The place for prophylactic cerclage in the infertile patient with established cervical incompetence who conceived twins after septum reduction. 

Keywords:

Twin gestation, cerclage, uterine septum, cervical incompetence, IVF, prophylactic 


Published online: Oct 25 2017

Jennifer Deanna1, Omar Abuzeid2, Islam Fahmi2, Ivana Vettriano3, Frederico Rocha4, Mostafa Abuzeid5

1Department of Obstetrics and Gyneacology, Genesys Regional Medical Center, Michigan State University Statewide Campus System, Grand Blanc, MI
2Department of Obstetrics and Gyneacology, Hurley Medical Center, MSU College of Human Medicine (Flint Campus), Flint, MI
3Division of Maternal Fetal Medicine, St. John Providence Hospital/ Michigan State University, South eld, MI, USA
4Division of Maternal Fetal Medicine, Department of Obstetrics and Gyneacology, Hurley Medical Center, MSU College of Human Medicine (Flint Campus), Flint, MI
5Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gyneacology, Hurley Medical Center, MSU College of Human Medicine (Flint Campus), Flint, MI 

Abstract

Introduction: It is well known that cervical incompetence and associated preterm birth confers greater morbidity and mortality on birth outcomes, with an additional increased risk of cervical incompetence in higher order gestations. While the pathophysiology of cervical incompetence has yet to be elucidated, research has identified risk factors and assessed outcomes of numerous interventions. Cervical cerclage has been shown, in certain situations involving singleton pregnancies, to improve outcomes. Conversely, rescue cerclage increases the risk of preterm birth in twin gestations. However, these studies did not consider the unique situation of infertile patients, with known cervical incompetence, who have utilized assisted reproductive technologies to attain pregnancy. This study aims to describe the outcomes of infertile patients with known cervical incompetence, carrying twin gestation, who have undergone cervical cerclage.

Methods: This case series includes eight infertile patients who have cervical incompetence resulting in fetal loss between 20-24 weeks after in vitro fertilization embryo transfer (IVF-ET). These patients continued with IVF treatments and subsequently conceived twins. All patients underwent prophylactic cervical cerclage placement before 12 weeks. The outcomes of these pregnancies are reviewed.

Results: All pregnancies resulted in the delivery of viable twins. Six of the eight pregnancies (75%) were carried beyond 34 weeks. One pregnancy delivered at 31 weeks and one pregnancy delivered at 25 weeks after placental abruption.

Conclusions: This data suggest that the use of prophylactic cervical cerclage may be beneficial in improving reproductive outcomes in infertile patients with known cervical incompetence that subsequently conceived twin gestations via IVF-ET treatment.