Comparison of two emergency cervical cerclage techniques in twin pregnancies: A retrospective cohort study matched with cervical dilation
Objectives This retrospective cohort study aimed to assess the efficacy of emergency cervical cerclage (ECC) performed with the combined McDonald‐Shirodkar technique in twin pregnancies between 18 and 26 weeks of pregnancy with painless cervical dilation 1 to 6 cm. Methods A retrospective cohort stu...
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| Veröffentlicht in: | International journal of gynecology and obstetrics 2024-03, Vol.164 (3), p.1036-1046 |
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| container_title | International journal of gynecology and obstetrics |
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| creator | Qiu, Liping Lv, Min Chen, Lujiao Chen, Zi Shen, Jayan Wang, Minmin Cai, Yuliang Zhao, Baihui Luo, Qiong |
| description | Objectives
This retrospective cohort study aimed to assess the efficacy of emergency cervical cerclage (ECC) performed with the combined McDonald‐Shirodkar technique in twin pregnancies between 18 and 26 weeks of pregnancy with painless cervical dilation 1 to 6 cm.
Methods
A retrospective cohort study matched with the degree of cervical dilation was conducted. The study group (case group) included women with twin pregnancies undergoing combined McDonald‐Shirodkar approach with cervical dilation ≥1 cm between 18 to 26 weeks of gestation at four institutions, from December 2015 to December 2022. To minimize confounding factors, we elucidated the causality structure using a directed acyclic graph and performed 1:1 case–control matching. A control group underwent the McDonald approach. The primary outcome was gestational age (GA) at delivery. The secondary outcomes were pregnancy latency; the rates of spontaneous preterm birth at |
| doi_str_mv | 10.1002/ijgo.15081 |
| format | Article |
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This retrospective cohort study aimed to assess the efficacy of emergency cervical cerclage (ECC) performed with the combined McDonald‐Shirodkar technique in twin pregnancies between 18 and 26 weeks of pregnancy with painless cervical dilation 1 to 6 cm.
Methods
A retrospective cohort study matched with the degree of cervical dilation was conducted. The study group (case group) included women with twin pregnancies undergoing combined McDonald‐Shirodkar approach with cervical dilation ≥1 cm between 18 to 26 weeks of gestation at four institutions, from December 2015 to December 2022. To minimize confounding factors, we elucidated the causality structure using a directed acyclic graph and performed 1:1 case–control matching. A control group underwent the McDonald approach. The primary outcome was gestational age (GA) at delivery. The secondary outcomes were pregnancy latency; the rates of spontaneous preterm birth at <28, <30, <32, and <34 weeks; and neonatal outcomes. Additional subanalysis was performed by dividing the patients into two subgroups of women with cervical dilation ≥3 cm and <3 cm.
Results
A total of 84 twin pregnancies were managed with either the combined McDonald‐Shirodkar approach (case group: n = 42) or the McDonald approach (control group: n = 42). Demographic characteristics were not significantly different in the two groups (P > 0.05). After adjusting for confounders that were represented by a directed acyclic graph, median GA at delivery was significantly higher (30.5 vs 27 weeks; Bate: 3.40 [95% confidence interval (CI), 2.13–4.67], P < 0.001) and median pregnancy latency was significantly longer (56 vs 28 days; Bate: 24.04 [95% CI, 13.31–34.78], P < 0.001) in the case group compared with the control group. Rates of spontaneous preterm birth at <28, <30, <32, and <34 weeks were significantly lower in the case group than in the control group. For neonatal outcomes, there was higher birth weight (1543.75 vs 980 g; Bate: 420.08 [95% CI, 192.18–647.98], P < 0.001) and significantly lower overall perinatal mortality (7.1% vs 31%; adjusted odds ratio, 0.16 [95% CI, 0.04–0.70], P = 0.014) in the case group compared with the control group. When cervical dilation was ≥3 cm, the combined McDonald‐Shirodkar procedure can significantly reduce perinatal mortality (8.3% vs 46.7%; adjusted odds ratio, 0.09 [95% CI, 0.01–0.77], P = 0.028), significantly decrease the risk of delivery at <28 and <30 weeks, and prolong GA at delivery and pregnancy latency compared with the McDonald procedure.
Conclusions
ECC performed with the combined McDonald‐Shirodkar procedure in women with twin pregnancies who have cervical dilation 1 to 6 cm in midtrimester pregnancy may reduce the rate of spontaneous preterm birth and improve perinatal and neonatal outcomes compared with the McDonald procedure, especially for twin pregnancies in women with cervical dilation of 3 to 6 cm and prolapsed membranes.
