Comparison of cerclage and pessary in prevention of preterm birth in twin pregnancies

Background: The preterm labor has increased in multiple pregnancies over the past 2 decades. Preterm labor has led to increase in neonatal mortality rates, long-term morbidity, respiratory distress, and neonatal infections. Thus, this study aimed at investigating the effect of cerclage versus pessary on the prevention of preterm birth in twin pregnancies. Methods: This prospective randomized clinical trial was performed on 50 women pregnant with twins who visited Taleghani hospital in 2016-2018. Their cervical length, which was measured by transvaginal ultrasonography (TVS), was less than 30 millimeters at week 14 of pregnancy. The participants were randomly divided into 2 groups (n=25). They separately underwent cervical pessary and cerclage. McDonald's procedure was performed in cerclage group from 14 to 27 weeks. The suture material was Mersilene Ethicon 5-0 double-armed s14 needle. Ring hodge pessary was also inserted in the vagina of the participants in the pessary group. All the patients were injected 250 mg intramuscular 17 alpha-hydroxyprogesterone caproate weekly from week 16 to week 36. All statistical analyses were performed using SPSS 18 software. Results: The results of this study showed that the mean ± standard deviation (SD) for pregnancy length of the cerclage and pessary groups were 238.6±32.4 and 223.6±16.6, respectively. Also, significant differences were found between the 2 groups (p=0.048). No significant difference was found in pregnancy (p=0.565), length of pessary/cerclage use (p=0.491), and BMI before and after delivery between the cerclage and pessary groups (p>0.05). Conclusion: The use of cerclage in twin pregnancies is recommended to increase the length of pregnancy.