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Prenat Diagn. 2012 Dec;32(12):1181-5. doi: 10.1002/pd.3982. Epub 2012 Oct 11.

Arabin cervical pessary to prevent preterm birth in severe twin-to-twin transfusion syndrome treated by laser surgery.

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  • 1Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain. ecarreras@vhebron.net

Abstract

OBJECTIVES:

To describe the outcome of patients with twin-to-twin transfusion syndrome and cervical length ≤ 25 mm, treated with laser and an Arabin cervical pessary.

METHODS:

Retrospective analysis of a consecutive series of all cases with severe twin-to-twin transfusion syndrome who underwent laser surgery: a group with cervical length above 25 mm (group A) and two groups who had a cervical length of 25 mm or less prior to the procedure. The first 8 cases (group B) were managed expectantly and the next 8 cases had a cervical pessary inserted immediately after laser surgery (group C). Gestational age at birth was the primary outcome. The secondary outcome was a composite one encompassing severe neonatal morbidity.

RESULTS:

The median gestational age at laser surgery was 20 weeks in all groups but the median gestational age at delivery was significantly higher in group C versus B (28 vs 32 weeks, p = 0.01). Severe neonatal morbidity was present in 18% in group C and 70% in group B (p < 0.01).

CONCLUSION:

Early results suggest a potential role for pessary use in prolonging gestation in cases with shortened cervix at the time of laser. A randomized trial to test this hypothesis should be performed.

© 2012 John Wiley & Sons, Ltd.

PMID:
23055333
[PubMed - indexed for MEDLINE]
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