Abstract：
BACKGROUND: There are no systematic reviews analyzing cervical cerclage\'s role in improving the perinatal outcome of the second twin in dichorionic diamniotic (DCDA) pregnancies following a second trimester or very early preterm birth of the first twin.
OBJECTIVE: The primary objective of this systematic review was to evaluate the effect of rescue cervical cerclage on delaying the delivery of the second twin after the delivery of the first twin in DCDA twin pregnancies. The secondary objective was to analyze the effect of rescue cervical cerclage on the perinatal outcome of the second twin in DCDA pregnancies compared to the non-cerclage group.
METHODS: A literature search was performed using PubMed, Medline databases, and the Cochrane Library. The studies selected were limited to human subjects and published online by December 2023. Two sets of results in this systematic review are described; the first set includes the outcomes of pregnancies with a DCDA twin pregnancy from the cohort of case series. The meta-analysis was performed for the cohort, and a combined narrative report was provided for the second set of results for the case reports.
RESULTS: A literature search resulted in 27 case series and 36 case reports. The case series analysis demonstrated that the mean gestation age of twin 2 at delivery with cervical cerclage (27.5 weeks) compared to those without cervical cerclage (24.4 weeks) was statistically significant (p < 0.001). Furthermore, analysis of the case series showed that twin 2 with cerclage had a statistically significant increase in latency period (days 44.7 vs 23.67) and birth weight (grams 3320 vs 2460) compared to the group without cerclage (p = -value was 0.001 and 0.01, respectively). It is difficult to draw any significant conclusion with complications of cervical cerclage; however, there were slightly more chorioamnionitis and respiratory distress syndrome in the cerclage group. The case report analysis showed no significant difference with or without cervical cerclage.
CONCLUSIONS: From this review, it can be concluded that in DCDA twin pregnancies, cervical cerclage insertion after the extremely premature delivery or miscarriage of twin 1 may increase the gestational age at delivery, prolong the delivery interval, and increase the birth weight of twin 2. However, a large prospective multicenter randomized control trial should be performed to assess the benefit of cervical cerclage in DCDA twins to improve the delivery interval latency period and perinatal outcome of twin 2 after the delivery of twin 1.
OBJECTIVE: The primary objective of this systematic review was to evaluate the effect of rescue cervical cerclage on delaying the delivery of the second twin after the delivery of the first twin in DCDA twin pregnancies. The secondary objective was to analyze the effect of rescue cervical cerclage on the perinatal outcome of the second twin in DCDA pregnancies compared to the non-cerclage group.
METHODS: A literature search was performed using PubMed, Medline databases, and the Cochrane Library. The studies selected were limited to human subjects and published online by December 2023. Two sets of results in this systematic review are described; the first set includes the outcomes of pregnancies with a DCDA twin pregnancy from the cohort of case series. The meta-analysis was performed for the cohort, and a combined narrative report was provided for the second set of results for the case reports.
RESULTS: A literature search resulted in 27 case series and 36 case reports. The case series analysis demonstrated that the mean gestation age of twin 2 at delivery with cervical cerclage (27.5 weeks) compared to those without cervical cerclage (24.4 weeks) was statistically significant (p < 0.001). Furthermore, analysis of the case series showed that twin 2 with cerclage had a statistically significant increase in latency period (days 44.7 vs 23.67) and birth weight (grams 3320 vs 2460) compared to the group without cerclage (p = -value was 0.001 and 0.01, respectively). It is difficult to draw any significant conclusion with complications of cervical cerclage; however, there were slightly more chorioamnionitis and respiratory distress syndrome in the cerclage group. The case report analysis showed no significant difference with or without cervical cerclage.
CONCLUSIONS: From this review, it can be concluded that in DCDA twin pregnancies, cervical cerclage insertion after the extremely premature delivery or miscarriage of twin 1 may increase the gestational age at delivery, prolong the delivery interval, and increase the birth weight of twin 2. However, a large prospective multicenter randomized control trial should be performed to assess the benefit of cervical cerclage in DCDA twins to improve the delivery interval latency period and perinatal outcome of twin 2 after the delivery of twin 1.
