<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1646-5830</journal-id>
<journal-title><![CDATA[Acta Obstétrica e Ginecológica Portuguesa]]></journal-title>
<abbrev-journal-title><![CDATA[Acta Obstet Ginecol Port]]></abbrev-journal-title>
<issn>1646-5830</issn>
<publisher>
<publisher-name><![CDATA[Euromédice, Edições Médicas Lda.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1646-58302021000100056</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Case report of ultrasound-indicated cerclage in triplet pregnancy]]></article-title>
<article-title xml:lang="pt"><![CDATA[Caso clínico de ciclorrafia indicada por ecografia em gravidez tripla]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Bettencourt-Silva]]></surname>
<given-names><![CDATA[Beatriz]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ladeiras]]></surname>
<given-names><![CDATA[Rita]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Duarte]]></surname>
<given-names><![CDATA[Carla]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Guerra]]></surname>
<given-names><![CDATA[Cláudia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Andrade]]></surname>
<given-names><![CDATA[Ana Maria]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital da Senhora da Oliveira  ]]></institution>
<addr-line><![CDATA[Guimarães ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Hospital da Senhora da Oliveira Departamento de Obstetrícia ]]></institution>
<addr-line><![CDATA[Guimarães ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Hospital da Senhora da Oliveira Departamento de Obstetrícia ]]></institution>
<addr-line><![CDATA[Guimarães ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>03</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>03</month>
<year>2021</year>
</pub-date>
<volume>15</volume>
<numero>1</numero>
<fpage>56</fpage>
<lpage>60</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S1646-58302021000100056&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S1646-58302021000100056&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S1646-58302021000100056&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract In triplet pregnancies, the risk of spontaneous delivery &lt;32 weeks gestation may be predicted by serial sonographic cervical evaluation. However, no intervention has been shown to improve neonatal outcomes in triplets with cervical shortening. Most data suggest no usefulness of ultrasound-indicated cerclage in multiple pregnancies, although recent studies in twin pregnancies reported promising results. The authors describe a case of a triplet gestation with pronounced mid-trimester asymptomatic cervical shortening. A cervical cerclage was performed as an effort to allow pregnancy viability. At the 28th gestational week, three newborns were delivered and had no severe complications in neonatal period.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Triplet pregnancy]]></kwd>
<kwd lng="en"><![CDATA[Short cervix]]></kwd>
<kwd lng="en"><![CDATA[Cervical cerclage.]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="book">
<collab>NICE</collab>
<source><![CDATA[NICE Clinical Guideline. Untargeted corticosteroids. Multiple Pregnancy: The Management of Twin and Triplet Pregnancies in the Antenatal Period]]></source>
<year>2011</year>
<page-range>143-9</page-range><publisher-loc><![CDATA[London ]]></publisher-loc>
<publisher-name><![CDATA[RCOG press]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<collab>Committee on Practice Bulletins-Obstetrics and Society for Maternal-Fetal Medicine</collab>
<article-title xml:lang=""><![CDATA[Practice Bulletin No 169: Multifetal Gestations: Twin, Triplet, and Higher-Order Multifetal Pregnancies]]></article-title>
<source><![CDATA[Obstet Gynecol]]></source>
<year>2016</year>
<volume>128</volume>
<page-range>e131-46</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Rebarber]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Roman]]></surname>
<given-names><![CDATA[AS]]></given-names>
</name>
<name>
<surname><![CDATA[Istwan]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Rhea]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Stanziano]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Prophylactic cerclage in the management of triplet pregnancies]]></article-title>
<source><![CDATA[Am J Obstet Gynecol]]></source>
<year>2005</year>
<volume>193</volume>
<page-range>1193-6</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Moragianni]]></surname>
<given-names><![CDATA[VA]]></given-names>
</name>
<name>
<surname><![CDATA[Cohen]]></surname>
<given-names><![CDATA[JD]]></given-names>
</name>
<name>
<surname><![CDATA[Smith]]></surname>
<given-names><![CDATA[SJ]]></given-names>
</name>
<name>
<surname><![CDATA[Rosenn]]></surname>
<given-names><![CDATA[MF]]></given-names>
</name>
<name>
<surname><![CDATA[Craparo]]></surname>
<given-names><![CDATA[FJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The role of ultrasound-indicated cerclage in triplets]]></article-title>
<source><![CDATA[Ultrasound Obstet Gynecol]]></source>
<year>2009</year>
<volume>34</volume>
<page-range>43-6</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Murray]]></surname>
<given-names><![CDATA[SR]]></given-names>
</name>
<name>
<surname><![CDATA[Stock]]></surname>
<given-names><![CDATA[SJ]]></given-names>
</name>
<name>
<surname><![CDATA[Cowan]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Cooper]]></surname>
<given-names><![CDATA[ES]]></given-names>
</name>
<name>
<surname><![CDATA[Norman]]></surname>
<given-names><![CDATA[JE]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Spontaneous preterm birth prevention in multiple pregnancy]]></article-title>
<source><![CDATA[Obstet Gynaecol]]></source>
<year>2018</year>
<volume>20</volume>
<page-range>57-63</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Poggi]]></surname>
<given-names><![CDATA[SH]]></given-names>
</name>
<name>
<surname><![CDATA[Ghidini]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Landy]]></surname>
<given-names><![CDATA[HJ]]></given-names>
</name>
<name>
<surname><![CDATA[Alvarez]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Pezzullo]]></surname>
<given-names><![CDATA[JC]]></given-names>
</name>
<name>
<surname><![CDATA[Collea]]></surname>
<given-names><![CDATA[JV]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Predictive value of transvaginal cervical length in triplet pregnancies for spontaneous preterm delivery at &amp;lt; or = 32 weeks]]></article-title>
