Comparison of Management Options for Twin Pregnancies Affected by Midtrimester Incidental Cervical Shortening [30J

Abstract

INTRODUCTION: Prematurity is the leading cause of neonatal death and twin gestations account for 25% of preterm deliveries. Cervical shortening is a risk factor for preterm delivery. The purpose of our study is to evaluate strategies to prevent spontaneous preterm birth in twins with a short cervix by transvaginal sonogram. METHODS: Retrospective cohort study comparing expectant management, vaginal progesterone and cerclage in the management of cervical shortening (<2.5 cm) in twins. Information regarding baseline characteristics and pregnancy outcomes were obtained. Comparisons were made using Student t-test for continuous variables and χ2 analysis or Fisher exact test for categorical variables. RESULTS: Between January 2006 and July 2016, 93 pairs of twin gestations with cervical shortening were identified. Strategies included expectant management (n=41, 44.1%), cerclage (n=30, 32.3%) and vaginal progesterone (n=22, 23.7%). Demographic characteristics were similar between groups. A trend was observed towards a shorter cervical length in cerclage group (1.67 cm expectant management, 1.31 cm cerclage and 1.77 cm vaginal progesterone, P=.06). Delivery information was available for 73 patients. Gestational age at delivery was similar between groups (31.7 weeks +- 4.6 in expectant management, 30.6 weeks +- 4.9 in cerclage and 32.5 weeks +- 3.9 in vaginal progesterone, P=.39). Rate of chorioamnionitis was also similar. CONCLUSION: Our data suggest that the gestational age at delivery of twin gestations with cervical shortening is not impacted by management strategy. There was no benefit to cerclage placement in preventing preterm birth. Large randomized studies comparing expectant management, vaginal progesterone and cervical cerclage are essential before altering clinical practice.