The use of ultrasound-indicated cerclage or cervical pessary in asymptomatic twin pregnancies with a short cervix at midgestation.

Abstract

Spontaneous preterm birth in women with a twin pregnancy is one of the main causes of perinatal mortality and morbidity. Our aim was to review the perinatal outcome of asymptomatic twin pregnancies with a sonographic short cervical length during the second trimester treated with an ultrasound-indicated cerclage or cervical pessary. Retrospective study on asymptomatic twin pregnancies with a short cervix (≤25mm) at transvaginal ultrasound examination during the second trimester treated with a cervical cerclage or pessary (2001-2017). The rate of preterm birth <28, 32 and 34weeks of gestation, neonatal mortality, neonatal morbidity and composite adverse neonatal outcome were compared in the groups of women treated with cerclage or pessary. Seventy-four twin pregnancies underwent a cerclage while a cervical pessary was inserted in 34 women with twins at our Department: 36 women with an ultrasound-indicated cerclage and 20 with a pessary were included in the analysis. Median gestational age at delivery was higher in women treated with cerclage compared with those with pessary placement (P=.02) and the rate of preterm birth before 34weeks of gestation was lower in the cerclage group (P=.03). Admissions to the Neonatal Intensive Care Unit were more frequent in pregnancies with pessary (P=.01), the length of admission was longer (P=.005) and composite adverse neonatal outcome occurred more often (P=.03) compared with the cerclage group. Ultrasound-indicated cerclage appears to reduce the rate of preterm birth before 34weeks of gestation in asymptomatic twin pregnancies with a short cervix during the second trimester, and also the composite adverse neonatal outcome compared with pessary.