PHILADELPHIA – Women carrying twins are at higher risk for premature birth and miscarriage – those whose cervix dilates before 24 weeks are at highest risk – and yet one common treatment is not recommended for this population.

Does cervical cerclage decrease preterm birth in twin pregnancies with a short cervix?

Conclusion: Cerclage placement for cervical length ≤2.5 cm in twin gestations did not decrease the rate of preterm birth at <35 weeks; however, cerclage placement for cervical length ≤1.5 cm was associated with a significantly decreased rate of preterm birth <35 weeks when compared to patients managed without cerclage.

Why is cerclage not recommended for twins?

Most of the limited research available has shown that preventive cerclage is ineffective and may lead to more preterm births. But the latest twin pregnancy study suggests that in emergency situations, when the cervix is already open, cerclage placement can delay preterm birth by an average of 5.6 weeks.

Can you have twins with short cervix?

This conduct was based on the studies of ProTwin and PECEP-Twins, which identified that twins with short cervix could benefit from the usage of the cervical pessary [29, 30]. Since January 2014 we have obtained 30 cases of dichorionic twin gestations with short cervix (≤25 mm).

Can your cervix dilate with a cerclage?

The concern is that the cervix might further dilate and to cause uterine activity. Cervical cerclage is surgical procedure in which stitches or surgical tape are used to close the cervix opening.

What happens if you have a short cervix?

When the cervix is unusually short, it is prone to dilation, and it provides less protection for the fetus and pregnant woman. Having a short cervix increases the risk of pregnancy loss, preterm labor, and early delivery. Doctors define preterm labor as cervical changes that happen before 37 weeks of pregnancy.

Is cervix stitch necessary for twin pregnancy?

Conclusion: Our metaanalysis indicates that cerclage placement is beneficial for the reduction of preterm birth and the prolongation of pregnancy in twin pregnancies with a cervical length of <15 mm or dilated cervix of >10 mm.

How effective is progesterone for short cervix?

The hormone progesterone, when given vaginally, reduced preterm birth by 42% in women at risk of premature delivery due to a short cervix, a new analysis shows. The cervix is the lower portion of the uterus. Typically the cervix shortens toward the end of pregnancy when the body prepares for birth.

Does pessary or cerclage prevent postpartum bleeding in twins with short ultrasound?

The contribution from Jarde et al. to this issue of BJOG confirms this truth. Though a systematic review and meta-analysis of the literature, they showed that neither pessary, nor cerclage, nor vaginal progesterone prevented PTB in twins with a short transvaginal ultrasound (TVU) cervical length (CL). A few things should be highlighted.

How effective is cerclage during pregnancy?

The analysis showed that in the group that received cerclage, gestation was prolonged by an average of 5.6 weeks (with a range of 2.0 to 9.3 weeks), and reduced infant mortality by 77%. “Cerclage is a heroic intervention in this group of women,” says Dr. Roman.

Does cerclage affect PTB in women with short TVU CL?

In contrast, TVU CL has a 70% sensitivity for PTB in singletons with both a prior PTB and a short TVU CL, and it’s not surprising that in this population cerclage has been shown to be associated with a reduction in PTB (Berghella et al. Obstet Gynecol. 2011;117:663–71).

Is vaginal progesterone effective in twins with a short TVU CL?

Fourth, in twins with a short TVU CL, vaginal progesterone seems to be for now the most promising intervention. Although Jarde et al. emphasise the possible benefit in secondary outcomes of this intervention in all twins, on a close reading of each related RCT the benefit of vaginal progesterone seems to come just in twins with a short TVU CL.