Cervical cerclage for prevention of preterm birth in women with twin pregnancy.

OBJECTIVE: To compare the effect of elective cervical cerclage in women with twin pregnancy on gestational age at time of delivery. METHOD: In a pragmatic fashion women in Abha Maternity Hospital, Saudi Arabia with twin gestations were allocated to receive either an elective cerclage (group I) or no cerclage (group II). Elective cerclage was performed at 12 to 14 weeks of gestation after sonographic examination of the fetus to confirm gestational age and exclude major congenital anomalies. In all cases, follow up of the pregnancy was continued until delivery. RESULTS: Of the 176 twin pregnancies included, cerclage was performed in 76 women, and no cerclage in 100 women. In Group I: 12 pregnancies ended in spontaneous miscarriage, 37 in preterm labor, and 27 women reached full term. There were a total of 106 live births in 62 women. In Group II: 8 women aborted, 44 women ended in preterm labor and 48 women reached full term. There were a total of 160 live births in 89 women. The gestational age at delivery ranged from 20 to 41 weeks. Multiple regression analysis did not show association between cerclage and time of delivery, although a trend was observed (P=0.056). CONCLUSION: Elective cerclage contributes little in prolongation of gestational age at the time of delivery in women with twin pregnancy, especially in women of high parity. Those with a previous history of preterm labor may be a subgroup that could benefit from elective cerclage.

Staphylococcus lugdunensis endometritis: a case report.

BACKGROUND: Staphylococcus lugdunensis has been reported to cause several localized and blood stream infections, but not endometritis. OBJECTIVE: To desribe a case of Staphylococcus lugdunensis endometritis associated with premature rupture of membranes. CASE REPORT.A 39-year old woman presented with premature rupture of membrane (PROM) and underwent an emergency caesarean section at 40 weeks of gestation. Her endometritis was characterized by a foul odour and was so extensive that the baby was adherent to the endometrium and had to be separated by a gentle pull. In spite of these, neither the mother nor her baby suffered any adverse effect. The organism exhibited several unusual characteristics that are atypical ofstaphylococci. The baby did not develop any sepsis. The mother responded well to antibiotics and both were discharged home on the 4th postoperative day. CONCLUSION: To the best of our knowledge, this is the first report of this organism causing endometritis.