Synopsis
This study estimated whether the novel technique of emergency cervical cerclage in twin pregnancies could reduce the risk of spontaneous preterm birth.]]></description><identifier>ISSN: 0020-7292</identifier><identifier>ISSN: 1879-3479</identifier><identifier>EISSN: 1879-3479</identifier><identifier>DOI: 10.1002/ijgo.15081</identifier><identifier>PMID: 37712448</identifier><language>eng</language><publisher>United States</publisher><subject>Cerclage, Cervical - methods ; cervical dilation ; Dilatation ; emergency cervical cerclage ; Female ; Humans ; Infant, Newborn ; McDonald ; neonatal outcomes preterm birth ; Perinatal Death ; Pregnancy ; Pregnancy Outcome ; Pregnancy, Twin ; Premature Birth - epidemiology ; Premature Birth - prevention & control ; Retrospective Studies ; Shirodkar ; twin pregnancy</subject><ispartof>International journal of gynecology and obstetrics, 2024-03, Vol.164 (3), p.1036-1046</ispartof><rights>2023 The Authors. published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.</rights><rights>2023 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3241-f6d31be05b62910c2720e5b9e897680048d86550b2648a2da6d2146149e416093</cites><orcidid>0000-0002-0782-4462</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fijgo.15081$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fijgo.15081$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37712448$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Qiu, Liping</creatorcontrib><creatorcontrib>Lv, Min</creatorcontrib><creatorcontrib>Chen, Lujiao</creatorcontrib><creatorcontrib>Chen, Zi</creatorcontrib><creatorcontrib>Shen, Jayan</creatorcontrib><creatorcontrib>Wang, Minmin</creatorcontrib><creatorcontrib>Cai, Yuliang</creatorcontrib><creatorcontrib>Zhao, Baihui</creatorcontrib><creatorcontrib>Luo, Qiong</creatorcontrib><title>Comparison of two emergency cervical cerclage techniques in twin pregnancies: A retrospective cohort study matched with cervical dilation</title><title>International journal of gynecology and obstetrics</title><addtitle>Int J Gynaecol Obstet</addtitle><description><![CDATA[Objectives
This retrospective cohort study aimed to assess the efficacy of emergency cervical cerclage (ECC) performed with the combined McDonald‐Shirodkar technique in twin pregnancies between 18 and 26 weeks of pregnancy with painless cervical dilation 1 to 6 cm.
Methods
A retrospective cohort study matched with the degree of cervical dilation was conducted. The study group (case group) included women with twin pregnancies undergoing combined McDonald‐Shirodkar approach with cervical dilation ≥1 cm between 18 to 26 weeks of gestation at four institutions, from December 2015 to December 2022. To minimize confounding factors, we elucidated the causality structure using a directed acyclic graph and performed 1:1 case–control matching. A control group underwent the McDonald approach. The primary outcome was gestational age (GA) at delivery. The secondary outcomes were pregnancy latency; the rates of spontaneous preterm birth at <28, <30, <32, and <34 weeks; and neonatal outcomes. Additional subanalysis was performed by dividing the patients into two subgroups of women with cervical dilation ≥3 cm and <3 cm.
Results
A total of 84 twin pregnancies were managed with either the combined McDonald‐Shirodkar approach (case group: n = 42) or the McDonald approach (control group: n = 42). Demographic characteristics were not significantly different in the two groups (P > 0.05). After adjusting for confounders that were represented by a directed acyclic graph, median GA at delivery was significantly higher (30.5 vs 27 weeks; Bate: 3.40 [95% confidence interval (CI), 2.13–4.67], P < 0.001) and median pregnancy latency was significantly longer (56 vs 28 days; Bate: 24.04 [95% CI, 13.31–34.78], P < 0.001) in the case group compared with the control group. Rates of spontaneous preterm birth at <28, <30, <32, and <34 weeks were significantly lower in the case group than in the control group. For neonatal outcomes, there was higher birth weight (1543.75 vs 980 g; Bate: 420.08 [95% CI, 192.18–647.98], P < 0.001) and significantly lower overall perinatal mortality (7.1% vs 31%; adjusted odds ratio, 0.16 [95% CI, 0.04–0.70], P = 0.014) in the case group compared with the control group. When cervical dilation was ≥3 cm, the combined McDonald‐Shirodkar procedure can significantly reduce perinatal mortality (8.3% vs 46.7%; adjusted odds ratio, 0.09 [95% CI, 0.01–0.77], P = 0.028), significantly decrease the risk of delivery at <28 and <30 weeks, and prolong GA at delivery and pregnancy latency compared with the McDonald procedure.
