Pregnancy outcomes of immediate versus delayed emergency cervical cerclage in twin pregnancies with cervical dilatation: A multicenter retrospective cohort study

OBJECTIVE: This study observes the influence of the immediate and delayed emergency cervical cerclage on the pregnancy outcomes of twin pregnancies with second-trimester cervical dilatation. METHODS: weeks of gestation and underwent emergency cervical cerclage at three tertiary maternity units in China between January 1, 2015, and April 30, 2024. The primary outcomes were gestational age (GA) at delivery and the rates of spontaneous preterm birth (sPTB) before 28 weeks and 32 weeks. Logistic regression and Kaplan-Meier survival curves were used to evaluate the pregnancy outcomes between two groups: the group that underwent delayed emergency cervical cerclage (n = 51) and the group that underwent immediate emergency cervical cerclage (n = 52). "Delayed" referred to beyond 24 h after the discovery of cervical dilation, while "Immediate" referred to within 24 h. RESULTS: Compared to the immediate surgery group, the delayed surgery group had a significantly longer GA at delivery (30.53 ± 4.02 vs. 28.66 ± 3.83 weeks; P = 0.018), and the rates of sPTB were significantly lower before 28 weeks (29.4% vs. 50%; adjusted odds ratio 2.82; 95% confidence interval [CI] 1.07-7.44; P = 0.037), and before 32 weeks (60.8% vs. 78.8%; adjusted odds ratio 3.35; 95% CI 1.13-9.95; P = 0.029). CONCLUSION: This retrospective cohort study demonstrated that delayed emergency cervical cerclage following appropriate preoperative preconditioning was associated with improved pregnancy outcomes, compared with immediate emergency cervical cerclage. Further research is needed to confirm these findings.