361. Effectiveness of Cervical Cerclage in Twin Pregnancies

Introduction: There are robust data in the literature that cervical cerclage inserted due to maternal history does not improve neonatal outcomes in twins. However, there is insufficient data about perinatal outcomes of cerclages inserted due to physical examination or ultrasound indications in twin pregnancies. Aim of the study: Assessment of the effectiveness of the emergency cervical cerclage and for ultrasound indications cervical cerclage in a twin pregnancy. Methods: Retrospective analysis of all patients in twin pregnancies qualified for cervical cerclage due to physical examination or ultrasound indications at St. Sophia Hospital in Warsaw from January 2020 to April 2021 after diagnosing cervical incompetence. Results: During the study period, we qualified for the study 14 cases of twin pregnancies with diagnosed cervical insufficiency on physical examination or USG, with live and normal fetuses in USG. At birth, the mean gestational age (GA) was 33 weeks, and it ranges from 25 – 37 GA. We took diagnostic smears from the cervical canal or prolapsed membranes and blood inflammatory tests. All patients were given antibiotics after procedure. There was no neonatal death. Two cases (14%) were delivered on time; four were delivered before 32 GA (27.0%). In one case, there was a premature rupture of membranes during the procedure. The mean time of pregnancy prolongation after the operation was ten weeks (ranges 2-18 weeks). There was one case with a poor perinatal outcome – both neonates had bronchopulmonary dysplasia and retinopathy grade 2, and one of them had NEC. In this case, labor was at 26 GA. Two cases are still ongoing (ten and seven weeks from the procedure). Conclusions: The obtained data suggest that cervical cerclage inserted based on physical examination or ultrasound examination may significantly extend pregnancy duration and improve neonatal outcomes.