Study protocol for two randomised controlled trials evaluating the effects of Cerclage in the reduction of extreme preterm birth and perinatal mortality in twin pregnancies with a short cervix or dilatation: The TWIN Cerclage studies

Lissa Van Gils*, Marjon A. De Boer, Judith Bosmans, Ruben Duijnhoven, Sam Schoenmakers, Jan B. Derks, Jelmer R. Prins, Salwan Al-Nasiry, Margo Lutke Holzik, Enrico Lopriore, Joris Van Drongelen, Marieke H. Knol, Judith O.E.H. Van Laar, Yves Jacquemyn, Caroline Van Holsbeke, Isabelle Dehaene, Liesbeth Lewi, Hannes Van Der Merwe, Wilfried Gyselaers, Sylvia A. Obermann-BorstMayella Holthuis, Ben W. Mol, Eva Pajkrt, Martijn A. Oudijk

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Introduction Twin pregnancies have a high risk of extreme preterm birth (PTB) at less than 28 weeks of gestation, which is associated with increased risk of neonatal morbidity and mortality. Currently there is a lack of effective treatments for women with a twin pregnancy and a short cervix or cervical dilatation. A possible effective surgical method to reduce extreme PTB in twin pregnancies with an asymptomatic short cervix or dilatation at midpregnancy is the placement of a vaginal cerclage. Methods and analysis We designed two multicentre randomised trials involving eight hospitals in the Netherlands (sites in other countries may be added at a later date). Women older than 16 years with a twin pregnancy at <24 weeks of gestation and an asymptomatic short cervix of ≤25 mm or cervical dilatation will be randomly allocated (1:1) to both trials on vaginal cerclage and standard treatment according to the current Dutch Society of Obstetrics and Gynaecology guideline (no cerclage). Permuted blocks sized 2 and 4 will be used to minimise the risk of disbalance. The primary outcome measure is PTB of <28 weeks. Analyses will be by intention to treat. The first trial is to demonstrate a risk reduction from 25% to 10% in the short cervix group, for which 194 patients need to be recruited. The second trial is to demonstrate a risk reduction from 80% to 35% in the dilatation group and will recruit 44 women. A cost-effectiveness analysis will be performed from a societal perspective. Ethics and dissemination This study has been approved by the Research Ethics Committees in the Netherlands on 3/30/2023. Participants will be required to sign an informed consent form. The results will be presented at conferences and published in a peer-reviewed journal. Participants will be informed about the results.

Original languageEnglish
Article numbere081561
JournalBMJ Open
Volume14
Issue number5
DOIs
Publication statusPublished - 10 May 2024

Keywords

  • fetal medicine
  • maternal medicine
  • obstetrics

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