Ultrasound-Indicated Versus Physical Examination-Indicated Cerclage in Twin Pregnancies Between 24 and 27 + 6 Weeks: An Exploratory Observational Analysis of Pregnancy and Neonatal Outcomes.

BACKGROUND

Recent advancements in assisted reproductive technology and delayed parenthood have led to a surge in twin pregnancies, with a high incidence of preterm birth (PTB) due to cervical insufficiency. Current guidelines recommend cervical cerclage for twin pregnancies before 24 weeks; however, data on cerclage efficacy beyond 24 weeks is scarce.

OBJECTIVE

This exploratory, hypothesis-generating study is aimed at examining the associations of cervical cerclage on pregnancy duration and neonatal outcomes in twin pregnancies with a short cervix between 24 and 27 + 6 weeks.

METHODS

This retrospective cohort study, conducted between July 1991 and July 2023 at Women's Hospital, Zhejiang University School of Medicine, involved twin pregnancies with a short cervix (≤ 25 mm) during the gestational period ranging from 24 weeks to 27 + 6 weeks. Skilled obstetricians performed cervical cerclage. Data on maternal and neonatal outcomes were collected and analyzed using statistical tests, with statistical significance set at p < 0.05.

RESULTS

A total of 73 twin pregnancies were analyzed. Participants were categorized into ultrasound-indicated cerclage group (n = 22), physical examination-indicated cerclage group (n = 33), and control group (n = 18). The ultrasound-indicated cerclage group showed significantly longer presentation-to-birth intervals (60.77 ± 21.64 days, p = 0.007) and higher birth weights (larger twin: 2273.33 ± 566.09 g, p = 0.026; smaller twin: 2086.90 ± 526.58 g, p = 0.029) compared with the control group. No significant differences were found in gestational age at delivery, Apgar scores, cesarean delivery rates, maternal morbidity, and neonatal morbidity among both groups.

CONCLUSIONS

Ultrasound-indicated cerclage in twin pregnancies at 24-27 + 6 weeks was observed to prolong presentation-to-birth interval and increase birth weight, whereas physical examination-indicated cerclage showed no statistically significant association with the measured outcomes. A randomized controlled clinical trial is needed to validate these findings.