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Medical/Surgical/Diseases/Complications

Poster Session 4

(959) The association between cervical cerclage and offspring long-term neurological morbidity among twin pregnancies

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: The body of evidence does not support the efficacy of routine cerclage in multiple gestations, but it may be useful in patients with a history of cervical insufficiency or a short cervix. Preterm delivery, commonly associated with twin pregnancies, was found to be linked to long-term neurologic impairment in the offspring. We aimed to study the association between twin pregnancies with and without cervical cerclage and the risk for offspring long-term neurological morbidity.

Study Design: A population-based retrospective cohort study was conducted, comparing the long-term neurological morbidity among twins born after pregnancies with and without cervical cerclage, between the years 1991-2021 in a tertiary medical center. The study groups were followed until 18 years of age for neurological-related morbidity. Data for the diagnosis of neurological morbidity of the offspring was extracted from community-based clinics and hospitalization records. A Kaplan-Meier survival curve was used to compare cumulative incidence, and multivariable Cox proportional hazard model was used to adjust for confounders.

Results: The study included 11,986 twins in which 180 (1.5%) were born in pregnancies with cervical cerclage. Being born after pregnancy with cerclage was not significantly associated with higher risk for neurological morbidity of the offspring (15.3% vs. 13.3% p=0.471, Table). Likewise, the cumulative incidence of long-term neurological morbidity was not significantly higher among twins born after pregnancies with cerclage (Kaplan-Meier survival curve, Log rank p=0.435, Figure). In the Cox proportional hazard regression model, after adjusting for gestational age at birth, being born after a pregnancy with cervical cerclage was not associated with long-term neurological morbidity (adjusted HR 1.16, 95% CI 0.77-1.73, p=0.467, Table).

Conclusion: Twins who are born after cerclage placement were not found to be in higher risk for long-term neurological morbidity.