Clinical Analysis Of Cervical Cerclage On The Maternal And Neonatal Outcomes In Twin Pregnancies

Objective:Retrospective analysis of the clinical medical records for patients with twin pregnancy and asymptomatically shortened or dilated cervix in the second trimester of pregnancy,to explore the clinical efficacy of transvaginal cervical cerclage in the treatment of cervical insufficiency(CI)in twin pregnancies,and to explore the effect of transvaginal cervical cerclage on the pregnancy outcome and neonatal outcome of twin pregnancy in different cervical conditions,.To provide clinical basis for improving maternal and fetal outcomes and provide clinical reference for standardized treatment of twin pregnancy complicated with CI.Methods:After inclusion and exclusion criteria,a total of 97 twins pregnant women with asymptomatic cervical shortening or dilation in the second trimester and hospital delivery were selected from January 2014 to December 2020 in our Hospital.According to whether cervical cerclage was performed or not,the patients were divided into two groups: operation group(n = 48)and control group(n = 49).The clinical data of pregnant women and newborns in the two groups were collected,and the differences of general data,pregnancy outcome and neonatal outcome between the two groups were compared.According to the cervical condition,the patients were further divided into four subgroups: cervical residual group(≥ 1.5cm,< 1.5cm)and cervical dilatation group(< 2cm,≥ 2cm),the differences of maternal and fetal outcomes in each subgroup were compared.Results:1.The gestational weeks,prolonged gestational weeks and neonatal birth weight in the transvaginal cervical cerclage group were higher than those in the control group,the incidence of preterm premature rupture of membranes(PPROM),premature rupture of membranes before 34 weeks,incidence of natural delivery at < 24 weeks,< 28 weeks,<32 weeks and < 34 weeks,the incidence of perinatal mortality,admission to the neonatal intensive care unit(NICU),the rate of continuous positive airway pressure(CPAP)and neonatal intraventricular hemorrhage(IVH)in neonates born alive in the operation group were lower than those in the control group(P < 0.05).And there were no significant differences in the rate of cervical laceration,placental abruption,clinical chorioamniotis and histologic chorioamniotis,neonatal hospitalization expenses,neonatal mortality and neonatal morbidity,including sepsis,respiratory distress syndrome(RDS),necrotizing enterocolitis(NEC),retinopathy of prematurity(ROP),bronchopulmonary dysplasia(BPD)in neonates born alive(P > 0.05).2.When the cervical residual length ≥ 1.5cm,the maternal and fetal outcomes of the operation group and the control group were compared,the prolonged gestational weeks in the operation group was higher than that in the control group(P < 0.05).There was no significant difference in SPTB at < 32 weeks and neonatal outcomes between the two groups(P > 0.05).3.When the cervical residual length was less than 1.5cm,the gestational weeks were prolonged and the birth weight of live births was higher in the surgery group,the incidence of chorioamnionitis,spontaneous preterm delivery < 32 weeks,length of stay in the NICU and hospitalization Expenses of live infants in the operation group were significantly lower than those in the control group(P < 0.05).There were no significant differences in delivery gestational age,postpartum hemorrhage and the incidence of PPROM,the rate of admission to the NICU,the rate of CPAP,neonatal morbidity and neonatal mortality between the two groups in neonates born alive(P > 0.05).4.When cervical dilation < 2.0cm,the maternal and infant outcomes were compared between the operation group and the control group,delivery gestational weeks,prolonged gestational weeks and the birth weight of live infants in the operation group were higher than those in the control group.the incidence of SPTB at < 32 weeks,the rate of admission to the NICU,the rate of CPAP and neonatal morbidity in the operation group were lower than those in the control group(P < 0.05).There were no significant differences in the incidence of PPROM,chorioamnionitis,postpartum hemorrhage,total duration of hospitalization in the NICU,hospitalization expenses and neonatal mortality between the two groups in neonates born alive(P > 0.05).5.When cervical dilation ≥2.0cm,the maternal and infant outcomes were compared,the prolongation of gestational age was significantly higher than control group(P < 0.05).There were no significant differences in postpartum hemorrhage,the incidence of PPROM,SPTB at < 32 weeks and chorioamnionitis between the two groups(P > 0.05).A total of 24 fetuses were delivered in the operation group,18 of which were live births,while 18 fetuses were delivered in the control group,and no live births.Conclusion:Transvaginal cervical cerclage is an effective surgical method for for the treatment of twin pregnancy complicated CI,which can reduce the incidence of natural delivery at<24 weeks,<28 weeks,<32 weeks and <34 weeks,significantly prolong the gestational weeks and reduce perinatal mortality.it can improve the pregnancy outcome and neonatal outcome without increasing the risk of serious complications.Further analysis,cervical cerclage is beneficial for twin pregnancies even when placed on a very short(<1.5cm)or dilated cervix,but does not improve the pregnancy outcome and neonatal outcome of twin pregnancies with cervical residual length ≥ 1.5cm.