Delayed interval delivery in twin pregnancies with spontaneous delivery before viability:The role of cervical cerclage combined with adjuvant broad-spectrum antibiotics and natural progesterone = Delayed interval delivery in twin pregnancies with spontaneous delivery before viability:The role of cervical cerclage combined with adjuvant broad-spectrum antibiotics and natural progesterone

다국어 초록 (Multilingual Abstract)

Objective: The aim of this study was to evaluate the proportion eligible for delayed interval delivery, and the efficacy of cervical cerclage combined with adjuvant broad-spectrum antibiotics and natural progesterone in prolonging the gestation in twin pregnancies with spontaneous delivery before viability.
Methods: This was a retrospective study including 17 consecutive dichorionic twins of which presenting fetus had been spontaneously delivered before viability(15.0-22.9 weeks) from January 2015 to June 2020. Cases without active labor pain within 6 hours after delivery of the first fetus were considered to be eligible for delayed interval delivery. Cervical cerclage combined with adjuvant broad-spectrum antibiotics and vaginal natural progesterone was performed in eligible cases. Obstetric outcomes and neonatal outcomes of the remaining fetus were analyzed.
Results: About 41% of patients(7/17) were not delivered within 6 hours after delivery of the first fetus. Among the 7 patients undelivered within 6 hours, two patients did not undergo cervical cerclage because of suspected chorioamnionitis(n=1) or preterm premature rupture of membrane(n=1). Five cases(29.4%) underwent cervical cerclage combined with adjuvant broad-spectrum antibiotics and natural progesterone use. The median interval from cervical cerclage to delivery was 111 days (range: 39-119 days) and the median gestational age at delivery was 34.9 weeks (range: 27.6-37.0 weeks). The rate of patients undelivered at 32, 34 and 36 weeks was 80%(4/5), 60%(3/5), and 40%(2/5). All the 5 neonates survived without major morbidity except mild chronic lung disease in one case born at 27.6 weeks.
Conclusion: About 29% of twin pregnancies with spontaneous delivery of the first fetus before 23 weeks were eligible for delayed interval delivery. Cervical cerclage combined with adjuvant broad-spectrum antibiotics and natural progesterone use seems to help maintain the pregnancy of remaining fetus after spontaneous delivery before 23 weeks in twin pregnancies.