{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T18:42:03Z","timestamp":1791312123425,"version":"4.3.1"},"reference-count":19,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2021,9,2]],"date-time":"2021-09-02T00:00:00Z","timestamp":1630540800000},"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":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Cervical cerclage is controversial in twin pregnancies, although recent data from the USA supports its use where \u201cphysical examination\u2010indicated\u201d. Limited data exist, however, in the extreme situation of 0\u2010mm ultrasound\u2010measured cervical length or even prolapsed membranes. This research compares the success of emergency cervical cerclage in multiple and singleton pregnancies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and methods<\/jats:title>\n                    <jats:p>\n                      This is a retrospective cohort study of all such cerclages performed at a tertiary hospital over a 15\u2010year period. \u201cEmergency\u201d was where transvaginal ultrasound\u2010assessed cervical length was 0\u00a0mm, with amniotic membranes at or beyond the external cervical os. Exclusion criteria were clinical or biochemical evidence of infection, regular contractions, bleeding, ruptured membranes, or gestation beyond 24\n                      <jats:sup>+0<\/jats:sup>\n                      \u00a0weeks. The primary outcome, or \u201csuccess\u201d, was defined as birth &gt;27\n                      <jats:sup>+6<\/jats:sup>\n                      \u00a0weeks of gestation, with the neonate alive 28\u00a0days later with no markers of adverse outcome (seizures, periventricular leukomalacia, intracranial hemorrhage more than Grade 2, or necrotizing enterocolitis). Demographic and cerclage variables were assessed against the primary outcome. Variables correlated with success were analyzed between multiple and singleton pregnancies. Comparison of all adverse outcomes was then adjusted using logistic regression.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 135 pregnancies were included (107 singletons and 28 multiples [all twins]). Success was achieved in 79 (58.5%; 57.9% in singletons, 60.7% in twins). Nulliparity, in utero transfer, symptoms, prolapsed membranes, and dilation more than 3\u00a0cm were predictors of failure, but twin pregnancy was not. After controlling for potential confounding variables, there was no significant difference in measures of success between singleton and twin pregnancies, apart from higher rates of neonatal unit admission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Emergency cervical cerclage, even in extreme situations, is as effective in twin pregnancies as it is in singletons.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aogs.14255","type":"journal-article","created":{"date-parts":[[2021,9,2]],"date-time":"2021-09-02T22:37:03Z","timestamp":1630622223000},"page":"2003-2008","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Emergency cervical cerclage in twin and singleton pregnancies with 0\u2010mm cervical length or prolapsed membranes"],"prefix":"10.1111","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2155-0338","authenticated-orcid":false,"given":"Georgina D.","family":"Freegard","sequence":"first","affiliation":[{"name":"Oxford Fetal Medicine Unit The John Radcliffe Hospital Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vera","family":"Donadono","sequence":"additional","affiliation":[{"name":"Oxford Fetal Medicine Unit The John Radcliffe Hospital Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4462-112X","authenticated-orcid":false,"given":"Lawrence W. M.","family":"Impey","sequence":"additional","affiliation":[{"name":"Oxford Fetal Medicine Unit The John Radcliffe Hospital Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,9,2]]},"reference":[{"key":"e_1_2_9_2_1","volume-title":"Twin and Triplet Pregnancy NICE Guideline","author":"National Institute for Clinical Excellence"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000168435.17200.53"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12600"},{"key":"e_1_2_9_5_1","first-page":"111","article-title":"Efficacy of physical examination\u2010indicated cerclage in twin pregnancies compared with singleton pregnancies: a systematic review and meta\u2010analysis","volume":"72","author":"Li C","year":"2020","journal-title":"Minerva Obstet Gynecol"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2020.06.047"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2000.104212"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1067\/S0002-9378(03)00718-X"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0028-1095182"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2018-315147"},{"key":"e_1_2_9_11_1","unstructured":"National Institute for Health and Care Excellence.Do not use cervical length (with or without fetal fibronectin) routinely to predict the risk of spontaneous preterm birth in twin or triplet pregnancies | NICE. Multiple Pregnancies. Published 2011. Accessed March 18 2021.https:\/\/www.nice.org.uk\/donotdo\/do\u2010not\u2010use\u2010cervical\u2010length\u2010with\u2010or\u2010without\u2010fetal\u2010fibronectin\u2010routinely\u2010to\u2010predict\u2010the\u2010risk\u2010of\u2010spontaneous\u2010preterm\u2010birth\u2010in\u2010twin\u2010or\u2010triplet\u2010pregnancies"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13575"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2016.01.172"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2017.1338260"},{"key":"e_1_2_9_15_1","first-page":"1","article-title":"Emergency cerclage placement in multifetal pregnancies with a dilated cervix and exposed membranes: case series","volume":"3","author":"Aguilera M","year":"2013","journal-title":"AJP Rep"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2017.1309021"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15918"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0208136"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2019.1625882"},{"key":"e_1_2_9_20_1","unstructured":"Emergency Cerclage in Twin Pregnancies at Imminent Risk of Preterm Birth: An Open\u2010Label Randomised Controlled Trial. Available online at:https:\/\/clinicaltrials.gov\/ProvidedDocs\/67\/NCT03818867\/Prot_SAP_000.pdf(Accessed August 11 2021)."}],"container-title":["Acta Obstetricia et Gynecologica Scandinavica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aogs.14255","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/aogs.14255","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aogs.14255","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T01:53:01Z","timestamp":1693187581000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/aogs.14255"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,2]]},"references-count":19,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2021,11]]}},"alternative-id":["10.1111\/aogs.14255"],"URL":"https:\/\/doi.org\/10.1111\/aogs.14255","archive":["Portico"],"relation":{},"ISSN":["0001-6349","1600-0412"],"issn-type":[{"value":"0001-6349","type":"print"},{"value":"1600-0412","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,2]]},"assertion":[{"value":"2021-06-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-08-17","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-09-02","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}