Cerclage for cervical shortening at fetoscopic laser photocoagulation in twin-twin transfusion syndrome

• Published in: American journal of obstetrics and gynecology Vol. 206; no. 5; pp. 425.e1 - 425.e7
• Main Authors: Papanna, Ramesha, MD, MPH, Habli, Mounira, MD, MPH, Baschat, Ahmet A., MD, Bebbington, Michael, MD, MHSc, Mann, Lovepreet K., MBBS, Johnson, Anthony, DO, Ryan, Greg, MB, Walker, Martin, MB, Lewis, David, MD, Harman, Christopher, MD, Crombleholme, Timothy, MD, Moise, Kenneth J., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.05.2012; Elsevier
• Subjects: Adult; Biological and medical sciences; Cerclage, Cervical; cervical cerclage; Cohort Studies; Female; Fetofetal Transfusion - surgery; Fetoscopy; Gestational Age; Gynecology. Andrology. Obstetrics; Humans; Infant, Newborn; Kaplan-Meier Estimate; Laser Coagulation; Medical sciences; Obstetrics and Gynecology; Perinatal Mortality; Pregnancy; Proportional Hazards Models; Retrospective Studies; short cervix; Treatment Outcome; twin-twin transfusion syndrome; Uterine Cervical Incompetence - surgery; cervical cerclage; short cervix; twin-twin transfusion syndrome; Photocoagulation; Surgical cerclage; Treatment; Surgery; Gynecology; Fetofetal transfusion; Laser; Shortening; Amniofetoscopy; Uterine cervix; Obstetrics
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2012.02.022

Objective The purpose of this study was to evaluate the benefit of cervical cerclage for cervical length ≤25 mm at the time of fetoscopic laser photocoagulation (FLP) for twin-twin transfusion syndrome. Study Design A multicenter, retrospective cohort study was conducted with 163 patients with a short cervix before FLP for twin-twin transfusion syndrome. Seventy-nine of the patients (48%) had cerclage placement at the surgeon's discretion. The outcome measures that were compared were gestational age at delivery and perinatal mortality rates for patients with cerclage and those who were treated conservatively. Outcomes were evaluated with the use of comparative statistics. Results There were no differences in the preoperative variables, except cerclage was performed more frequently for a cervical length of ≤15 mm ( P < .001). There were no differences in the gestational age at delivery (28.8 ± 5.4 vs 29.1 ± 5.6 weeks with and without cerclage, respectively; P = .15); perinatal mortality rates were similar between the 2 groups. Conclusion The benefit of cerclage for patients with short cervix before FLP remains questionable.