630 Management of short cervix in twin-twin transfusion syndrome

Abstract

There is no proven treatment for prevention of preterm birth (PTB) in twin-twin transfusion syndrome (TTTS). Our objective is to compare pregnancy and neonatal outcomes following cervical cerclage to cervical pessary in twin pregnancies complicated by TTTS and short cervix. We conducted a retrospective cohort study of all TTTS cases with a cervical length <30mm at time of evaluation managed in a single center between 2008 – 2018. The TTTS was managed with expectant management, amnioreduction, or selective fetoscopic laser photocoagulation (SFLP). Pregnancies with congenital abnormalities were excluded. Comparisons were made using the Student’s t, Mann-Whitney U, Kruskall-Wallis, and Chi-squared tests as appropriate, with significance reported as p < 0.05. Of 1,340 pregnancies with TTTS evaluated in our center during the study period, 122 had a cervical length <30mm and met inclusion criteria. Cervical cerclage was placed in 79 pregnancies, and cervical pessary in 29. There were no statistical differences in the baseline characteristics between the cerclage and pessary groups. No differences were noted in gestational age at delivery, indications for delivery, pregnancy complications, or survival between the cervical cerclage and pessary groups. In pregnancies complicated by TTTS and short cervix, similar outcomes were noted when treated with cervical cerclage or pessary. A pessary may offer a less invasive treatment option with similar results. Future studies are needed to determine the optimal treatment strategy in these complex pregnancies.View Large Image Figure ViewerDownload Hi-res image Download (PPT)