{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:43:24Z","timestamp":1786977804343,"version":"build-2736575974"},"reference-count":40,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,9,15]],"date-time":"2023-09-15T00:00:00Z","timestamp":1694736000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This retrospective cohort study aimed to assess the efficacy of emergency cervical cerclage (ECC) performed with the combined McDonald\u2010Shirodkar technique in twin pregnancies between 18 and 26\u2009weeks of pregnancy with painless cervical dilation 1 to 6\u2009cm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study matched with the degree of cervical dilation was conducted. The study group (case group) included women with twin pregnancies undergoing combined McDonald\u2010Shirodkar approach with cervical dilation \u22651\u2009cm between 18 to 26\u2009weeks of gestation at four institutions, from December 2015 to December 2022. To minimize confounding factors, we elucidated the causality structure using a directed acyclic graph and performed 1:1 case\u2013control matching. A control group underwent the McDonald approach. The primary outcome was gestational age (GA) at delivery. The secondary outcomes were pregnancy latency; the rates of spontaneous preterm birth at &lt;28, &lt;30, &lt;32, and &lt;34\u2009weeks; and neonatal outcomes. Additional subanalysis was performed by dividing the patients into two subgroups of women with cervical dilation \u22653\u2009cm and &lt;3\u2009cm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 84 twin pregnancies were managed with either the combined McDonald\u2010Shirodkar approach (case group:\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200942) or the McDonald approach (control group:\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200942). Demographic characteristics were not significantly different in the two groups (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&gt;\u20090.05). After adjusting for confounders that were represented by a directed acyclic graph, median GA at delivery was significantly higher (30.5 vs 27\u2009weeks; Bate: 3.40 [95% confidence interval (CI), 2.13\u20134.67],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001) and median pregnancy latency was significantly longer (56 vs 28\u2009days; Bate: 24.04 [95% CI, 13.31\u201334.78],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001) in the case group compared with the control group. Rates of spontaneous preterm birth at &lt;28, &lt;30, &lt;32, and &lt;34\u2009weeks were significantly lower in the case group than in the control group. For neonatal outcomes, there was higher birth weight (1543.75 vs 980\u2009g; Bate: 420.08 [95% CI, 192.18\u2013647.98],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001) and significantly lower overall perinatal mortality (7.1% vs 31%; adjusted odds ratio, 0.16 [95% CI, 0.04\u20130.70],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.014) in the case group compared with the control group. When cervical dilation was \u22653\u2009cm, the combined McDonald\u2010Shirodkar procedure can significantly reduce perinatal mortality (8.3% vs 46.7%; adjusted odds ratio, 0.09 [95% CI, 0.01\u20130.77],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.028), significantly decrease the risk of delivery at &lt;28 and &lt;30\u2009weeks, and prolong GA at delivery and pregnancy latency compared with the McDonald procedure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ECC performed with the combined McDonald\u2010Shirodkar procedure in women with twin pregnancies who have cervical dilation 1 to 6\u2009cm in midtrimester pregnancy may reduce the rate of spontaneous preterm birth and improve perinatal and neonatal outcomes compared with the McDonald procedure, especially for twin pregnancies in women with cervical dilation of 3 to 6\u2009cm and prolapsed membranes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.15081","type":"journal-article","created":{"date-parts":[[2023,9,15]],"date-time":"2023-09-15T06:28:06Z","timestamp":1694759286000},"page":"1036-1046","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Comparison of two emergency cervical cerclage techniques in twin pregnancies: A retrospective cohort study matched with cervical dilation"],"prefix":"10.1002","volume":"164","author":[{"given":"Liping","family":"Qiu","sequence":"first","affiliation":[{"name":"Department of Obstetrics Huzhou Maternity &amp; Child Health Care Hospital  Huzhou Zhejiang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Lv","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Women's Hospital, Zhejiang University, School of Medicine  Hangzhou Zhejiang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lujiao","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Zhejiang University, School of Medicine  Hangzhou Zhejiang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zi","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Zhejiang University, School of Medicine  Hangzhou Zhejiang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayan","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Huzhou Maternity &amp; Child Health Care Hospital  Huzhou Zhejiang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minmin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics The First People's Hospital of Fuyang  Fuyang Zhejiang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuliang","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Shaoxing Maternity &amp; 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