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KMID : 0191120200350110066
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Journal of Korean Medical Science
2020 Volume.35 No. 11 p.66 ~ p.66
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Effect of Cervical Cerclage on the Risk of Recurrent Preterm Birth after a Twin Spontaneous Preterm Birth
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Kim Shin-Young
Park Hyun-Soo
Kwon Ha-Yan
Seol Hyun-Joo
Bae Jin-Gon
Ahn Ki-Hoon
Na Sung-Hun
Lee Se-Jin
Lee Mi-Young
Lee Seung-Mi
Kwak Dong-Wook
Park Jung-Yoon
Park In-Yang
Won Hye-Sung
Kim Moon-Young
Ko Hyun-Sun
Hwang Han-Sung
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Abstract
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Background: This study aimed to evaluate the effect of cervical cerclage on the recurrence risk for preterm birth in singleton pregnant women after a twin spontaneous preterm birth (sPTB).
Methods: This multicenter retrospective cohort study included women who had a singleton pregnancy from January 2009 to December 2018 at 10 referral hospitals and a twin sPTB before the current pregnancy. We compared the cervical lengths during pregnancy and pregnancy outcomes, according to the placement of prophylactic or emergency cerclage. We evaluated the independent risk factors for sPTB (< 37 weeks of gestation) in a subsequent singleton pregnancy.
Results: For the index singleton pregnancy, preterm birth occurred in seven (11.1%) of 63 women. There was no significant difference in the cervical lengths during pregnancy in women with and without cerclage. In a multivariate logistic regression analysis, the placement of emergency cerclage was an independent risk factor for subsequent singleton preterm birth (odds ratio [OR], 93.188; 95% confidence interval [CI], 1.633?5,316.628; P = 0.027); however, the placement of prophylactic cerclage (OR, 19.264; 95% CI, 0.915?405.786; P = 0.057) was not a factor. None of the women who received prophylactic cerclage delivered before 35 weeks' gestation in the index singleton pregnancy.
Conclusion: Cerclage did not lower the risk of preterm birth in a subsequent singleton pregnancy after a twin sPTB. However, emergency cerclage was an independent risk factor for preterm birth and there was no preterm birth before 35 weeks' gestation in the prophylactic cerclage group. Therefore, close monitoring of the cervical length and prophylactic cerclage might be considered in women who have experienced a twin sPTB at extreme gestation.
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KEYWORD
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Twins, Premature Birth, Preterm Premature Rupture of the Membranes, Uterine Cervical Incompetence, Cervical Cerclage
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