Purpose To evaluate the outcomes of cervical cerclage
(CC) in twin pregnancies.
Methods Retrospective analysis of twin pregnancies
undergoing CC between January 2001 and December 2009
at our Institution. CC was offered in case of a cervical
length measurement B20 mm (ultrasound-indicated CC) or
in case of cervical dilatation with membranes at or beyond
the external cervical os (physical examination-indicated
CC). Cervicovaginal and rectal swabs were obtained preoperatively.
Perioperative antibiotics and tocolysis were
administered.
Results There were 28 cases of ultrasound-indicated and
14 of physical examination-indicated CC. Positive swab
cultures were observed in 21 % of cases. The incidence of
preterm delivery\34 weeks was 32 % [95 % confidence
interval (CI) 16–52 %] and 50 % (95 % CI 23–77 %) in
the ultrasound-indicated and physical examination-indicated
CC group, respectively. The incidence of premature
rupture of membranes \34 weeks was 21 % (95 % CI
8–41 %) and 29 % (95 % CI 8–58 %) in the ultrasoundindicated
and physical examination-indicated CC group,
respectively. Perinatal survival was 96 % (95 % CI
88–100 %) in the ultrasound-indicated CC group, and
86 % (95 % CI 67–96 %) in the physical examinationindicated
CC group.Conclusions We showed a high-risk of preterm delivery
in both groups, but with a high overall perinatal survival.
Our data stress the importance of re-evaluating the efficacy
of CC in twin pregnancies by properly designed clinical
trials, particularly if it is physical examination indicated
