Email this article Utility of prophylactic cervical cerclage in intra-cytoplasmic sperm injection twins: a prospective study
Abstract
Background: Several interventions have been used to reduce the rate of preterm birth and prolonging gestation in a twin pregnancy and routine usage of cervical cerclage in twin pregnancy conceived after intra-cytoplasmic sperm injection (ICSI) procedure has found to be beneficial.
Methods: Prospective case series studies, series of expectant mothers with twin pregnancy conceived by ICSI were studied under tertiary care hospital setting. A total of 108 cases with twin pregnancy were included during a period of 2016 to 2019. Obstetric profile of all the cases was taken; cervical cerclage procedure was done at 14-16 weeks of gestation (McDonald method) after a normal nuchal translucency scan and a double marker test. Pregnancy outcome parameters like abortion, preterm labour/delivery, premature rupture of membranes (PROM), and mode of delivery, gestational age at delivery, birth weight and neonatal complications were assessed.
Results: Mean age of the mothers was 30.61±4.45 years, rates of the pregnancy outcome parameters were abortion 0%, preterm labour 11.1%, premature rupture of membranes (PROM) 9.3%, mean gestational age at delivery was at 34.56±1.71 weeks. Neonatal outcome parameters were mean birth weight was at 2279±470 grams, 77.8% of the neonates had normal APGAR scores. The rates of NICU admission was 28%, RDS– 24.1%, 3.7% had sepsis and 92.6% of neonates survived and 7.4% died.
Conclusions: In ICSI twin pregnancies with normal cervical measurements, prophylactic cervical cerclage is effective in prolonging pregnancy and preventing preterm delivery and thereby minimizing neonatal morbidity and mortality.
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Beall A, Cherney A. History and challenges surrounding ovarian stimulation in the treatment of infertility. Fertil Steril. 2012;97(4):795-801.
Chauhan P, Scardo A, Hayes E, Abuhamad Z, Berghella V. Twins: Prevalence, problems, and preterm births. Am J Obstet Gynecol 2010;203: 305-15.
Office for National Statistics. Gestation-specific infant mortality, 2012. Available at: http://www.ons.gov.uk/ons/rel/child-health/gestation -specific-infant-mortality-in-England and Wales/20 12/stb-gestation-specific-infant-morta lity-2012.html. Accessed on 20 June 2020.
Office for National Statistics. Births in England and Wales by characteristics of birth, 2013. Available at: http://www.ons.gov.uk/ons/rel/vsob1/chara cteristics-of-birth-2-England-and-Wales/2013/sbchar acteristics-of-births-2.html. Accessed on 15 June 2020.
Qin J, Wang H, Sheng X, Liang D, Xie Q, Gao S. Assisted reproductive technology and risk of adverse obstetric outcomes in dichorionic twin pregnancies: a systematic review and meta-analysis. FertilSteril. 2016;105(5):1180-92.
McDonald D, Han Z, Mulla S, et al. Preterm birth and low birth weight among in vitro fertilization twins: a systematic review and meta-analyses. Euro J Obstet Gynecol Reprod Biol. 2010;148(2):105-13.
Pinborg A. IVF/ICSI twin pregnancies: risks and prevention. Hum Reprod Update. 2005;11(6):575-93.
Jauniaux E, Ben-Ami I, Maymon R. Do assisted-reproduction twin pregnancies require additional antenatal care? Reprod Biomed Online. 2013;26(2):107-19.
Allen M, Wilson D, Cheung Aý. Pregnancy outcomes after assisted reproductive technology. J Obstet Gynaecol Can. 2006;28(3):220-50.
Hamilton E, Martin A, Osterman J, Curtin C, Matthews J. Births: Final data for 2014. Natl Vital Stat Rep 2015;64:1‑64.
Zanardini C, Pagani G, Fichera A, Prefumo F, Frusca T. Cervical cerclage in twin pregnancies. Arch Gynecol Obstet 2013;288:267-71.
Schuit E, Stock S, Rode L, Rouse J, Lim C, Norman E, et al. Effectiveness of progestogens to improve perinatal outcome in twin pregnancies: An individual participant data meta‑analysis. Int J Obstet Gynaecol. 2015;122:27-37.
Obeidat N, Alchalabi H, Obeidat M, Sallout B, Hamadneh S, et al. Effectiveness of prophylactic cervical Cerclage in prolonging higher‑order multiple pregnancies. Sultan Qaboos Univ Med J 2017;17:e314-8.
