Perinatal outcome of triplet gestation: Does prophylactic cerclage make a difference?

Abstract

Objective: To compare the perinatal outcome of triplet gestations with and without prophylactic cerclage. Methods: A retrospective chart review of all triplet gestations delivered between January 1988 and June 1997 was performed. Only women initiating prenatal care before 15 weeks gestation were included. The cerclage group was compared to the no-cerclage group for maternal and perinatal outcome variables. Student t-test, Chi-square, and Fisher's exact test were used for analysis. Results: Twenty of the 59 (33.8%) sets of triplet gestations had prophylactic cerclage. There were no differences between groups when compared for maternal age, parity, preterm labor rate, gestational diabetes, anemia, antenatal steroid use, histologic chorioamnionitis, and postoperative endometritis. In addition, there were no differences in mean birth weight, Apgar scores, respiratory distress syndrome (RDS), intraventricular hemorrhage/periventricular leucomalacia (IVH/PVL), and neonatal mortality. Although the mean gestational age at delivery for the cerclage group (32.8 +-2.4 weeks) was not different from the no-cerclage group (31.5 ? 3.6 weeks), the proportion of pregnancies delivered at 31 weeks or more, and at 32 weeks or more, was significantly higher in the cerclage group (90 vs. 62%, P = .02; 80 vs. 54%, P = .05), respectively. In addition, the incidence of extremely low birth weight (LBW) was significantly decreased in the cerclage compared with the no-cerclage group (1.7 vs. 15.4%, P = .005). Conclusions: Prophylactic cerclage decreased significantly the incidence of extremely LBW neonates in triplet pregnancies. The proportion of neonates delivered at 31 weeks or more, and at 32 weeks or more was higher in the cerclage group.

Triplet gestation: Clinical outcome of 14 cases

“…It exposes the patient to some preventive measures shown to reduce preterm deliveries in multiple pregnancies. 12,13 About twothird of the patients in this study booked for antenatal care. Early diagnosis of triplet pregnancy allows for the initiation of a pattern of measures to prevent preterm birth and prematurity.…”

“…There are divergent views on the place of prophylactic cerclage in triplet gestations with regards to the foetal outcome. Some authors found it beneficial, 12,15 others found no benefit to its use. 14,16,17 However, Ramin 18 found ultrasonographic assessment of cervical length to be a useful adjuvant in the management of triplet gestation.…”

Effectiveness of Prophylactic Cervical Cerclage in Prolonging Higher-Order Multiple Pregnancies

“…8,13,19 The criteria for patient and sample size selection and hospitalisation in previous research is not uniform. 10,[19][20][21] Some studies have demonstrated that prophylactic cerclage is of no value in prolonging gestation in high-order multiple pregnancies. 10,14,19,22 In contrast, other studies have found that prophylactic cerclage significantly increases the mean gestational age and decreases the incidence of extreme prematurity.…”

“…10,14,19,22 In contrast, other studies have found that prophylactic cerclage significantly increases the mean gestational age and decreases the incidence of extreme prematurity. [20][21][22] Nevertheless, routine prophylactic cervical cerclage is not recommended for every woman with a multiple pregnancy and the safety and efficacy of the procedure as a form of preterm birth prevention should be appraised on a case-by-case basis according to obstetric history and cervical assessment. 12,14 In a study of current practices to prevent preterm births, Baker et al found that the majority of Canadian specialists (82%) recommended routine cervical length assessment at 16-21 gestational weeks, with none supporting routine cerclage insertion; however, 71% stated that they would perform cerclage based on the patient's history or an ultrasound.…”

Diagnostik und Prophylaxe der Cervixinsuffizienz in der Mehrlingsschwangerschaft

“…Die Wirksamkeit einer prophylaktischen Cerclage in Einlingsund Zwillingsschwangerschaften ohne anamnestisches Risiko einer Cervixinsuffizienz ist nicht belegt [9,10]. Zwei kontrollierte randomisierte Studien haben sich bisher mit der Wirksamkeit einer Cerclage in Zwillingsschwangerschaften auseinandergesetzt [11,12].…”