Utility of prophylactic cervical cerclage in intra-cytoplasmic sperm injection twins: a prospective study

ABSTRACT

Background: Several interventions have been used to reduce the rate of preterm birth and prolonging gestation in a twin pregnancy and routine usage of cervical cerclage in twin pregnancy conceived after intra-cytoplasmic sperm injection (ICSI) procedure has found to be beneficial.Methods: Prospective case series studies, series of expectant mothers with twin pregnancy conceived by ICSI were studied under tertiary care hospital setting. A total of 108 cases with twin pregnancy were included during a period of 2016 to 2019. Obstetric profile of all the cases was taken; cervical cerclage procedure was done at 14-16 weeks of gestation (McDonald method) after a normal nuchal translucency scan and a double marker test. Pregnancy outcome parameters like abortion, preterm labour/delivery, premature rupture of membranes (PROM), and mode of delivery, gestational age at delivery, birth weight and neonatal complications were assessed.Results: Mean age of the mothers was 30.61±4.45 years, rates of the pregnancy outcome parameters were abortion 0%, preterm labour 11.1%, premature rupture of membranes (PROM) 9.3%, mean gestational age at delivery was at 34.56±1.71 weeks. Neonatal outcome parameters were mean birth weight was at 2279±470 grams, 77.8% of the neonates had normal APGAR scores. The rates of NICU admission was 28%, RDS– 24.1%, 3.7% had sepsis and 92.6% of neonates survived and 7.4% died.Conclusions: In ICSI twin pregnancies with normal cervical measurements, prophylactic cervical cerclage is effective in prolonging pregnancy and preventing preterm delivery and thereby minimizing neonatal morbidity and mortality.