Outcomes of emergency cervical cerclage after amnioreduction in twin pregnancies with a fully dilated cervix and amniotic membrane prolapse.

Abstract

Objective: The aim of this study was to evaluate the effectiveness of emergency cervical cerclage (EmC) in twin pregnancies with a fully dilated cervix and amniotic membrane prolapse.

Material and methods: This retrospective study examined records from December 2015 to December 2022 and included 20 twin pregnancies. The patients were divided into two groups, the EmC group (EmC group) and the no EmC (control) group, and pregnancy outcomes were compared.

Results: EmC was performed after amnioreduction in 11 twin pregnancies. Nine patients who refused EmC were followed up with expectant management. The mean gestational age at first examination was similar between the EmC (21.36±1.62 weeks) and control group (21.00±3.16 weeks, p=0.372). The median (range) volume of removed amniotic fluid was 151.82 (120-420) mL. Cases in the EmC group gained a significantly longer delay until delivery (47.72±28.14 days) compared to controls (2.33±0.5 days, p<0.001). All of the women in the control group gave birth within three days following admission to hospital. The mean gestational age at birth was significantly higher in the EmC group (28.18±4.53 weeks) than in the control group (21.57±3.53 weeks, p<0.001). Thirteen (59.09%) infants survived in the EmC group while only two infants (22.22%) of one patient survived in the control group (p<0.001).

Conclusion: EmC increases the survival rate of infants by prolonging the gestational age at delivery in twin pregnancies. Clinicians and patients should be encouraged regarding the use of EmC in twin pregnancies with a fully dilated cervix and prolapsed amniotic membranes.