Twin Pregnancies—Emergency Cerclage in the Second Trimester and Delivery of Second Twins 110 and 123 Days Later

ABSTRACT Background: Since the 1980s, the global twinning rate has risen to about 1.6 million twin pairs annually due to the widespread use of IVF. Twin pregnancies carry a higher risk of complications compared to singleton pregnancies, with cervical insufficiency being a significant concern that can lead to preterm birth and adverse perinatal outcomes. It is estimated that around 430 000 cases of twins deliver prior to 28 weeks of gestation annually. The twin miscarriage rate at the second trimester is estimated at 5%–10%, amounting to 80–160 000 losses annually in the pre‐viable period. Emergency cerclage is often used in such cases to provide mechanical support to the cervix and prolong gestation. This report presents two cases of emergency cerclage in the second trimester for twin pregnancies, with delivery of the second twin after intervals of 110 and 123 days. Case 1: A 36‐year‐old woman at 21 + 1 weeks presented with bulging membranes. Despite initial attempts to manage the condition, the membranes ruptured, necessitating the extraction of the first twin. Emergency cerclage was successfully performed to preserve the remaining twin, and was delivered by caesarean section at 36 + 6 weeks. Case 2: A 48‐year‐old woman at 16 + 6 weeks with premature rupture of membranes underwent extraction of the non‐viable twin, followed by emergency cerclage. The second twin was delivered by caesarean section at 34 + 3 weeks. Both cases involved close monitoring of inflammatory markers and regular follow‐ups. Prophylactic antibiotics were administered post‐operatively, with no tocolysis required. Indomethacin and progesterone were used to manage uterine activity and inflammation. Conclusion: These cases highlight the potential benefits of emergency cerclage in twin pregnancies with cervical insufficiency. Success was attributed to rigorous monitoring, appropriate antibiotic use and careful management of uterine activity. These cases contribute valuable insights into the complex decision‐making process involved in such high‐risk pregnancies and highlight the importance of individualised care plans.