Cervical stitch (cerclage) for preventing preterm birth in multiple pregnancy

For multiple gestations, cervical cerclage may not be effective for preventing preterm births and reducing perinatal deaths or neonatal morbidity compared to no cerclage.

Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment in half of the studies and unclear blinding of outcome assessment) and by imprecise results (wide confidence intervals).

Summary

A Cochrane review included 5 studies with a total of 128 subjects, of which 122 women had twin gestations, and six women had triplet gestations. Two trials (n = 73 women) assessed history-indicated cerclage, while three trials (n = 55 women) assessed ultrasound-indicated cerclage. Compared with no cerclage, there was no statistically significant differences in perinatal deaths (19.2% vs 9.5%; RR 1.74, 95% CI 0.92 to 3.28; 5 trials, n=262), serious neonatal morbidity (15.8% vs 13.6%; average RR 0.96, 95% CI 0.13 to 7.10; 3 trials, n = 116), or composite perinatal death and neonatal morbidity (40.4% vs 20.3%; average RR 1.54, 95% CI 0.58 to 4.11; 3 trials, n = 116). There were no significant differences among the following: preterm birth less than 34 weeks (average RR 1.16, 95% CI 0.44 to 3.06; 4 trials, n = 83), low birthweight less than 2500 g (average RR 1.10, 95% CI 0.82 to 1.48; 4 trials, n = 172), respiratory distress syndrome (average RR 1.70, 95% CI 0.15 to 18.77; 3 trials, n = 116), and caesarean section (elective and emergency) (RR 1.24, 95% CI 0.65 to 2.35; 3 trials, n = 77). No trials reported on long-term infant neurodevelopmental outcomes.

Clinical comments

Date of latest search: 30 June 2014

Ədəbiyyat

1. Rafael TJ, Berghella V, Alfirevic Z. Cervical stitch (cerclage) for preventing preterm birth in multiple pregnancy. Cochrane Database Syst Rev 2014;(9):CD009166.