470: Comparison of physical examination and ultrasound indicated cerclages between singleton and twin pregnancies

Abstract

Physical examination indicated cerclage (PEIC) and Ultrasound indicated cerclage (UIC) are well stablished strategies for reducing preterm birth in singleton pregnancies. However, their indication in twin pregnancies is a controversial issue as no data from RCT are available to demonstrate their efficacy. The aim of this study was to compare perinatal outcomes after PEIC and UIC between singleton and twin gestations. Retrospective observational study including patients having PEIC or UIC in Hospital Clinic of Barcelona, from 2007 to 2016. Exclusion criteria were: monochorionic-monoamniotic placentation, major fetal anomalies and elective termination of pregnancy. Wilcoxon-test and Chi-square and Fisher’s exact test were used to compare continuous and categorical variables, respectively. Differences were considered statistically significant when p-value <0.05. 129 women with cercalge were evaluated. 60 women (43 singletons and 17 twins) underwent PEIC, and 2singleton pregnancies were lost to follow-up. 69women (56 singleton and 13 twins) underwent UIC, and 7 (6 singleton and 1 twin) were lost to follow up. Basal characteristics were similar between both PEIC groups, except that there were more twin pregnancies conceived by ART. Between UIC groups, there were more nulliparous and women with a previous preterm birth among twin pregnancies. Perinatal outcomes of PEIC and UIC are shown in Tables 1 and 2, respectively. No significant differences in the perinatal outcomes between singleton and twin pregnancies who underwent PEIC were observed. Regarding UIC, and despite latency to delivery in twins with UIC was significantly shorter compared to singletons, latency to delivery reached a median of 12 weeks. More PPROM and NICU admission were observed in twin pregnancies who underwent a UIC. Outcomes of PEIC were comparable between singleton and twin pregnancies. Outcome of UIC in twins show worse results compared to singletons but latency to delivery is still clinically relevant. Therefore, PEIC and UIC in twin pregnancies deserve further study as they may play a role as a therapeutic approach.View Large Image Figure ViewerDownload Hi-res image Download (PPT)