open access
Vol 88, No 11 (2017)
Review paper
Published online: 2017-11-30
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Short cervix in twin pregnancies: current state of knowledge and the proposed scheme of treatment
1, 2, 3
Affiliations- Department of Obstetrics and Perinatology, Jagiellonian University Medical College, Cracow, Poland
- Department of Perinatology, Medical University of Lodz, ul. Wileńska 37, 94-029 Łódź, Poland
- Department of Gynecology and Obstetrics, Centre of Postgraduate Medical Education, Bielański Hospital, ul. Cegłowska 80, 01-809 Warsaw, Poland
open access
Vol 88, No 11 (2017)
REVIEW PAPERS Obstetrics
Published online: 2017-11-30
Abstract
Short cervical length (SCL) should be defined as cervical length (CL) less than 25 mm between 18 and 22 weeks of gestation. This definition of SCL is fully applicable for singleton pregnancies but is not entirely correct for twin pregnancies. So far there are no explicit guidelines on the treatment of twin pregnancy with SCL.
The use of progesterone in the treatment of SCL and preterm birth (PTB) prophylaxis is one of the interventions recommended by the Polish Ministry of Health for cervical shortening in singleton pregnancies. In twin pregnancies attention should be paid to the potential benefits of using vaginal progesterone in reduction of neonatal mortality and incidence of neonatal complications in a group of patients with twin pregnancies and CL less than 25 mm or below the 10th percentile for the gestational age, measured between 18 and 22 weeks of gestation.
It is still difficult to identify the benefits of using pessaries in the prevention of PTB in twin pregnancies. The usage of pessaries appears to be beneficial only in selected subpopulations of patients with asymptomatic CL less than 25 mm or 10th percentile for gestational age.
The use of cervical cerclage in PTB prevention in twin pregnancies is limited to cases where the external cervical dilation is >1 cm and <4 cm between 16 and 24 weeks of gestation.
Considering the necessity for screening for asymptomatic shortening of the cervix twin pregnancies establishing a practice directions in case of positive screening result seems to be crucial.
Abstract
Short cervical length (SCL) should be defined as cervical length (CL) less than 25 mm between 18 and 22 weeks of gestation. This definition of SCL is fully applicable for singleton pregnancies but is not entirely correct for twin pregnancies. So far there are no explicit guidelines on the treatment of twin pregnancy with SCL.
The use of progesterone in the treatment of SCL and preterm birth (PTB) prophylaxis is one of the interventions recommended by the Polish Ministry of Health for cervical shortening in singleton pregnancies. In twin pregnancies attention should be paid to the potential benefits of using vaginal progesterone in reduction of neonatal mortality and incidence of neonatal complications in a group of patients with twin pregnancies and CL less than 25 mm or below the 10th percentile for the gestational age, measured between 18 and 22 weeks of gestation.
It is still difficult to identify the benefits of using pessaries in the prevention of PTB in twin pregnancies. The usage of pessaries appears to be beneficial only in selected subpopulations of patients with asymptomatic CL less than 25 mm or 10th percentile for gestational age.
The use of cervical cerclage in PTB prevention in twin pregnancies is limited to cases where the external cervical dilation is >1 cm and <4 cm between 16 and 24 weeks of gestation.
Considering the necessity for screening for asymptomatic shortening of the cervix twin pregnancies establishing a practice directions in case of positive screening result seems to be crucial.
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Keywords
twin pregnancy, cervical insufficiency, pessary, cervical cerclage, progesterone, pregnancy complication
About this articleTitle
Short cervix in twin pregnancies: current state of knowledge and the proposed scheme of treatment
Journal
Issue
Article type
Review paper
Pages
626-632
Published online
2017-11-30
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4075
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3589
DOI
Pubmed
Bibliographic record
Ginekol Pol 2017;88(11):626-632.
Keywords
twin pregnancy
cervical insufficiency
pessary
cervical cerclage
progesterone
pregnancy complication
Authors
Hubert Huras
Jarosław Kalinka
Romuald Dębski
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