Nav: Home

At-risk twin pregnancies benefit from an intervention called cerclage

June 29, 2020

(PHILADELPHIA) - Women carrying twins are at higher risk for premature birth and miscarriage - those whose cervix dilates before 24 weeks are at highest risk - and yet one common treatment is not recommended for this population. A new multi-center randomized-controlled trial from Thomas Jefferson University shows that cerclage, an intervention that sutures a dilating cervix closed, can help prevent preterm birth and miscarriage. The findings could overturn existing guidelines.

The clinical trial was stopped early because of positive results in the intervention group. The researchers showed that perinatal mortality was significantly decreased in women receiving cerclage.

"For women with twin pregnancies and early signs of labor and cervix dilation, there was really very little we could offer," says first author, Amanda Roman, MD, Associate Professor in the Department of Obstetrics and Gynecology at Thomas Jefferson University. "This study provides powerful evidence that there is an effective treatment we can use."

The results were published online in the American Journal of Obstetrics and Gynecology (AJOG) on June 24th.

Women who showed signs of preterm labor, as confirmed by a cervical exam that indicates dilation, were enrolled in the study and randomized to either receive cerclage plus antibiotics and indomethacin (an anti-pain medication) , or standard of care. Of the 30 women enrolled, 17 women were randomized to the cerclage group and 13 to non-cerclage. The women in both groups were similar in demographics including age, race, body-mass index and other factors for preterm birth.

The trial enrolled 30 patients across 8 medical centers over the course of four years. "The small number of participants reflects how rare this condition is among all pregnancies," says Dr. Roman. "But because women were randomized to treatment and non-treatment groups, the results are strong, as confirmed by the independent Data Safety Monitoring Board."

The analysis showed that in the group that received cerclage, gestation was prolonged by an average of 5.6 weeks (with a range of 2.0 to 9.3 weeks), and reduced infant mortality by 77%.

"Cerclage is a heroic intervention in this group of women," says Dr. Roman. "The possibility of losing a pregnancy is devastating. So we're very encouraged by these results demonstrating a life-saving intervention for women with twins experiencing early asymptomatic cervical dilation."

"We've already incorporated this cerclage into our practice and have been able to offer this to pregnant mothers with twins with great success," says senior author Vincenzo Berghella, MD, Director of the Division of Maternal Fetal Medicine at Jefferson. "These results have the potential to change practice, and help many more women have healthy twin babies."

Dr. Roman and her collaborators are also exploring whether cerclage might prove effective for another subset of women carrying twins, specifically women whose cervical length has shortened, which is a precursor to cervical dilation, between 16 and 23 weeks. They have a clinical trial currently open. Women participating in the study will be randomized to receiving cerclage or no cerclage (ClinicalTrials.gov # NCT03340688).
-end-
No external financial support was received for this study. The authors report no conflicts of interest.

Article Reference: Amanda Roman, Noelia Zork, Sina Haeri, Corina N. Schoen, Gabriele Saccone, Sarah Colihan, Craig Zelig, Alexis C. Gimovsky, Neil S. Seligman, Fulvio Zullo, Vincenzo Berghella, "Physical Exam Indicated Cerclage in Twin pregnancy: a Randomized Controlled Trial," AJOG, DOI: 10.1016/j.ajog.2020.06.047, 2020.

Media Contact: Edyta Zielinska, 215-955-7359, edyta.zielinska@jefferson.edu.

Thomas Jefferson University

Related Miscarriage Articles:

Miscarriage risk increases each week alcohol is used in early pregnancy
Each week a woman consumes alcohol during the first five to 10 weeks of pregnancy is associated with an incremental 8% increase in risk of miscarriage, according to a study by Vanderbilt University Medical Center (VUMC) researchers.
Mild thyroid dysfunction affects one in five women with a history of miscarriage or subfertility
Mild thyroid abnormalities affect up to one in five women with a history of miscarriage or subfertility which is a prolonged time span of trying to become pregnant, according to a new study published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism.
Miscarriage and ectopic pregnancy may trigger long-term post-traumatic stress
One in six women experience long-term post-traumatic stress following miscarriage or ectopic pregnancy.
Recurrent miscarriage: Diabetes drug could lead to new treatment
A drug designed to tackle diabetes could also be repurposed as the first treatment to prevent miscarriage by targeting the lining of the womb itself, according to a clinical trial led by the University of Warwick.
BU study finds celebrity disclosures increase discussion of miscarriage on twitter
A new Boston University School of Public Health (BUSPH) study characterizes how Twitter users discuss miscarriage and preterm birth.
Certain steps help lead to healthy pregnancies in women with rheumatoid arthritis
For women with rheumatoid arthritis (RA), taking certain steps to ensure that they have a healthy pregnancy leads to a reduced risk of complicated birth or miscarriage, according to a study in Arthritis Care & Research.
Progesterone from an unexpected source may affect miscarriage risk
Progesterone signaling is key to a healthy pregnancy. An Austrian team's research suggests a link between recurrent miscarriage and disrupted progesterone synthesis.
Finding support outside the clinic -- the intersection of instagram and miscarriage
An interdisciplinary team of researchers explore how women use the platform to talk openly about the emotional distress of a miscarriage and how social media can inform patient care.
Is disability a risk factor for miscarriage?
A new study compared the proportion of women with any cognitive, physical, or independent living disability who experienced a miscarriage during the previous 5-year period to women without disabilities.
Chromosomal abnormalities uncovered in many couples struggling with recurrent miscarriage
A new study by investigators from Brigham and Women's Hospital, Shandong University and the Chinese University of Hong Kong uses a special genetic sequencing technique known as low-pass genome sequencing (GS) to look for chromosomal abnormalities in couples with RM.
More Miscarriage News and Miscarriage Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: The Power Of Spaces
How do spaces shape the human experience? In what ways do our rooms, homes, and buildings give us meaning and purpose? This hour, TED speakers explore the power of the spaces we make and inhabit. Guests include architect Michael Murphy, musician David Byrne, artist Es Devlin, and architect Siamak Hariri.
Now Playing: Science for the People

#576 Science Communication in Creative Places
When you think of science communication, you might think of TED talks or museum talks or video talks, or... people giving lectures. It's a lot of people talking. But there's more to sci comm than that. This week host Bethany Brookshire talks to three people who have looked at science communication in places you might not expect it. We'll speak with Mauna Dasari, a graduate student at Notre Dame, about making mammals into a March Madness match. We'll talk with Sarah Garner, director of the Pathologists Assistant Program at Tulane University School of Medicine, who takes pathology instruction out of...
Now Playing: Radiolab

What If?
There's plenty of speculation about what Donald Trump might do in the wake of the election. Would he dispute the results if he loses? Would he simply refuse to leave office, or even try to use the military to maintain control? Last summer, Rosa Brooks got together a team of experts and political operatives from both sides of the aisle to ask a slightly different question. Rather than arguing about whether he'd do those things, they dug into what exactly would happen if he did. Part war game part choose your own adventure, Rosa's Transition Integrity Project doesn't give us any predictions, and it isn't a referendum on Trump. Instead, it's a deeply illuminating stress test on our laws, our institutions, and on the commitment to democracy written into the constitution. This episode was reported by Bethel Habte, with help from Tracie Hunte, and produced by Bethel Habte. Jeremy Bloom provided original music. Support Radiolab by becoming a member today at Radiolab.org/donate.     You can read The Transition Integrity Project's report here.