Short Cervix - Twins
Condition: Short Cervix
Study type: Observational

Summary: 
      This is a retrospective chart review. The purpose of this study will be to look at the
      outcomes of twin pregnancies diagnosed with short cervix along with the intervention
      (treatment) that these patients received.
    

Detailed description: 
      In 2010, the incidence of preterm birth in twin gestations was 23% before 34 weeks and 58%
      before 37 weeks, while the overall incidence of PTB in all pregnancies was only 3.41% and
      11.5%, respectively. Twin gestations are also at increased risk of being low birth weight
      infants.

      Goldenberg et al demonstrated in 1996 that a cervical length less than 25 mm at 24 weeks
      gestation in twin pregnancies was the best predictor of preterm birth at <32 weeks, <35
      weeks, and < 37 weeks. In 1999, Souka et al reported that in twin pregnancies with a cervical
      length less than 15 mm at 23 weeks gestation, the preterm birth rate <32 weeks was
      approximately 66%.

      A Cochrane Review from 2014 concluded that placing a cerclage is not associated with a
      significant difference regarding perinatal deaths or neonatal morbidity, but this analysis
      was for all forms of cerclage in multiple gestations (physical examination-indicated,
      history-indicated, and ultrasound-indicated). It did also state "ultrasound-indicated
      cerclage appears to be associated with an increased risk for the composite adverse neonatal
      outcome, including respiratory distress syndrome, low and very low birthweight, given there
      is no evidence of a consistent subgroup effect, the observed results can most likely be
      attributed to chance."

      In a 2015 retrospective cohort study of twin pregnancies with asymptomatic short cervix,
      Amanda Roman et al demonstrate similar results to those of the Cochrane Review for patients
      with CL <25 mm. However, they did show a trend towards prolonged pregnancy, decreased
      spontaneous PTB <34 weeks, and fewer NICU admissions for a subset of patients with CL < 15 mm
      that received a cerclage compared to control.

      In February 2016, Goya et al investigated the role of the pessary for women with twin
      gestations and short cervix diagnosed via ultrasound. A significant reduction in the rate of
      preterm birth prior to 34 weeks was found in the pessary group (16.2% vs 39.4%), with no
      significant differences in neonatal morbidity or mortality.

      Chart review will collect information documented on the data collection sheet, including
      medical and OB history, current pregnancy course, treatment for short cervix and information
      on hospitalization including labor and delivery, postpartum course and neonatal birth
      information.

      The investigators will analyses and compare this group of women using short cervix diagnosis,
      management decisions and outcomes during the antepartum period, labor, delivery and post
      partum course for possible signs and symptoms of those at risk for Pre Term Birth and
      outcomes of their infants.
    

Intervention name(s): Management
Intervention type(s): Other
Intervention description(s): management of twin pregnancies with a short cervix diagnosed between 16 0/7 WGA to 27 6/7 WGA.
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        14-55yrs of age Female all ethnic backgrounds