Cerclage in twin gestations: the need to consider the effect of antibiotics and indomethacin

We read with interest the paper by Roman et al,1Roman A. Zork N. Haeri S. al.Physical examination-indicated cerclage in twin pregnancy: a randomized controlled trial.Am J Obstet Gynecol. 2020; 223: 902.e1-902.e11Abstract Full Text PDF Scopus (20) Google Scholar which reports trial of cervical patients considered to have physical examination–indicated cerclage. The results study reported American Journal Obstetrics and Gynecology are contrast those systematic review Rafael al,2Rafael T.J. Berghella V. Alfirevic Z. Cervical stitch (cerclage) for preventing preterm birth multiple pregnancy.Cochrane Database Syst Rev. 2014; : CD009166PubMed that is not an effective intervention prevent or reduce perinatal death neonatal morbidity. In addition, ultrasound-indicated was associated increased risk respiratory distress syndrome, low birthweight, very birthweight. Nevertheless, given number trials, as well substantial heterogeneity subgroup differences, authors concluded these findings data must be interpreted caution.2Rafael There increasing evidence pregnancies short dilated cervix harmful may beneficial. Specifically, al3Roman Rochelson B. Martinelli P. al.Cerclage pregnancy between 16 24 weeks gestation: retrospective cohort study.Am 2016; 215: 98.e1-98.e11Abstract (36) suggested outcome improved based on study. has shown encouraging results. Nonetheless, we recommend caution because small clinical some differences control group (eg, lower length <25 mm, higher dilation, 1.3 earlier gestational age at diagnosis). Furthermore, allocated did receive indomethacin treatment (P=.008) antibiotics (P=.02) same rate group. recent singleton both reduced delivery intra-amniotic infection inflammation insufficiency. Indeed, administration related resolution 75% cases, beyond 34 54.5% cases.4Oh K.J. Romero R. Park J.Y. al.Evidence antibiotic subset infection/inflammation presenting insufficiency.Am 2019; 221: 140.e1-140.e18Abstract (42) It important consider effect can confound acute insufficiency had subclinical sterile inflammation.3Roman This information should taken into account when designing future trials interpreting available evidence. Physical trialAmerican & GynecologyVol. 223Issue 6PreviewWomen second trimester loss early birth; there currently no proven therapy this women. Full-Text