Conclusions
ECC performed with the combined McDonald‐Shirodkar procedure in women with twin pregnancies who have cervical dilation 1 to 6 cm in midtrimester pregnancy may reduce the rate of spontaneous preterm birth and improve perinatal and neonatal outcomes compared with the McDonald procedure, especially for twin pregnancies in women with cervical dilation of 3 to 6 cm and prolapsed membranes.
Synopsis
This study estimated whether the novel technique of emergency cervical cerclage in twin pregnancies could reduce the risk of spontaneous preterm birth.]]></description><subject>Cerclage, Cervical - methods</subject><subject>cervical dilation</subject><subject>Dilatation</subject><subject>emergency cervical cerclage</subject><subject>Female</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>McDonald</subject><subject>neonatal outcomes preterm birth</subject><subject>Perinatal Death</subject><subject>Pregnancy</subject><subject>Pregnancy Outcome</subject><subject>Pregnancy, Twin</subject><subject>Premature Birth - epidemiology</subject><subject>Premature Birth - prevention & control</subject><subject>Retrospective Studies</subject><subject>Shirodkar</subject><subject>twin pregnancy</subject><issn>0020-7292</issn><issn>1879-3479</issn><issn>1879-3479</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><recordid>eNp9kMFOGzEQhq2qqITQSx-g8rGqtODxem1vbyiCEITEBc4rr3eSGO2ut7aTKI_AW3dDgN64zIw033zS_IT8AHYBjPFL97zyF1AwDV_IBLQqs1yo8iuZjEuWKV7yU3IW4zNjDBTAN3KaKwVcCD0hLzPfDSa46HvqlzTtPMUOwwp7u6cWw9ZZ0x4G25oV0oR23bu_G4zU9SM9liHgqje9dRj_0CsaMAUfB7TJbZFav_Yh0Zg2zZ52Jtk1NnTn0vq_u3GtSc735-RkadqI39_6lDzdXD_ObrP7h_lidnWf2ZwLyJayyaFGVtSSl8AsV5xhUZeoSyU1Y0I3WhYFq7kU2vDGyIaDkCBKFCBZmU_Jr6N3CP7wSKo6Fy22renRb2LFx3OlRS5hRH8fUTu-FAMuqyG4zoR9Baw6RF8doq9eox_hn2_eTd1h84G-Zz0CcAR2rsX9J6pqcTd_OEr_AbopkCU</recordid><startdate>202403</startdate><enddate>202403</enddate><creator>Qiu, Liping</creator><creator>Lv, Min</creator><creator>Chen, Lujiao</creator><creator>Chen, Zi</creator><creator>Shen, Jayan</creator><creator>Wang, Minmin</creator><creator>Cai, Yuliang</creator><creator>Zhao, Baihui</creator><creator>Luo, Qiong</creator><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0782-4462</orcidid></search><sort><creationdate>202403</creationdate><title>Comparison of two emergency cervical cerclage techniques in twin pregnancies: A retrospective cohort study matched with cervical dilation</title><author>Qiu, Liping ; Lv, Min ; Chen, Lujiao ; Chen, Zi ; Shen, Jayan ; Wang, Minmin ; Cai, Yuliang ; Zhao, Baihui ; Luo, Qiong</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3241-f6d31be05b62910c2720e5b9e897680048d86550b2648a2da6d2146149e416093</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Cerclage, Cervical - methods</topic><topic>cervical dilation</topic><topic>Dilatation</topic><topic>emergency cervical cerclage</topic><topic>Female</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>McDonald</topic><topic>neonatal outcomes preterm birth</topic><topic>Perinatal Death</topic><topic>Pregnancy</topic><topic>Pregnancy Outcome</topic><topic>Pregnancy, Twin</topic><topic>Premature Birth - epidemiology</topic><topic>Premature Birth - prevention & control</topic><topic>Retrospective Studies</topic><topic>Shirodkar</topic><topic>twin pregnancy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Qiu, Liping</creatorcontrib><creatorcontrib>Lv, Min</creatorcontrib><creatorcontrib>Chen, Lujiao</creatorcontrib><creatorcontrib>Chen, Zi</creatorcontrib><creatorcontrib>Shen, Jayan</creatorcontrib><creatorcontrib>Wang, Minmin</creatorcontrib><creatorcontrib>Cai, Yuliang</creatorcontrib><creatorcontrib>Zhao, Baihui</creatorcontrib><creatorcontrib>Luo, Qiong</creatorcontrib><collection>Wiley-Blackwell Open Access Titles</collection><collection>Wiley Free Content</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of gynecology and obstetrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Qiu, Liping</au><au>Lv, Min</au><au>Chen, Lujiao</au><au>Chen, Zi</au><au>Shen, Jayan</au><au>Wang, Minmin</au><au>Cai, Yuliang</au><au>Zhao, Baihui</au><au>Luo, Qiong</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of two emergency cervical cerclage techniques in twin pregnancies: A retrospective cohort study matched with cervical dilation</atitle><jtitle>International journal of gynecology and obstetrics</jtitle><addtitle>Int J Gynaecol Obstet</addtitle><date>2024-03</date><risdate>2024</risdate><volume>164</volume><issue>3</issue><spage>1036</spage><epage>1046</epage><pages>1036-1046</pages><issn>0020-7292</issn><issn>1879-3479</issn><eissn>1879-3479</eissn><abstract><![CDATA[Objectives
This retrospective cohort study aimed to assess the efficacy of emergency cervical cerclage (ECC) performed with the combined McDonald‐Shirodkar technique in twin pregnancies between 18 and 26 weeks of pregnancy with painless cervical dilation 1 to 6 cm.
