{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T20:35:00Z","timestamp":1792010100090,"version":"4.4.0"},"reference-count":31,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,8,29]],"date-time":"2019-08-29T00:00:00Z","timestamp":1567036800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Cervical cerclage, when performed in twin gestation, has been reported to be associated with poor outcome. However, the role of first\u2010trimester history\u2010indicated cerclage among women with a twin pregnancy and a history of preterm birth has not been evaluated. The aim of this study was to assess pregnancy outcomes among women with a twin pregnancy who underwent first\u2010trimester history\u2010indicated cervical cerclage compared with outcomes in those managed expectantly.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective matched case\u2013control study. The study group comprised all women with a twin pregnancy who had undergone first\u2010trimester history\u2010indicated cerclage during the period 2006 to 2017 at Hadassah\u2010Hebrew University Medical Center. A control group of women with a twin pregnancy who were managed expectantly was established by matching age, history of spontaneous preterm birth (20\u201336 weeks' gestation) and year of delivery. Pregnancy and delivery characteristics and neonatal outcomes were compared between the two groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Data from 82 women with a twin gestation were analyzed, of whom 41 underwent first\u2010trimester history\u2010indicated cerclage and 41 were matched controls who were managed expectantly. Gestational age at delivery was higher in the cerclage group than in those managed expectantly (median 35 <jats:italic>vs<\/jats:italic> 30 weeks; <jats:italic>P<\/jats:italic> &lt; 0.0001). Rates of spontaneous preterm birth before 24 weeks (2.4% <jats:italic>vs<\/jats:italic> 19.5%; odds ratio (OR), 0.10 (95% CI, 0.01\u20130.87); <jats:italic>P<\/jats:italic> = 0.03), before 28 weeks (12.2% <jats:italic>vs<\/jats:italic> 34.1%; OR, 0.27 (95% CI, 0.09\u20130.84); <jats:italic>P<\/jats:italic> = 0.03), before 32 weeks (22.0% <jats:italic>vs<\/jats:italic> 56.1%; OR, 0.22 (95% CI, 0.08\u20130.58); <jats:italic>P<\/jats:italic> = 0.003) and before 34 weeks (34.1% <jats:italic>vs<\/jats:italic> 82.9%; OR, 0.11 (95% CI, 0.04\u20130.30); <jats:italic>P<\/jats:italic> &lt; 0.0001) were significantly lower in the cerclage group than in the control group. Median birth weight was higher in the cerclage group (2072 g <jats:italic>vs<\/jats:italic> 1750 g; <jats:italic>P<\/jats:italic> = 0.003), with lower rates of low birth weight (&lt; 2500 g) (65.0% <jats:italic>vs<\/jats:italic> 89.4%; <jats:italic>P<\/jats:italic> = 0.001) and very low birth weight (&lt; 1500 g) (21.3% <jats:italic>vs<\/jats:italic> 37.9%; <jats:italic>P<\/jats:italic> = 0.03) than in the group managed expectantly. Rates were also lower in the cerclage group for stillbirth, admission to the neonatal intensive care unit, respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, sepsis, neonatal mortality and composite adverse neonatal outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>History\u2010indicated cerclage performed in the first trimester, as compared with expectant management, in women with a twin pregnancy had an overall positive effect on pregnancy and neonatal outcomes. These findings suggest the need for adequate randomized trials on cerclage placement in this subset of women. Copyright \u00a9 2018 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.20192","type":"journal-article","created":{"date-parts":[[2018,12,14]],"date-time":"2018-12-14T07:20:17Z","timestamp":1544772017000},"page":"517-523","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["History\u2010indicated cervical cerclage in management of twin pregnancy"],"prefix":"10.1002","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2472-5204","authenticated-orcid":false,"given":"A.","family":"Rottenstreich","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Hadassah\u2010Hebrew University Medical Center  Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1282-5379","authenticated-orcid":false,"given":"G.","family":"Levin","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Hadassah\u2010Hebrew University Medical Center  Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Kleinstern","sequence":"additional","affiliation":[{"name":"Department of Health Sciences Research Mayo Clinic  Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Zigron","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Hadassah\u2010Hebrew University Medical Center  Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Rottenstreich","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Shaare Zedek Medical Center  Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"U.","family":"Elchalal","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Hadassah\u2010Hebrew University Medical Center  Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1412-5862","authenticated-orcid":false,"given":"S.","family":"Yagel","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Hadassah\u2010Hebrew University Medical Center  Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,8,29]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2012-3769"},{"key":"e_1_2_7_3_1","volume-title":"Born Too Soon: The Global Action Report on Preterm Birth","author":"March of Dimes","year":"2012"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2010.04.031"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60074-4"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2013.11.007"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0020-7292(02)00340-5"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13669-013-0058-3"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12600"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2014.03.037"},{"key":"e_1_2_7_11_1","first-page":"CD009166","article-title":"Cervical stitch (cerclage) for preventing preterm birth in multiple pregnancy","volume":"9","author":"Rafael TJ","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000443276.68274.cc"},{"key":"e_1_2_7_13_1","volume-title":"Cervical Cerclage: Green\u2010Top Guideline No. 60","author":"Royal College of Obstetricians and Gynaecologists (RCOG)","year":"2011"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1701-2163(15)30764-7"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1963.tb04186.x"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.123.7.991"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-197801000-00001"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(78)80282-0"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1993.tb15300.x"},{"key":"e_1_2_7_20_1","first-page":"1091","article-title":"ACOG Practice Bulletin. 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