Effect of Cervical Cerclage on the Risk of Recurrent Preterm Birth after a Twin Spontaneous Preterm Birth

• Published in: Journal of Korean medical science Vol. 35; no. 11; pp. e66 - 10
• Main Authors: Kim, Shinyoung, Park, Hyun Soo, Kwon, Hayan, Seol, Hyun-Joo, Bae, Jin Gon, Ahn, Ki Hoon, Lee, Se Jin, Lee, Mi-Young, Lee, Seung Mi, Kwak, Dong Wook, Park, Jung Yoon, Park, In Yang, Won, Hye-Sung, Kim, Moon Young, Ko, Hyun Sun, Hwang, Han Sung
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Academy of Medical Sciences 23.03.2020; 대한의학회
• Subjects: Adult; Cerclage, Cervical; Cervix Uteri; Female; Humans; Logistic Models; Multivariate Analysis; Original; Pregnancy; Pregnancy Outcome; Pregnancy, Twin; Premature Birth - prevention & control; Republic of Korea; Retrospective Studies; Risk Factors; 의학일반; Republic of Korea; Premature Birth; Uterine Cervical Incompetence; Twins; Cervical Cerclage; Preterm Premature Rupture of the Membranes
• ISSN: 1011-8934; 1598-6357; 1598-6357
• DOI: 10.3346/jkms.2020.35.e66

This study aimed to evaluate the effect of cervical cerclage on the recurrence risk for preterm birth in singleton pregnant women after a twin spontaneous preterm birth (sPTB). This multicenter retrospective cohort study included women who had a singleton pregnancy from January 2009 to December 2018 at 10 referral hospitals and a twin sPTB before the current pregnancy. We compared the cervical lengths during pregnancy and pregnancy outcomes, according to the placement of prophylactic or emergency cerclage. We evaluated the independent risk factors for sPTB (< 37 weeks of gestation) in a subsequent singleton pregnancy. For the index singleton pregnancy, preterm birth occurred in seven (11.1%) of 63 women. There was no significant difference in the cervical lengths during pregnancy in women with and without cerclage. In a multivariate logistic regression analysis, the placement of emergency cerclage was an independent risk factor for subsequent singleton preterm birth (odds ratio [OR], 93.188; 95% confidence interval [CI], 1.633-5,316.628; = 0.027); however, the placement of prophylactic cerclage (OR, 19.264; 95% CI, 0.915-405.786; = 0.057) was not a factor. None of the women who received prophylactic cerclage delivered before 35 weeks' gestation in the index singleton pregnancy. Cerclage did not lower the risk of preterm birth in a subsequent singleton pregnancy after a twin sPTB. However, emergency cerclage was an independent risk factor for preterm birth and there was no preterm birth before 35 weeks' gestation in the prophylactic cerclage group. Therefore, close monitoring of the cervical length and prophylactic cerclage might be considered in women who have experienced a twin sPTB at extreme gestation.