(771) The effects of cerclage in twin pregnancies according to cervical length: a multicenter retrospective study

Friday, February 10, 2023

10:30 AM – 12:00 PM

Objective: To determine the efficacy of cerclage in twin pregnancies according to cervical length (CL) in mid-trimester

Study Design: A multicenter retrospective cohort study was performed from 10 tertiary centers. The study population included twin pregnancies who had delivered after 20 weeks of gestation. Cases with one or two fetal demises before 20 weeks were excluded. Electronic medical records were reviewed. Short CL was defined as ≤ 2.5cm.

Results: Among 1,473 cases with available data about CL measured before 24 weeks, 7 patients who had received cerclage before measurement of CL were excluded from the analysis. Short CL was diagnosed in 127 cases and 42% (53/127) received cerclage. Among the cases without short CL, maternal baseline characteristics were comparable between two groups, however the mean value of maternal age was significantly higher in the group without cerclage than that with in the cases with short CL (36 vs. 34 years, p=0.020). The group with cerclage had significantly higher rate of preterm labor (63% vs. 22%, p < 0.001) and histologic chorioamnionitis (33% vs. 10%, p=0.006) than that without cerclage among the cases without short CL. The Cox-proportional hazards regression showed cerclage group had significantly shorter gestational age at delivery with hazard ratio (HR) 1.8; 95% confidence interval (CI) 1.11-2.87; p-value=0.016 among the cases without short CL. Among the cases with short CL, cerclage group significantly prolonged gestational age (HR 0.5, 95% CI 0.28-0.77, p-value=0.003) and had longer interval from CL measurement to delivery (HR 0.5; 95% CI 0.30-0.82; p-value=0.006). The cerclage group had significantly lower rates of respiratory distress syndrome and bronchopulmonary dysplasia in neonates than the other (both p < 0.05 in multivariate logistic regression) in the cases with short CL.

Conclusion: The cerclage in twin pregnancies with short CL ≤ 2.5cm showed significant prolongation of pregnancy and lower neonatal respiratory morbidities, however cerclage to cases without short CL might increase the risk of preterm labor and histologic chorioamnionitis.

Primary Author(s)

Jee Yoon Park, MD (she/her/hers)
Seoul National University Bundang Hospital
Seongnam-si, Kyonggi-do, Republic of Korea

Coauthor(s)

Kyong-No Lee, MD
Fellowship
Seoul National University Bundang Hospital
Seongnam, Kyonggi-do, Republic of Korea
HK
Hyeon Ji Kim, MD
Seoul National University Bundang Hospital
Seongnam-si, Kyonggi-do, Republic of Korea
HK
Ha Yan Kwon, MD
Yonsei University College of Medicine
Seoul, Seoul-t'ukpyolsi, Republic of Korea
JK
Jong Woon Kim, MD
Chonnam National University Medical School
Seongnam-si, Kyonggi-do, Republic of Korea
JB
Jin-Gon Bae, MD
Keimyung University Dongsan Medical Center
Seongnam-si, Kyonggi-do, Republic of Korea
JS
Ji-Hee Sung, MD
Samsung Medical Center, Sungkyunkwan University School of Medicine
Seoul, Seoul-t'ukpyolsi, Republic of Korea
SL
Se Jin Lee, MD
Kangwon National University Hospital
Seongnam-si, Kyonggi-do, Republic of Korea
Young Mi Jung, MD
Seoul National University College of Medicine
Seoul, Seoul-t'ukpyolsi, Republic of Korea
YH
You Jung Han, MD, PhD
CHA Gangnam Medical Center
Seoul, Seoul-t'ukpyolsi, Republic of Korea
Subeen Hong, MD
Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
Seoul, Seoul-t'ukpyolsi, Republic of Korea

Presenting Author(s)

JJ
Jin-Hoon Jung, MD, PhD
Professor
Asan Medical Center, University of Ulsan College of Medicine
Seoul, Seoul-t'ukpyolsi, Republic of Korea