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Minerva Ginecologica 2020 Apr 21

DOI: 10.23736/S0026-4784.20.04518-9

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Efficacy of physical examination-indicated cerclage in twin pregnancies compared with singleton pregnancies: a systematic review and meta-analysis

Chunbo LI, Keqin HUA

Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China


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INTRODUCTION: To compare the pregnancy outcomes of physical examination-indicated cerclage (PEIC) between twin and singleton pregnancies with acute cervical insufficiency.
EVIDENCE ACQUISITION: We searched Medline, Ovid, Scopus, EBSCO, ClinicalTrials.gov and the Cochrane Central Register of Controlled Trials from their commencement until Dec 2019 for relevant studies. Patient-level data abstraction and analysis were done by two independent authors.
EVIDENCE SYNTHESIS: A total of five studies with 786 women were included in the final analysis. The pooled outcomes showed that PEIC was associated with a similar reduction in preterm birth (PTB) at <32 [Risk ratio (RR) 0.93, 95% CI 0.79- 1.11, I2 = 0%, P = 0.43], and 28 (RR 1.03, 95% CI 0.82-1.29, I2 = 0%, P = 0.81) weeks of gestation; however, a much higher frequency of PTB was observed at <36 (RR 0.74, 95% CI 0.66-0.83, I2 = 0%, P < 0.000), and 34 (RR 0.80, 95% CI 0.68- 0.93, I2 = 0%, P = 0.004) weeks of gestation in twin pregnancies than in singleton pregnancies. No significant differences in perinatal outcomes, including neonatal death (RR 1.03, 95% CI 0.64-1.67, I2 = 52%, P = 0.900), stillbirth (RR 0.73, 95% CI 0.37-1.44, I2=0%, P=0.360), perinatal mortality (RR 0.94, 95% CI 0.65-1.38, P = 0.760) and neonatal complications were found between twin and singleton pregnancies.
CONCLUSIONS: Our meta-analysis indicated that PEIC achieved good perinatal prognosis in both singleton and twin pregnancies. However, because the available evidence is insufficient to attain a strong conclusion, so further high-quality trials are needed to confirm our findings.


KEY WORDS: Cervical incompetence; Rescue cerclage; Twin pregnancies; Meta-analysis

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