Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Fetal Diagn Ther. 2012;32(4):246-50. doi: 10.1159/000338734. Epub 2012 Aug 22.
Placement of emergency cerclage at mid-trimester is controversial. At present, clinical trials comparing outcomes of mid-trimester cerclage to bed rest in twin pregnancies are lacking. Our aim was to examine the efficacy, safety and outcomes of mid-trimester cerclage in patients carrying twin gestations.
We retrospectively studied the outcomes of 14 patients carrying twin gestations with significant cervical dynamics who underwent cerclage. Outcomes of patients with cervical effacement only and patients with bulging membranes through the external os were examined. The interval between cerclage and delivery and the complication rates were calculated.
The average time interval between cerclage placement and delivery was 71.1 days overall. Patients with cervical shortening or effacement only (n = 10) gave birth an average of 80.2 days after the procedure, while 4 patients with bulging membranes gave birth an average of 48.5 days after cerclage placement. The overall procedure failure rate, defined as delivery before 28 completed weeks, was 14.2%.
Patients carrying twin gestations with advanced cervical changes might benefit from therapeutic cerclage. Further studies are required to demonstrate whether there is a difference compared to bed rest alone.
在妊娠中期行紧急宫颈环扎术存在争议。目前，尚无比较中期宫颈环扎术与双胎妊娠卧床休息结局的临床试验。我们的目的是评估宫颈环扎术治疗双胎妊娠的疗效、安全性和结局。
我们回顾性研究了 14 例因宫颈动力学异常行宫颈环扎术的双胎妊娠患者的结局。检查了仅宫颈缩短或消失患者和宫颈口膨出膜患者的结局。计算了宫颈环扎术至分娩的间隔时间和并发症发生率。
总的来说，宫颈环扎术至分娩的平均时间间隔为 71.1 天。仅宫颈缩短或消失（n=10）的患者在手术后平均 80.2 天分娩，而 4 例宫颈口膨出膜的患者在宫颈环扎术后平均 48.5 天分娩。总的手术失败率（定义为在 28 周前分娩）为 14.2%。
宫颈变化进展的双胎妊娠患者可能受益于治疗性宫颈环扎术。需要进一步的研究来证明与单纯卧床休息相比是否存在差异。
