Prophylactic cerclage in the management of triplet pregnancies

Abstract

ObjectiveTo determine if prophylactic cerclage improves pregnancy outcome in women with triplet pregnancies.Study designTriplet pregnancies with ≥1 day of outpatient surveillance beginning at <32.0 weeks' gestation were identified from a database of women in the United States who received outpatient preterm labor surveillance services between 1/90 and 5/04. Triplet pregnancies managed with prophylactic cerclage were compared with triplet pregnancies in which cerclage was not placed. Patients with a diagnosis of cervical incompetence in a previous or in the index pregnancy were excluded from analysis. The primary outcome was incidence of preterm birth prior to 32 weeks. Demographic information, gestational age at delivery, and neonatal outcomes were also compared. Groups were compared using Fisher's Exact Test and Student's independent t test statistics. Two-sided P values < .05 were considered statistically significant.ResultsTabled 1TableNo CerclageCerclagen = 3,030n = 248P valueGA at delivery33.0 ± 2.533.1 ± 2.60.634<32 weeks27.5%27.4%1.000<28 weeks4.5%4.0%0.873Birth weight1819 ± 4761817 ± 4640.946Live weight99.3% (9,028)99.1% (737)0.617NICU admit81.1% (7, 376)79.8% (594)0.924Nursery days22.7 ± 20.621.1 ± 19.90.237 Open table in a new tab ConclusionIn triplet gestations wthout cervical incompetence in past or present pregnancy, prophylactic cerclage did not result in improved pregnancy and neonatal outcomes. ObjectiveTo determine if prophylactic cerclage improves pregnancy outcome in women with triplet pregnancies. To determine if prophylactic cerclage improves pregnancy outcome in women with triplet pregnancies. Study designTriplet pregnancies with ≥1 day of outpatient surveillance beginning at <32.0 weeks' gestation were identified from a database of women in the United States who received outpatient preterm labor surveillance services between 1/90 and 5/04. Triplet pregnancies managed with prophylactic cerclage were compared with triplet pregnancies in which cerclage was not placed. Patients with a diagnosis of cervical incompetence in a previous or in the index pregnancy were excluded from analysis. The primary outcome was incidence of preterm birth prior to 32 weeks. Demographic information, gestational age at delivery, and neonatal outcomes were also compared. Groups were compared using Fisher's Exact Test and Student's independent t test statistics. Two-sided P values < .05 were considered statistically significant. Triplet pregnancies with ≥1 day of outpatient surveillance beginning at <32.0 weeks' gestation were identified from a database of women in the United States who received outpatient preterm labor surveillance services between 1/90 and 5/04. Triplet pregnancies managed with prophylactic cerclage were compared with triplet pregnancies in which cerclage was not placed. Patients with a diagnosis of cervical incompetence in a previous or in the index pregnancy were excluded from analysis. The primary outcome was incidence of preterm birth prior to 32 weeks. Demographic information, gestational age at delivery, and neonatal outcomes were also compared. Groups were compared using Fisher's Exact Test and Student's independent t test statistics. Two-sided P values < .05 were considered statistically significant. ResultsTabled 1TableNo CerclageCerclagen = 3,030n = 248P valueGA at delivery33.0 ± 2.533.1 ± 2.60.634<32 weeks27.5%27.4%1.000<28 weeks4.5%4.0%0.873Birth weight1819 ± 4761817 ± 4640.946Live weight99.3% (9,028)99.1% (737)0.617NICU admit81.1% (7, 376)79.8% (594)0.924Nursery days22.7 ± 20.621.1 ± 19.90.237 Open table in a new tab ConclusionIn triplet gestations wthout cervical incompetence in past or present pregnancy, prophylactic cerclage did not result in improved pregnancy and neonatal outcomes. In triplet gestations wthout cervical incompetence in past or present pregnancy, prophylactic cerclage did not result in improved pregnancy and neonatal outcomes.