# Efficiency of cervical cerclage and pessary in addition to vaginal progesterone to prevent preterm birth in twin pregnancies: a case-control study from a tertiary center

## TL;DR

This study found that adding cervical cerclage or pessary to vaginal progesterone does not improve outcomes for twin pregnancies at risk of preterm birth.

## Contribution

The study provides clinical evidence that cervical cerclage or pessary offer no additional benefit over vaginal progesterone in twin pregnancies.

## Key findings

- Cervical cerclage or pessary added to vaginal progesterone did not improve delivery after 34 weeks.
- Intraamniotic sludge was a negative independent factor for delivery after 34 weeks.
- No significant differences in effectiveness were found between treatment groups.

## Abstract

This study evaluated the efficiency of cervical cerclage and pessary in addition to vaginal progesterone to prevent preterm birth in twin pregnancies.

This retrospective case-control study included 46 cases of twin pregnancy with cervical insufficiency delivered at Ankara Bilkent City Hospital between January 2022 and January 2024. Patients were grouped as those receiving cervical cerclage in addition to vaginal progesterone (n = 10), cervical pessary in addition to vaginal progesterone (n = 11), and only vaginal progesterone (n = 25). Patients’ data were obtained from the hospital’s database. Obstetric parameters (gravidity, parity, abortion, artificial reproductive technologies, second-trimester abortion) and ultrasound parameters (cervical length, intraamniotic sludge) were recorded. Gestational week at birth, latency period (diagnosis to delivery), and delivery after 34 weeks were evaluated for effectiveness. All parameters were compared between groups and evaluated for effectiveness as an independent factor for preterm birth.

The primary effectiveness parameters of latency period, birth week, and delivery after 34 weeks did not differ statistically between groups. When the parameters were evaluated independently of treatment groups for their effects on delivery after 34 weeks with multivariate regression analysis, the presence of intraamniotic sludge was found to be a negative independent factor for delivery after 34 weeks (p = 0.03).

Cervical cerclage or pessary in addition to vaginal progesterone had no additional benefit for achieving birth after 34 gestational weeks. The only factor that had a negative effect on birth after 34 gestational weeks was the presence of intraamniotic sludge. Our clinical experience with twin pregnancies may provide insight into treatment options for clinicians.