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Cervical stitch for preventing preterm birth in women with a multiple pregnancy-An observational study done at Mathrutva fertility centre

2020-03-11

Carrying more than one baby increases a woman’s risk of delivering Preterm. The risks increase with the number of babies being carried.

Babies born prematurely are more likely to experience poor outcomes including serious ill health and death. Despite the progress in modern obstetric practice, preterm labour is second leading cause of death in the 1st month of life and the main cause of perinatal morbidity and mortality; it remains a difficult problem to prevent, delay or even stop. It occurs in 5%-13% of all pregnancies before 37 weeks gestation but its incidence in twin pregnancies is about 25%.

Cervical cerclage is a surgical procedure carried out during pregnancy to try to prevent preterm birth by limiting shortening and opening of the cervix. It is performed by placing suture material around the cervix, which is accessed either by the vagina or through the mother’s abdomen laparoscopically. The effectiveness and safety of this procedure for multiple gestations remains uncertain. The likelihood of spontaneous preterm birth can be assessed by looking at the mothers obstetric history, a physical examination, or transvaginal ultrasound examination in the second trimester.

Several interventions have been used to reduce the rate of preterm birth in a twin pregnancy, such as bed rest, prophylactic tocolysis, nutritional advice, administration of 17 α-hydroxyprogesterone caproate, vaginal progesterone, cervical pessary and CC.

Unfortunately, these interventions have not been shown to reduce the risk of preterm birth in unselected twin pregnancy.

So at our centre we decided to do a study on the effect of prophylactic cervical encirclage on twin gestation conceived after IVF – ICSI treatment.

The observation of our study was comparable with few other studies.

Results: Mean age of the mothers was 30.61 ± 4.45 years, rates of the pregnancy outcome parameters were as follows – Abortion 0%, preterm labour 11.1%, PROM 9.3%, mean gestational age at delivery was at 34.56 ± 1.71 weeks. Neonatal outcome parameters – mean birth weight was at 2279 ± 470 grams, 77.8% of the neonates had normal APGAR scores. The rates of NISU admission was 28%, RDS – 24.1%, 3.7% had sepsis and 92.6% of neonates survived and 7.4% died.

Conclusion: In ICSI twin pregnancies with normal cervical measurements, prophylactic cervical cerclage is effective in prolonging pregnancy and preventing preterm delivery and thereby minimizing neonatal morbidity and mortality.

Blog reviewd by: Dr. C S Manjunath
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