Transabdominal cervical cerclage in triplet pregnancies and risk of extreme prematurity and neonatal loss

Abstract

There are no reports indicating the effect of prophylactic transabdominal cerclage (TAC) on the prolongation of multifetal pregnancies. We report the use of TAC in triplets, which evolved over 20 years in one practice. A retrospective cohort study of triplet pregnancies was conducted. Obstetric and neonatal outcomes were compared among women who underwent a prophylactic TAC or transvaginal cerclage and no cerclage. Of the 141 women who delivered triplets, prophylactic TAC was associated with reduced incidence of extreme prematurity and improved incidence of neonatal/postnatal survival. With the exception of mode of conception, prepregnancy weight, and the use of home monitoring uterine activity monitor, procardia and terbutaline, no major differences were found in terms of patient characteristics and pregnancy and delivery management among the three groups. It was concluded that in triplet pregnancies, prophylactic placement of a TAC appears to lower the incidence of delivery before 28 weeks.

Transabdominal Cerclage

“…When women who underwent a TAC for reasons other than triplet pregnancy were excluded from the analysis, triplet pregnancies with a TAC were statistically more likely to deliver after 28 weeks compared with those who had a TVC or no cerclage (P = 0.027). 13 Sustained closure of the internaloswithTACmaybethereasonfor reduction of extreme prematurity as well as the observed reduction of incidence of rupturedmembranesasaprimaryevent. 13 Data on triplets managed with TAC subsequent to the cadre reported in 2011 show that the 34 additional patients so managed have not delivered before 28 weeks.…”

“…13 Sustained closure of the internaloswithTACmaybethereasonfor reduction of extreme prematurity as well as the observed reduction of incidence of rupturedmembranesasaprimaryevent. 13 Data on triplets managed with TAC subsequent to the cadre reported in 2011 show that the 34 additional patients so managed have not delivered before 28 weeks. However, balancing the risk of such prophylactic surgery in an already complicated pregnancy against the 13% risk of delivery of 3 extremely premature babies, with their attendant possibility of death and long-term disability, is complex.…”

Embarazo triple monocorial triamniótico: Experiencia de dos casos y revisión de la literatura

“…Las técnicas de reproducción asistida y las gestaciones en edad materna tardías explicarían este aumento (1). Un 93% de los embarazos triples son prematuros (edad gestacional promedio de 32-33 semanas), el 13% de los embarazos triples son prematuros extremos y su mortalidad esta aumentada 10 veces cuando se comparan con embarazos únicos (2). A pesar del aumento de su incidencia, los embarazos monocoriales triples espontáneos son muy poco frecuentes (1).…”

Editorial decisions: What should we publish?

“…We reject articles that look similar in theme to those we have recently accepted, or multiple articles from the same group of contributors. This issue contains an article by Sumners et al (2011), which describes the considerable experience of a group from Indiana, USA over many years of using transabdominal cervical cerclage in triplet pregnancy. The article has gone back and forward between authors and reviewers, and has finally been seen by a small representative group of our Editorial Board.…”