Combined fetal reduction and cervical cerclage in twin pregnancies complicated by cervical insufficiency: Effects on perinatal outcomes

Abstract Background Twin pregnancies and cervical insufficiency are high risk factors for miscarriage or delivery. This study aims to investigate the clinical value of combing fetal reduction and cervical cerclage in improving perinatal outcomes in twin pregnancies complicated by cervical insufficiency. Methods This retrospective cohort study was conducted in two centers. A total of 57 women with twin pregnancies who underwent cervical cerclage were included in the study (2019–2022). Among them, 25 twin pregnancies were reduced to singleton pregnancies before cervical cerclage (reduction group), while 32 cases underwent cervical cerclage without fetal reduction (ongoing group). Demographic data, clinical features, maternal and neonatal outcomes were collected from the electronic medical system. Pregnancy and delivery characteristics, as well as neonatal outcomes, were compared between the two groups. Results The rates of preterm birth and cesarean section were significant lower in the reduction group compared to the ongoing group (preterm birth, 12.0% vs. 31.2%, p = 0.007; cesarean section, 52.0% vs. 78.1%, p = 0.015). The mean birth weight of twin pairs in the reduction group was higher than that in the ongoing group (2230 vs. 2724 grams, p = 0.005). There were no significant differences in the pregnancy complications and neonatal outcomes between the two groups, including preeclampsia, gestational diabetes mellitus, low birth weight, sepsis, intra-ventricular hemorrhage (IVH), admission to the neonatal intensive care unit (NICU), respiratory distress syndrome (RDS), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), and Apgar score below 7 at 5 minutes (p > 0.05 for each). Conclusion Our study suggests that fetal reduction from twin to singleton followed by cervical cerclage is associated with a decreased risk of preterm birth and higher birth weight in twin pregnancies complicated by cervical insufficiency.