Cerclage and Progesterone for Twin Pregnancies

Combined Cervical Cerclage and Vaginal Progesterone May Readjust the Deregulated Cervicovaginal Fluid Inflammatory Milieu and Improve Outcomes of Twin Pregnant Women

Twin pregnancies face a high risk of complications, most notably preterm birth (delivery before 37 weeks), which is a major cause of infant death and illness globally. For women carrying twins who are identified as having a short cervical length (cervix measuring 25 millimeters or less), there is currently no single, highly effective preventative treatment. This study is a randomized clinical trial designed to determine if a combined therapy of Cervical Cerclage (a surgical stitch to support the cervix) and Vaginal Progesterone (a hormone medication) is more effective than standard care in preventing preterm birth and improving the overall health outcomes for both the mother and the babies. The trial will also investigate the biological basis of this effect by measuring specific inflammation markers (cytokines like Interleukin-1$\beta$, 6, 8, and Tumor Necrosis Factor-α) in the cervical fluid before and after the intervention, to see if the combined treatment helps to reduce harmful local inflammation.

Inclusion Criteria:

• Type of Pregnancy: Women with confirmed twin pregnancy (TP).
• Cervical Length: Short cervical length (CL) defined as ≤25 mm.
• Timing of Diagnosis: Short cervix detected via transvaginal ultrasound (TVU) at 11-13 weeks + 6 days, or detected during bi-weekly follow-up exams until 23 weeks + 6 days.
• Consent: Participants willing to undergo randomization and comply with the follow-up protocol.

Exclusion Criteria:

• Multiple Gestation (High Order): Triplet or higher-order pregnancies.
• Fetal/Uterine Complications: Polyhydramnios, premature rupture of membranes (PPROM), or known uterine abnormalities.
• Acute Symptoms: Vaginal bleeding, fever, or signs of fetal distress.
• Maternal Comorbidities: Pre-existing or gestational hypertension, and diabetes mellitus.