Methods
A retrospective cohort study matched with the degree of cervical dilation was conducted. The study group (case group) included women with twin pregnancies undergoing combined McDonald‐Shirodkar approach with cervical dilation ≥1 cm between 18 to 26 weeks of gestation at four institutions, from December 2015 to December 2022. To minimize confounding factors, we elucidated the causality structure using a directed acyclic graph and performed 1:1 case–control matching. A control group underwent the McDonald approach. The primary outcome was gestational age (GA) at delivery. The secondary outcomes were pregnancy latency; the rates of spontaneous preterm birth at <28, <30, <32, and <34 weeks; and neonatal outcomes. Additional subanalysis was performed by dividing the patients into two subgroups of women with cervical dilation ≥3 cm and <3 cm.
Results
A total of 84 twin pregnancies were managed with either the combined McDonald‐Shirodkar approach (case group: n = 42) or the McDonald approach (control group: n = 42). Demographic characteristics were not significantly different in the two groups (P > 0.05). After adjusting for confounders that were represented by a directed acyclic graph, median GA at delivery was significantly higher (30.5 vs 27 weeks; Bate: 3.40 [95% confidence interval (CI), 2.13–4.67], P < 0.001) and median pregnancy latency was significantly longer (56 vs 28 days; Bate: 24.04 [95% CI, 13.31–34.78], P < 0.001) in the case group compared with the control group. Rates of spontaneous preterm birth at <28, <30, <32, and <34 weeks were significantly lower in the case group than in the control group. For neonatal outcomes, there was higher birth weight (1543.75 vs 980 g; Bate: 420.08 [95% CI, 192.18–647.98], P < 0.001) and significantly lower overall perinatal mortality (7.1% vs 31%; adjusted odds ratio, 0.16 [95% CI, 0.04–0.70], P = 0.014) in the case group compared with the control group. When cervical dilation was ≥3 cm, the combined McDonald‐Shirodkar procedure can significantly reduce perinatal mortality (8.3% vs 46.7%; adjusted odds ratio, 0.09 [95% CI, 0.01–0.77], P = 0.028), significantly decrease the risk of delivery at <28 and <30 weeks, and prolong GA at delivery and pregnancy latency compared with the McDonald procedure.
Conclusions
ECC performed with the combined McDonald‐Shirodkar procedure in women with twin pregnancies who have cervical dilation 1 to 6 cm in midtrimester pregnancy may reduce the rate of spontaneous preterm birth and improve perinatal and neonatal outcomes compared with the McDonald procedure, especially for twin pregnancies in women with cervical dilation of 3 to 6 cm and prolapsed membranes.
Synopsis
This study estimated whether the novel technique of emergency cervical cerclage in twin pregnancies could reduce the risk of spontaneous preterm birth.]]></abstract><cop>United States</cop><pmid>37712448</pmid><doi>10.1002/ijgo.15081</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-0782-4462</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | International journal of gynecology and obstetrics, 2024-03, Vol.164 (3), p.1036-1046 |
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| source | MEDLINE; Wiley Journals |
| subjects | Cerclage, Cervical - methods cervical dilation Dilatation emergency cervical cerclage Female Humans Infant, Newborn McDonald neonatal outcomes preterm birth Perinatal Death Pregnancy Pregnancy Outcome Pregnancy, Twin Premature Birth - epidemiology Premature Birth - prevention & control Retrospective Studies Shirodkar twin pregnancy |
| title | Comparison of two emergency cervical cerclage techniques in twin pregnancies: A retrospective cohort study matched with cervical dilation |
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