Adverse perinatal outcome in triplet pregnancies could be attributed to early and very early premature deliveries. The obvious way to improve perinatal outcome is to reduce the number of iatrogenic triplet conceptions, to perform multifetal pregnancy reductions, and to use methods which could prolong pregnancy. The aim of our retrospective cohort study was to determine whether prophylactic cerclage performed in the second trimester in patients with no symptoms of premature labor, with an indication based solely on the diagnosis of the triplet pregnancy, would result in prolongation of the gestation in these pregnancies, resulting in better perinatal mortality and morbidity rates. Between 1st July, 1990 and 30th June, 2006, 122 triplet pregnancies were followed by the 1st Department of Obstetrics and Gynecology. Out of the 114 cases ending with delivery, a prophylactic cerclage was performed in 18 cases (15.8%) between the 18th and 23rd weeks of pregnancy. The control group included 96 patients (84.2%) with triplet pregnancy without cerclage. The gestational age at delivery (31.5±3.6 vs. 32.4±3.2 weeks), the rate of very early premature (<28 weeks) deliveries (11.1 % vs. 8.3%; RR: 1.33, 95% CI: 0.31-5.77) and early premature deliveries (55.6% vs. 39.6%; RR: 1.40, 95% CI: 0.87-2.77), the mean birth weight of the newborns (1537±498 vs. 1682±507), the rate of very-very-low-birth-weight (<1000 g) infants (13.2% vs. 9.6%; RR: 1.37, 95% CI) and very-low-birth-weight (<1500 g) infants (45.3% vs. 36.7%; RR: 1.24, 95% CI: 0,89-1,72) did not differ in the two groups. There was no difference in the late intrauterine mortality, early or total neonatal mortality rates, crude or corrected perinatal mortality rates, respectively. We observed a higher late neonatal mortality rate in the cerclage group (56.6%o vs. 3.6%o, p=0.014; RR: 15.91, 95% CI: 1.69-150.01). There was no difference in the neonatal morbidity rates. Our results demonstrate that prophylactic cerclage performed in the second trimester of triplet pregnancies does not reduce the risk of early premature delivery or the risk of birth of very-low-birth-weight infants, and does not improve the prognosis. Taking into account the complications of the procedure and the lack of advantages, routine use of prophylactic cerclage in triplet pregnancies is not recommended.
|Translated title of the contribution||Prophylactic cerclage does not improve the prognosis of triplet pregnancies|
|Number of pages||10|
|Journal||Magyar Noorvosok Lapja|
|Publication status||Published - Aug 7 2007|
ASJC Scopus subject areas
- Reproductive Medicine
- Obstetrics and Gynaecology