Cervical cerclage for preventing preterm birth in twin pregnancies. A systematic review and meta-analysis

Objectives: To evaluate the effect of cervical cerclage on preventing preterm birth in twin pregnancies. Methods: We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Current Controlled Trials, China Biology Medicine (CBM), Chinese National Knowlegde Infrastructure (CNKI) and VIP Chinese Journal database (VIP) from April to August 2012. All available randomized trials comparing the effects of cervical cerclage for preventing preterm birth in twin pregnancies with no cerclage were included. The study took place in the First Affiliated Hospital of ChongQing Medical University, Chongqing, People’s Republic of China. Results: Five eligible studies with a total of 310 participants were finally included. No statistically significant differences were found between patients who received cervical cerclage and those who did not receive cervical cerclage, in terms of preterm birth (RR 0.91, 95% CI 0.78-1.18), live births (RR 0.93, 95% CI 0.87-1.01) and mode of delivery (RR 1.34, 95% CI 0.61-2.98) per randomized woman. These results of preterm birth, premature rupture of menbrane, model of delivery did not change before and after sensitivity analysis. Conclusion: No significant difference was observed between cervical cerclage group and no cerclage group in twin pregnancies and large scale randomized controlled trials are needed to strengthen clinical usage of cervical cerclage.