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Routine Cervical Cerclage in Higher Order Multiple Gestation — Does It Prolong the Pregnancy?

Published online by Cambridge University Press:  21 February 2012

Alexander Strauss*
Affiliation:
Department of Obstetrics and Gynecology — Großhadern, University of Munich, Germany. [email protected]
Ivo M. Heer
Affiliation:
Department of Obstetrics and Gynecology — Großhadern, University of Munich, Germany.
Udo Janßen
Affiliation:
Department of Obstetrics and Gynecology — Großhadern, University of Munich, Germany.
Christian Dannecker
Affiliation:
Department of Obstetrics and Gynecology — Großhadern, University of Munich, Germany.
Peter Hillemanns
Affiliation:
Department of Obstetrics and Gynecology — Großhadern, University of Munich, Germany.
Susanne Müller-Egloff
Affiliation:
Department of Obstetrics and Gynecology — Großhadern, University of Munich, Germany.
*
*Address for correspondence: Alexander Strauss MD, Department of Obstetrics and Gynecology — Großhadern, University of Munich, Marchioninistrasse 15, D-81377 Munich, Germany.

Abstract

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Preterm birth following cervical dilatation is the greatest threat to infants of a multiple pregnancy. Lacking reliable data concerning the effect of prophylactic cerclage, we compared a study group to controls for maternal and perinatal outcome. Sixteen of 94 triplet-, 9 of 18 quadruplet/quintuplet-pregnancies, treated with prophylactic cerclage, were retrospectively compared to those without cervical cerclage respectively. Kruskal-Wallis test and Mann-Whitney-U test were performed as non-parametric one way analysis of variance. For the analysis of frequencies Chi Square test or Fisher’s exact test were performed. Odds ratio with 95% confidence interval was used to compare the need for intravenous tocolysis as well as perinatal morbidity and mortality. Gestational age at delivery was not different from the controls in all studied groups. Birth weight revealed a 200g dominance for the “no cerclage-triplets”, while this significant difference was inverted for quadruplets/quintuplets (1245g vs. 1069g). With respect to gestational age at birth, need for hospitalisation or medical intervention no benefit was achieved. Moreover, perinatal outcome analysed by arterial pH, APGAR-Score and perinatal mortality was not altered by a prophylactic cerclage. Perinatal morbidity for quadruplets and quintuplets was even higher in cerclage pregnancies. Therefore, these retrospective results disclaim a positive impact of cervical cerclage on pregnancy management or perinatal outcome in multifetal pregnancies.

Type
Articles
Copyright
Copyright © Cambridge University Press 2002