Prophylactic Cervical Cerclage (Modified Shirodkar Operation) for Twin and Triplet Pregnancies After Fertility Treatment

Abstract

Background: Multiple pregnancy rates have increased in the recent years mainly due to an increase in the number of assisted reproduction cycles performed. These pregnancies are associated with maternal and perinatal complications. These complications may arise due to premature delivery. This clinical study was performed in order to assess the effectiveness of prophylactic vaginal cervical cerclage in multiple pregnancies.

Methods: A modified Shirodkar method was applied in twin and triplet pregnancies conceived by fertility treatments, at 13 to 14 weeks of gestation. The suture was fully embedded under the vaginal mucosa in order to avoid the risk of infection.

Results: Our cohort of patients included 31 women with twin and five with triplet pregnancies. The mean gestational age for twins and triplets was 35 + 4 and 33 + 6 and the mean birthweight was 2,267 g and 1,820 g, respectively. Nearly half of the twins and all of the triplets delivered were admitted in the neonatal intensive care unit. Only one neonate had a very low birth weight. No significant differences were noted in the effect of different fertility techniques in the outcome measures studied.

Conclusions: Multiple pregnancies conceived with the aid of fertility treatment benefited from the prophylactic application of a prophylactic cervical vaginal cerclage.




doi: http://dx.doi.org/10.4021/jcgo143w