{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T21:10:57Z","timestamp":1788469857222,"version":"build-2803163510"},"reference-count":29,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,1,13]],"date-time":"2022-01-13T00:00:00Z","timestamp":1642032000000},"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;amp; Gyne"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Preoperative short cervical length (CL) remains a major risk factor for preterm birth after laser surgery for twin\u2013twin transfusion syndrome (TTTS), but the optimal intervention to prolong pregnancy remains elusive. The objective of this study was to compare secondary methods for the prevention of preterm birth in twin pregnancies with TTTS undergoing fetoscopic laser photocoagulation (FLP), in the setting of a short cervix at the time of FLP, in five North American Fetal Treatment Network (NAFTNet) centers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a secondary analysis of data collected prospectively at five NAFTNet centers, conducted from January 2013 to March 2020. Inclusion criteria were a monochorionic diamniotic twin pregnancy complicated by TTTS, undergoing FLP, with preoperative CL\u2009&lt;\u200930\u2009mm. Management options for a short cervix included expectant management, vaginal progesterone, pessary (Arabin, incontinence or Bioteque cup), cervical cerclage or a combination of two or more treatments. Patients were not included if the intervention was initiated solely on the basis of having a twin gestation rather than at the diagnosis of a short cervix. Demographics, ultrasound characteristics, operative data and outcomes were compared. The primary outcome was FLP\u2010to\u2010delivery interval. Propensity\u2010score matching was performed, with each treatment group matched (1:1) to the expectant\u2010management group for CL, in order to estimate the effect of each treatment on the FLP\u2010to\u2010delivery interval.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 255 women with a twin pregnancy complicated by TTTS and a short cervix undergoing FLP were included in the study. Of these, 151 (59%) were managed expectantly, 32 (13%) had vaginal progesterone only, 21 (8%) had pessary only, 21 (8%) had cervical cerclage only and 30 (12%) had a combination of treatments. A greater proportion of patients in the combined\u2010treatment group had had a prior preterm birth compared with those in the expectant\u2010management group (33% <jats:italic>vs<\/jats:italic> 9%; <jats:italic>P<\/jats:italic>\u2009=\u20090.01). Mean preoperative CL was shorter in the pessary, cervical\u2010cerclage and combined\u2010treatment groups (14\u201316\u2009mm) than in the expectant\u2010management and vaginal\u2010progesterone groups (22\u2009mm for both) (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). There was no significant difference in FLP\u2010to\u2010delivery interval between the groups, nor in gestational age at delivery or the rate of live birth or neonatal survival. Vaginal progesterone was associated with a decrease in the risk of delivery before 28\u2009weeks' gestation compared with cervical cerclage and combined treatment (<jats:italic>P<\/jats:italic>\u2009=\u20090.03). Using propensity\u2010score matching for CL, cervical cerclage was associated with a reduction in FLP\u2010to\u2010delivery interval of 13\u2009days, as compared with expectant management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A large proportion of pregnancies with TTTS and a short maternal cervix undergoing FLP were managed expectantly for a short cervix, establishing a high (62%) risk of delivery before 32\u2009weeks in this condition. No treatment that significantly improved outcome was identified; however, there were significant differences in potential confounders and there were also likely to be unmeasured confounders. Cervical cerclage should not be offered as a secondary prevention for preterm birth in twin pregnancies with TTTS and a short cervix undergoing FLP. A large randomized controlled trial is urgently needed to determine the effects of treatments for the prevention of preterm birth in these pregnancies. \u00a9 2021 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.23708","type":"journal-article","created":{"date-parts":[[2021,6,15]],"date-time":"2021-06-15T18:48:32Z","timestamp":1623782912000},"page":"169-176","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Interventions to prevent preterm delivery in women with short cervix before fetoscopic laser surgery for twin\u2013twin transfusion syndrome"],"prefix":"10.1002","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1313-1192","authenticated-orcid":false,"given":"C.","family":"Buskmiller","sequence":"first","affiliation":[{"name":"Division of Maternal\u2013Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences UTHealth The University of Texas McGovern Medical School and the Fetal Center at Children's Memorial Hermann Hospital  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6276-854X","authenticated-orcid":false,"given":"E. P.","family":"Bergh","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2013Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences UTHealth The University of Texas McGovern Medical School and the Fetal Center at Children's Memorial Hermann Hospital  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8752-5920","authenticated-orcid":false,"given":"C.","family":"Brock","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2013Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences UTHealth The University of Texas McGovern Medical School and the Fetal Center at Children's Memorial Hermann Hospital  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0189-8265","authenticated-orcid":false,"given":"J.","family":"Miller","sequence":"additional","affiliation":[{"name":"Johns Hopkins Center for Fetal Therapy, Department of Gynecology and Obstetrics Johns Hopkins University School of Medicine  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1927-2084","authenticated-orcid":false,"given":"A.","family":"Baschat","sequence":"additional","affiliation":[{"name":"Johns Hopkins Center for Fetal Therapy, Department of Gynecology and Obstetrics Johns Hopkins University School of Medicine  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Galan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Colorado Denver, Colorado Fetal Care Center, Children's Hospital of Colorado  Denver CO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Behrendt","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Colorado Denver, Colorado Fetal Care Center, Children's Hospital of Colorado  Denver CO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Habli","sequence":"additional","affiliation":[{"name":"Cincinnati Children's Fetal Care Center  Cincinnati OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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