EP19.18: Physical examination‐indicated cerclage in singleton and twin pregnancies: risk factors for predicting preterm birth

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All patients underwent PEIC from Jan 2014 to Dec 2019. Singleton or twin pregnancy between 16 and 23 weeks with painless cervical dilation (≥1cm) and prolapsed membranes was included. MCMA twins, fetal anomalies, PPROM, or regular uterine contraction were excluded. Transvaginal sonography was performed postoperatively. We compared outcomes between singletons and twins. Perioperative findings, postoperative cervical length (CL) were analysed to evaluate predictive factors for delivery< 28 weeks. 123 patients were identified: 25 women, twins; and 98 women, singletons. There were no significant differences in characteristics, and gestational age at PEIC between singletons and twins. The rate of delivery<28 weeks was not different (p = 0.12). The mean PEIC-to-delivery latency, and gestation age at delivery were not differed between twins and singletons (p = 0.17; p = 0.12, respectively). Then predictive factors for delivery<28 weeks were analysed: 52 women delivered<28 weeks (group A), and 71 women delivered≧28weeks (group B). Group A showed more advanced preoperative cervical dilatation, prolapsed membrane compared to Group B (p < 0.01; p = 0.01, respectively). Group A also showed more positive fetal fibronectin (FFN), higher neutrophil-lymphocyte ratio (NLR), and shorter postoperative CL than Group B (p = 0.01; p = 0.01; p = 0.001, respectively). Multivariate analysis demonstrated positive FFN, higher NLR, and shorter CL were significant factors for predicting delivery<28 weeks after PEIC. PEIC in twins seems to be beneficial and compatible as PEIC in singletons. Most importantly, we suggested 3 significant factors for predicting delivery<28 weeks following PEIC: preoperative labs (NLR, and FFN); and postoperative CL.

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