Twin Cerclage

August 30, 2017
1033704
Pregnancy, OB Gyn
Corina Schoen, MD
Baystate Medical Center, 759 Chestnut Street, Springfield, MA
The purpose of this research is to determine whether the use of cervical cerclage in women with twin pregnancy and cervical dilation before 24 weeks will prevent, or reduce the occurrence of preterm birth. While some case reports have found that cervical cerclage may prevent preterm birth in twin pregnancies, the use of cervical cerclage to prevent preterm birth in this study is experimental.

Inclusion Criteria

1. Pregnant women more than 18 years of age
2. Diamniotic twin pregnancy (limits the participants to female gender)
3. Asymptomatic
4. Cervical dilation 1- 5 cm and/or visible membranes by pelvic exam or speculum exam on second trimester ultrasound between 16-23 6/7 weeks gestation

Exclusion Criteria

1. Singleton or higher order than twins multiple gestation
2. Cervical dilation more than 5 cm
3. Amniotic membranes prolapsed into the vagina, unable to visualize cervix
4. Fetal reduction after 14 weeks form higher order
5. Monoamniotic twins
6. Twin-twin transfusion syndrome
7. Ruptured membranes prior to randomization
8. Major fetal structural anomaly
9. Fetal chromosomal abnormality
10. Cerclage already in place for other indication
11. Active vaginal bleeding
12. Suspicion of chorioamnionitis
13. Placenta previa
14. Painful regular uterine contractions
15. Labor

 

The overall objective of this study is to assess the efficacy of the use of a physical exam indicated cerclage for prevention of PTB in a population of women with twin gestations, dilated cervix and visible membranes at the time of speculum exam between 16 0/7 to 23 6/7 weeks.
Ongoing
Dr. Corina Schoen
413-794-3470