks (2.5% vs. 19.0%, p = 0.03), <34 weeks (15.0% vs. 38.1%, p = 0.02), and <37 weeks of gestation (27.5% vs. 73.8%, p < 0.001). Regarding the neonatal outcomes, pregnancies in the reduction group had a greater median birth weight (3110.0 vs.2282.5 g, p < 0.001), lower rates of birth weight <2500 g (25.0% vs. 64.3%, p < 0.001), birth weight <1500 g (2.5% vs. 23.8%, p = 0.002), neonatal intensive care unit admission (15.0% vs. 41.7%, p = 0.005), and respiratory distress syndrome (7.5% vs. 25.0%, p = 0.02), compared with the ongoing group. Neonatal survival rate in the reduction group had an insignificant higher trend than that in the ongoing group (97.5% vs. 85.7%, p = 0.059). Multivariate regression analysis showed that fetal reduction combined with cervical cerclage treatment was associated with a lower risk of preterm birth <34 weeks (aOR 0.25, 95% CI 0.08-0.83, p = 0.02) and <37 weeks (aOR 0.13, 95% CI (0.05-0.37), p < 0.001) of gestation.
CONCLUSIONS: Fetal reduction combined with cervical cerclage strategy was associated with optimized gestational age at delivery and neonatal birth weight in twin pregnancies complicated by cervical insufficiency, representing a relatively safe strategy to prevent preterm birth in this population.
METHODS: A retrospective cohort study was conducted in two tertiary hospitals in China. A total of 82 twins complicated by cervical insufficiency who received either fetal reduction combined with cervical cerclage treatment (reduction group, n = 40) or only prophylactic cervical cerclage (ongoing group, n = 42) were included in this study. The primary outcome is gestational age at delivery. The secondary outcomes included series of maternal and neonatal outcomes.
RESULTS: Compared with the ongoing group, twins in the reduction group had a higher median gestational age (38.1 vs. 35.0 weeks, p < 0.001) and lower rates of preterm birth of <24 weeks (0% vs. 14.3%, p = 0.03), <28 weeks (2.5% vs. 19.0%, p = 0.03), <34 weeks (15.0% vs. 38.1%, p = 0.02), and <37 weeks of gestation (27.5% vs. 73.8%, p < 0.001). Regarding the neonatal outcomes, pregnancies in the reduction group had a greater median birth weight (3110.0 vs.2282.5 g, p < 0.001), lower rates of birth weight <2500 g (25.0% vs. 64.3%, p < 0.001), birth weight <1500 g (2.5% vs. 23.8%, p = 0.002), neonatal intensive care unit admission (15.0% vs. 41.7%, p = 0.005), and respiratory distress syndrome (7.5% vs. 25.0%, p = 0.02), compared with the ongoing group. Neonatal survival rate in the reduction group had an insignificant higher trend than that in the ongoing group (97.5% vs. 85.7%, p = 0.059). Multivariate regression analysis showed that fetal reduction combined with cervical cerclage treatment was associated with a lower risk of preterm birth <34 weeks (aOR 0.25, 95% CI 0.08-0.83, p = 0.02) and <37 weeks (aOR 0.13, 95% CI (0.05-0.37), p < 0.001) of gestation.
CONCLUSIONS: Fetal reduction combined with cervical cerclage strategy was associated with optimized gestational age at delivery and neonatal birth weight in twin pregnancies complicated by cervical insufficiency, representing a relatively safe strategy to prevent preterm birth in this population.