Refuerzo S, Momirova V, Peaceman M, Sciscione A, Rouse J, Caritis N, et al. Neonatal outcomes in twin pregnancies delivered moderately preterm, late preterm, and term. Am J Perinatol 2010;27:537-42.
Rafael J, Berghella V, Alfirevic Z. Cervical stitch (cerclage) for preventing preterm birth in multiple pregnancy. Cochrane Database of Systematic Reviews 2014;9:Art. No.: CD009166.
Shehata, Hesham B, Hussein N, Maher Abdel Hafez. Prophylactic Cerclage in ICSI Twins: To Do or Not to Do? A Randomized Controlled Study. Women’s Heal Gynaeco 2016;2(6):42:1-6.
Kalra K, Ratcliffe J, Barnhart T, Coutifaris C. Extended embryo culture and an increased risk of preterm delivery. Obstet Gynecol. 2012;120(1):69-75.
Ericson A, Nygren KG, Olausson PO, Kallen B. Hospital care utilization of infants born after IVF. Hum Reprod. 2002;17(4):929-32.
American College of Obstetricians and Gynecologists Committee on Practice Bulletins-Obstetrics, Society for Maternal-Fetal Medicine, ACOG Joint Editorial Committee. ACOG Practice Bulletin #56: Multiple gestation: complicated twin, triplet, and high-order multifetal pregnancy. Obstet Gynecol. 2004;104(4):869-83.
Anbazhagan A, Hunter A, Breathnach FM, Mcauliffe FM, Michael GP, Sean D, et al. Comparison of outcomes of twins conceived spontaneously and by artificial reproductive therapy success. J Matern Fetal Neonatal Med. 2014;27(5):458-62.
Nicolaides H, Syngelaki A, Poon C, de Paco Matallana C, Plasencia W, Molina FS, et al. Cervical pessary placement for prevention of preterm birth in unselected twin pregnancies: a randomized controlled trial. Am J Obstet Gynecol. 2016;214(1):3.
Abdulmalek Y. The benefit of prophylactic cervical cerclage in twin pregnancies. Med J Babylon 2019;16:128-35.
Abbasi N, Barrett J, Melamed N. Outcomes following rescue cerclage in twin pregnancies. J Matern Fetal Neonatal Med. 2018;31:2195-2201.
Leonidas Mamas, Eudoxia Mamas. Prophylactic Cervical Cerclage (Modified Shirodkar Operation) for twin and triplet Pregnancies after fertility Treatment. J Clin Gynecol Obstet. 2013;2(2):68-75.
Michelle H, Betsy E, Donnell O, Melanie M, Maykin, Juan M, et al. Impact of cerclage in twin pregnancies on preterm birth rate before 32 weeks. J Matern Fetal Neonatal Med. 2018;32(13):2143-51.
Houlihan C, Poon L, Ciarlo M, Kim E, Guzman E, Nicolaides K. Cervical cerclage for preterm birth prevention in twin gestation with short cervix: a retrospective cohort study. Ultrasound Obstet Gynecol. 2016;48:752-6.
Li C, Shen J, Hua K. Cerclage for women with twin pregnancies: a systematic review and metaanalysis. Am J Obstet Gynecol. 2019;220(6):543-57.
Jia X, Xi R, Liu, MD, Xin L, Xiao Q. Xiao, Hong B. Cervical cerclage for preventing preterm birth in twin pregnancies: A systematic review and meta-analysis. Saudi Med J. 2013;34(6):632-8.
Jarde, O Lutsiv, Park C, Barrett J, Beyene J, Saito S, et al. Preterm birth prevention in twin pregnancies with progesterone, pessary, or cerclage: a systematic review and meta-analysis. Preterm birth prevention in twin pregnancies with progesterone, pessary, or cerclage: asystematic review and meta-analysis. Int J Obstet Gynaecol . 2017;124:1163-73.
Leonidas Mamas, Eudoxia Mamas. Prophylactic Cervical Cerclage (Modified Shirodkar Operation) for Twin and Triplet Pregnancies After Fertility Treatment. J Clin Gynecol Obstet. 2013;2(2):68-75.
Gupta M, Emary K, Impey L. Emergency cervical cerclage: predictors of success. J Matern Fetal Neonatal Med. 2010;23(7):670-4.
Nelson L, Dola T, Tran T, Carter M, Luu H, Dola C. Pregnancy outcomes following placement of elective, urgent and emergent cerclage. J Matern Fetal Neonatal Med. 2009;22(3):269-73.
