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Prematurity

Poster Session 2

(619) Effectiveness of cerclage in twin pregnancies with short cervix: systematic review and meta-analysis

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

Evaluate the effectiveness of cervical cerclage in preventing preterm birth (PTB) and improving neonatal outcomes in women with a twin pregnancy and an asymptomatic short cervix (≤ 25mm).

Study Design: On 17 April 2023, we systematically searched PubMed, MEDLINE, EMBASE, Web of Science, and Cochrane Library databases. Included were randomized controlled trials (RCTs), cohort, and case-control studies comparing cerclage vs. expectant management in women with twin pregnancies and an asymptomatic short cervix (≤ 25mm) before 24 weeks.

Results:

We included 10 retrospective cohort studies and 1 prospective cohort, involving 563 patients with cerclage and 489 controls. Information regarding women involved in the RCTs could not be obtained because this data has not been made publicly available. In women with a cervical length of ≤ 25mm significantly less preterm births were reported in women with a cerclage as compared to expectant management (PTB before 37 weeks (RR 0.87, 95% CI 0.77-0.98), 34 weeks (RR 0.75, 0.62-0.91), 32 weeks (RR 0.61, 0.41-0.91), and 28 weeks (RR 0.62, 0.42-0.91) of gestation). Upon further analysis of studies explicitly describing spontaneous PTB (sPTB), in the cerclage group were less sPTB before 34 weeks (RR 0.72, 0.54-0.95) and 32 weeks (RR 0.70, 0.51-0.97). Cerclage was related to lower risk ratios for infants < 1500g and respiratory distress syndrome.

In a subgroup of women with cervical length < 15mm, cerclage reduced PTB before 34 weeks (RR 0.62, 0.44-0.87), 32 weeks (RR 0.62, 0.44-0.86), and 28 weeks (RR 0.53, 0.34-0.84), while the gestational age at birth was more advanced (MD 3.87 weeks, 2.97-4.77). In addition, sPTB was less frequent in women with a cerclage (before 34 weeks (RR 0.61, 0.41-0.91) and 32 weeks (RR 0.50, 0.33-0.77)).

Conclusion:

Based on our meta-analysis, of observational studies, cerclage may benefit women with a twin pregnancy with cervical length < 25mm and < 15mm by reducing PTB and prolonging pregnancy. However, a large RCT is needed to validate these findings.