(871) Early vs. late placement of cervical cerclage performed due to cervical insufficiency in twins

Friday, January 31, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

Neriya Zion Yohay, MD, MBA

Medical Student
Department of Military Medicine and “Tzameret”, Faculty of Medicine, Hebrew University of Jerusalem and Medical Corps, Israel Defense Forces, Jerusalem, Israel
Beer Sheva, HaDarom, Israel

Coauthor(s)

Tamar Wainstock, PhD (she/her/hers)

Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Beer Sheva, HaDarom, Israel
ZY

Zehava Yohay, MHA, RN

Pain Unit, Soroka University Medical Center, Beer Sheva, Israel
Beer Sheva, HaDarom, Israel
DE

Debi Elharar, MHA, RN

Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Beer Sheva, HaDarom, Israel
TB

Talia Birenstock, BSc

Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Beer Sheva, HaDarom, Israel
GE

Guy Elharar, MD

Sackler Faculty of Medicine, Tel Aviv university.
Beer Sheva, HaDarom, Israel
Eyal Sheiner, MD, PhD

Head of department of Obstetrics and Gynecology, Soroka University Medical Center
Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Beer Sheva, HaDarom, Israel

Objective: The study was aimed to assess the impact of early vs. late (above 15 weeks gestation) cervical cerclage placement performed due to cervical insufficiency in twins on perinatal outcome.

Study Design: A retrospective cohort study was conducted including all patients with twin pregnancy (n=92 women) with cervical cerclage. Deliveries occurred between the years 1990 and 2023 in a tertiary medical center. Perinatal outcome was compared between women who underwent cervical cerclage placement ≤15 weeks and women who underwent cervical cerclage placement >15 weeks. Adverse perinatal outcome was defined as either 5 minute Apgar scores < 7 or neonatal intensive care unit (NICU) admission of at least one of the twins. Multiple logistic regression models were used to control for confounders.

Results: A total of 92 women were included in the study, complete data was available for 77 women. Late placement of cervical cerclage ( >15 weeks, n=34), was found as a risk factor for PTD less than 35 weeks (79.4% vs. 58.1%, OR 2.77, 1.01 – 8.33; P = 0.048). No significant association was noted between late cerclage placement due to cervical insufficiency in twins and adverse perinatal outcome (29.4% vs. 15.6%, OR 2.5, 0.75 – 7.14; P = 0.138) as compared with early placement (Table). Using multivariable analysis, controlling for maternal age, late cerclage placement was noted as an independent risk factor for PTD < 35weeks gestation (adjusted OR 2.94, 95% CI 1.02 - 8.33; P = 0.047).

Conclusion: Late placement of cervical cerclage ( >15 weeks) in twin pregnancies, performed due to cervical insufficiency, is an independent risk factor for preterm delivery of less than 35 weeks gestation. Nevertheless, in our population, late vs. early placement of cerclage is not a risk factor for adverse perinatal outcome.