Effect of cerclage on obstetrical outcome in twin gestations with a shortened cervical length.

Abstract

Our purpose was to determine the impact of cerclage placement on obstetric outcome in twin gestations with a shortened cervical length. A prospective cohort study of 147 consecutive twin pregnancies (July 1994 to March 2001) who underwent transvaginal ultrasonographic cervical length measurement between 18 and 26 weeks' gestation. Cerclage was offered to women with cervical lengths < or = 25 mm. Patients were segregated into quartiles by cervical length. Regression analysis and chi(2) tests were used to determine the effect of cervical length and cerclage on parameters of prematurity. One hundred twenty-eight twin gestations met inclusion criteria, including 21 (16.4%) who underwent cerclage for a cervical length < or = 25 mm. Decreasing cervical length was significantly associated with a shorter length of gestation, lower combined birth weight, delivery at < or = 34 weeks, preterm premature rupture of fetal membranes, and very low birth weight. None of these outcomes was altered by cerclage placement. Midtrimester cerclage does not alter the risks of prematurity associated with a shortened cervical length in twin gestations.