Should cervical cerclage be offered to all women with twin pregnancy, or rather be reserved for those women with transvaginal sonographic evidence of cervical incompetence?
NO
cervical cerclage should be done if
1. clinically indicated with history of mid-trimester miscarriage (uterine contraction followed by cervical dilatation and delivery of baby and placenta).
2. Ultrasound indicated through trans-vaginal shortening of uterine cervix or trans-vaginal funneling of the uterine cervix.
In fact, for twin pregnancies there is absolutely no indication for a cervical cerclage. Studies have consistently shown that it confers worse
I think if there are signs of cervical incompetency then cervical encerclage is done.twin pregnancy per say is not an indication for cervical encerclage.
Liu XR1, Luo X, Xiao XQ, Qi HB. Cervical cerclage for preventing preterm birth in twin pregnancies. A systematic review and meta-analysis. Saudi Med J. 2013 Jun;34(6):632-8.
OBJECTIVES: To evaluate the effect of cervical cerclage on preventing preterm birth in twin pregnancies.
METHODS: We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Current Controlled Trials, China Biology Medicine (CBM), Chinese National Knowlegde Infrastructure (CNKI) and VIP Chinese Journal database (VIP) from April to August 2012. All available randomized trials comparing the effects of cervical cerclage for preventing preterm birth in twin pregnancies with no cerclage were included. The study took place in the First Affiliated Hospital of ChongQing Medical University, Chongqing, People's Republic of China.
RESULTS: Five eligible studies with a total of 310 participants were finally included. No statistically significant differences were found between patients who received cervical cerclage and those who did not receive cervical cerclage, in terms of preterm birth (RR 0.91, 95% CI 0.78-1.18), live births (RR 0.93, 95% CI 0.87-1.01) and mode of delivery (RR 1.34, 95% CI 0.61-2.98) per randomized woman. These results of preterm birth, premature rupture of menbrane, model of delivery did not change before and after sensitivity analysis.
CONCLUSION: No significant difference was observed between cervical cerclage group and no cerclage group in twin pregnancies and large scale randomized controlled trials are needed to strengthen clinical usage of cervical cerclage.
I think that if there is an indication (incompetence of cervix, short cervix) the cerclage may be a good treatment. Of course, it's necessery to exclude any infection.
Best regards
I agree that twin pregnancy per se is not a valid indication for elective insertion of a cervical cerclage and agree that Lui et al limited systematic review and meta analysis would confirm this view.
In terms of ultrasound cervical surveillance or emergent cervical dilatation caution must be exercised in terms of excluding intrauterine infection if cerclage is to be considered but once again robust evidence is lacking to justify cervical cerclage in these situations even in the absence of intrauterine infection although a number may be tempted to do so between 18 and 24 weeks gestation.
The use of an Arabin cervical pessary as a less invasive method to prevent preterm labour has shown some promise in singleton pregnancies (PECEP Ttail and Hui et al) and has been used in twin pregnancies sporadically awaiting a more extensive trial to be instituted
I think that the best time for application of cerclage is 13-16 week. It is a period when still not stretch the lower segment of the uterus. That way will be reduce the risk of unsuccessful application cerclage.
Best regards
No , unless there is a history of cervical incompetence.
But CL should be measured through this pregnancy
What is the meaning of "empirically"?
Yes, all women with singleton or twin pregnancies should have a cervical length measurement at 18-24 weeks of gestation.
Conde-Agudelo A, Romero R.Prediction of preterm birth in twin gestations using biophysical and biochemical tests.Am J Obstet Gynecol. 2014 Dec;211(6):583-595.
it should be performed according to the previous history of pret erm birth , and after performin a correct Cervical Lenght Measurament.
Cerclage is reserved for twin pregnancy with indications for cerclage such as single pregnancy.
History of preterm labor and delivery soon after removal of previous cervical cerclage. It is crucial to follow up CL measurments.