[Clinical study of modified cervical cerclage at different surgical timings in twin pregnant women with cervical insufficiency].

To explore the clinical efficacy of three different surgical timings of modified cervical cerclage in twin pregnant women with cervical insufficiency. The clinical data of 73 twin pregnant women who underwent modified cervical cerclage and had pregnancy outcomes in Qilu Hospital of Shandong University (Qingdao) from April 2014 to July 2023 were retrospectively analyzed. According to the different timings of surgery, they were divided into prophylactic cerclage group, ultrasound-indicated cerclage group (further divided into cervical length (CL)≤15 mm and 15 mm<CL<25 mm subgroups) and emergency cerclage group. The differences in pregnancy and neonatal outcomes among the three groups were compared. The clinical data and pregnancy outcomes of pregnant women delivered at <34 weeks and ≥34 weeks were compared, and multivariate logistic regression was used to analyze the influencing factors of preterm birth before 34 weeks. (1) The prolonged gestational age and postoperative CL in the prophylactic cerclage group were longer than those in the ultrasound-indicated cerclage group; the gestational age at delivery, prolonged gestational age, postoperative CL, live birth rate and neonatal birth weight in the prophylactic cerclage group were higher than those in the ultrasound-indicated cerclage group, and the preterm birth rate before 34, 32 and 28 weeks of gestation and premature rupture of membranes were lower than those in the emergency cerclage group; the gestational age of delivery, prolonged gestational age, postoperative CL, live birth rate and the rate of neonatal birth weight of the pregnant women in the ultrasound-indicated cerclage group were higher than those in the emergency cerclage group, and the rate of premature birth before 34, 32 and 28 weeks of gestation and late neonatal birth weight <1 500 g were lower than those in the emergency cerclage group; the differences were statistically significant (all <0.05). (2) The gestational age and postoperative CL in the 15 mm<CL<25 mm group were longer than those in the CL≤15 mm group, and the gestational age at delivery and neonatal birth weight in the CL≤15 mm group were higher than those in the emergency cerclage group. The incidence of preterm birth before 32 weeks of gestation and birth weight <1 500 g in the cervical dilatation group were significantly lower than those in the emergency cerclage group (all <0.05). (3) The incidence of abnormal cervicovaginal discharge and postoperative C-reactive protein (CRP) level of pregnant women with delivery gestational age <34 weeks were significantly higher than those of pregnant women with delivery gestational age ≥34 weeks, while preoperative CL and postoperative CL were significantly shorter than those of pregnant women with delivery gestational age ≥34 weeks (all <0.05). Multivariate logistic regression analysis showed that postoperative CRP>10 mg/L was a risk factor for preterm birth before 34 weeks of gestation (=5.230, 95%: 1.616-16.929; =0.006). In twin pregnant women with cervical insufficiency, prophylactic cerclage has the same surgical effect as ultrasound-indicated cerclage, while both prophylactic cerclage and ultrasound-indicated cerclage could significantly improve maternal and fetal outcomes compared with emergency cerclage. Twin pregnancies with CL≤15 mm might benefit from cervical cerclage. Postoperative CRP>10 mg/L is an independent risk factor for preterm birth before 34 weeks of gestation.