Cervical Cerclage Performed at 24-32+0 Weeks in Twin Pregnancies: A Multicenter Descriptive Cohort Study.

Background and

Objectives

Twin pregnancies carry a high risk of preterm birth, and cerclage for a short or dilated cervix is typically placed before 24 weeks. Its use at or after 24 weeks is less well characterized in twins. Materials and

Methods

We describe the perinatal course of twin pregnancies that underwent cervical cerclage at 24-32+0 weeks at three university hospitals in South Korea between 2015 and 2024, with pregnancies treated before 24 weeks as a descriptive reference. Entry into the late group required remaining undelivered at 24 weeks without prior cerclage, so the groups do not share a common baseline and were not compared.

Results

Eighteen pregnancies received cerclage at 24-32+0 weeks (median 26.3 weeks), and 25 received it before 24 weeks. In the late group, delivery occurred at a median of 34.1 weeks (IQR 31.7-35.4) after a mean cerclage-to-delivery interval of 45.8 days (95% CI 34.7-56.9). No fetal, neonatal, or perinatal death occurred (0 of 36 fetuses in 18 pregnancies; 95% CI 0.0-17.6%, calculated on the 18 pregnancies). NICU admission was 83.3% (95% CI 62.3-93.8), and adverse neonatal morbidity was 55.6% (95% CI 34.2-75.0).

Conclusions

No perinatal death was recorded in this descriptive series. Because no untreated control group was available, these findings do not establish efficacy but provide a real-world basis for future prospective controlled trials.