摘要：
背景：没有系统评价分析子宫颈环扎术在改善第二双胎妊娠中期或第一双胎早产早期早产后的二胎羊膜双胎（DCDA）妊娠围产期结局中的作用。
目的：本系统综述的主要目的是评估在DCDA双胎妊娠中，在第一胎分娩后，挽救性宫颈环扎术对延迟第二胎分娩的影响。次要目的是分析与非环扎组相比，在DCDA妊娠中，抢救宫颈环扎组对第二双胞胎围产期结局的影响。
方法：使用PubMed进行了文献检索，Medline数据库,还有Cochrane图书馆.选择的研究仅限于人类受试者，并于2023年12月在线发表。本系统综述中描述了两组结果；第一组包括病例系列队列中DCDA双胎妊娠的结局。对该队列进行了荟萃分析，并为病例报告的第二组结果提供了综合叙述报告。
结果：文献检索结果为27例病例系列和36例病例报告。病例系列分析表明，与没有宫颈环扎的分娩者（24.4周）相比，双胎2在宫颈环扎分娩时的平均孕龄（27.5周）具有统计学意义（p<0.001）。此外，对病例系列的分析显示，与没有环扎的组相比，双胎2的潜伏期（44.7天vs23.67天）和出生体重（克数3320vs2460）有统计学上的显着增加（p=-值分别为0.001和0.01）。很难得出宫颈环扎术并发症的任何重要结论；然而，环扎组绒毛膜羊膜炎和呼吸窘迫综合征稍多.病例报告分析显示有无宫颈环扎术差异无统计学意义。
结论：从这篇综述来看，可以得出结论，在DCDA双胞胎怀孕中，双胎1极早产或流产后插入宫颈环扎术可能会增加分娩时的胎龄，延长交货间隔，增加双胞胎的出生体重2.然而,应开展一项大型前瞻性多中心随机对照试验,以评估DCDA双胎宫颈环扎术对改善双胎1分娩后双胎2的分娩间隔潜伏期和围产期结局的益处.
目的：本系统综述的主要目的是评估在DCDA双胎妊娠中，在第一胎分娩后，挽救性宫颈环扎术对延迟第二胎分娩的影响。次要目的是分析与非环扎组相比，在DCDA妊娠中，抢救宫颈环扎组对第二双胞胎围产期结局的影响。
方法：使用PubMed进行了文献检索，Medline数据库,还有Cochrane图书馆.选择的研究仅限于人类受试者，并于2023年12月在线发表。本系统综述中描述了两组结果；第一组包括病例系列队列中DCDA双胎妊娠的结局。对该队列进行了荟萃分析，并为病例报告的第二组结果提供了综合叙述报告。
结果：文献检索结果为27例病例系列和36例病例报告。病例系列分析表明，与没有宫颈环扎的分娩者（24.4周）相比，双胎2在宫颈环扎分娩时的平均孕龄（27.5周）具有统计学意义（p<0.001）。此外，对病例系列的分析显示，与没有环扎的组相比，双胎2的潜伏期（44.7天vs23.67天）和出生体重（克数3320vs2460）有统计学上的显着增加（p=-值分别为0.001和0.01）。很难得出宫颈环扎术并发症的任何重要结论；然而，环扎组绒毛膜羊膜炎和呼吸窘迫综合征稍多.病例报告分析显示有无宫颈环扎术差异无统计学意义。
结论：从这篇综述来看，可以得出结论，在DCDA双胞胎怀孕中，双胎1极早产或流产后插入宫颈环扎术可能会增加分娩时的胎龄，延长交货间隔，增加双胞胎的出生体重2.然而,应开展一项大型前瞻性多中心随机对照试验,以评估DCDA双胎宫颈环扎术对改善双胎1分娩后双胎2的分娩间隔潜伏期和围产期结局的益处.