<source><![CDATA[J Matern Fetal Neonatal Med]]></source>
<year>2002</year>
<volume>12</volume>
<page-range>46-9</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Guzman]]></surname>
<given-names><![CDATA[ER]]></given-names>
</name>
<name>
<surname><![CDATA[Walters]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[O&amp;apos;Reilly-Green]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Use of cervical ultrasonography in prediction of spontaneous preterm birth in triplet gestations]]></article-title>
<source><![CDATA[Am J Obstet Gynecol]]></source>
<year>2000</year>
<volume>183</volume>
<page-range>1108-13</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Moragianni]]></surname>
<given-names><![CDATA[VA]]></given-names>
</name>
<name>
<surname><![CDATA[Aronis]]></surname>
<given-names><![CDATA[KN]]></given-names>
</name>
<name>
<surname><![CDATA[Craparo]]></surname>
<given-names><![CDATA[FJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Biweekly ultrasound assessment of cervical shortening in triplet pregnancies and the effect of cerclage placement]]></article-title>
<source><![CDATA[Ultrasound Obstet Gynecol]]></source>
<year>2011</year>
<volume>37</volume>
<page-range>617-8</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="">
<collab>NICE</collab>
<source><![CDATA[NICE Guideline. Preterm labour and birth. National Institute for Health and Care Excellence: Clinical Guidelines]]></source>
<year>2015</year>
<publisher-loc><![CDATA[London ]]></publisher-loc>
</nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Barbosa]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Bek Helmig]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Hvidman]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Twin pregnancies treated with emergency or ultrasound-indicated cerclage to prevent preterm births]]></article-title>
<source><![CDATA[J Matern Fetal Neonatal Med]]></source>
<year>2019</year>
<page-range>1-6</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Han]]></surname>
<given-names><![CDATA[MN]]></given-names>
</name>
<name>
<surname><![CDATA[O&#8217;Donnell]]></surname>
<given-names><![CDATA[BE]]></given-names>
</name>
<name>
<surname><![CDATA[Maykin]]></surname>
<given-names><![CDATA[MM]]></given-names>
</name>
<name>
<surname><![CDATA[Gonzalez]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
<name>
<surname><![CDATA[Tabsh]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Gaw]]></surname>
<given-names><![CDATA[SL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The impact of cerclage in twin pregnancies on preterm birth rate before 32 weeks]]></article-title>
<source><![CDATA[J Matern Fetal Neonatal Med]]></source>
<year>2019</year>
<volume>32</volume>
<page-range>2143-51</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Houlihan]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Poon]]></surname>
<given-names><![CDATA[LC]]></given-names>
</name>
<name>
<surname><![CDATA[Ciarlo]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Kim]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Guzman]]></surname>
<given-names><![CDATA[ER]]></given-names>
</name>
<name>
<surname><![CDATA[Nicolaides]]></surname>
<given-names><![CDATA[KH]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Cervical cerclage for preterm birth prevention in twin gestation with short cervix a retrospective cohort study]]></article-title>
<source><![CDATA[Ultrasound Obstet Gynecol]]></source>
<year>2016</year>
<volume>48</volume>
<page-range>752-6</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Roman]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Rochelson]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Fox]]></surname>
<given-names><![CDATA[NS]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Efficacy of ultrasound-indicated cerclage in twin pregnancies]]></article-title>
<source><![CDATA[Am J Obstet Gynecol]]></source>
<year>2015</year>
<volume>212</volume>
<page-range>788 e1-6</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bernasko]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Lee]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Pagano]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Kohn]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Is routine prophylactic cervical cerclage associated with significant prolongation of triplet gestation]]></article-title>
<source><![CDATA[J Matern Fetal Neonatal Med]]></source>
<year>2006</year>
<volume>19</volume>
<page-range>575-8</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Schuit]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Stock]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Rode]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Effectiveness of progestogens to improve perinatal outcome in twin pregnancies an individual participant data meta-analysis]]></article-title>
<source><![CDATA[BJOG]]></source>
<year>2015</year>
<volume>122</volume>
<page-range>27-37</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<collab>ACOG Committee on Obstetric Practice</collab>
<article-title xml:lang=""><![CDATA[Committee Opinion No 713: Antenatal Corticosteroid Therapy for Fetal Maturation]]></article-title>
<source><![CDATA[Obstet Gynecol]]></source>
<year>2017</year>
<volume>130</volume>
<page-range>e102-e9</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="">
<collab>WHO</collab>
<source><![CDATA[WHO Guidelines Approved by the Guidelines Review Committee. Maternal intervations. WHO Recommendations on Interventions to Improve Preterm Birth Outcomes]]></source>
<year>2015</year>
<page-range>13-42</page-range><publisher-loc><![CDATA[Geneva ]]></publisher-loc>
</nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Murphy]]></surname>
<given-names><![CDATA[DJ]]></given-names>
</name>
<name>
<surname><![CDATA[Caukwell]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Joels]]></surname>
<given-names><![CDATA[LA]]></given-names>
</name>
<name>
<surname><![CDATA[Wardle]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Cohort study of the neonatal outcome of twin pregnancies that were treated with prophylactic or rescue antenatal corticosteroids]]></article-title>
<source><![CDATA[Am J Obstet Gynecol]]></source>
<year>2002</year>
<volume>187</volume>
<page-range>483-8</page-range></nlm-citation>
</ref>
<ref id="B19">
<label>19</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mulder]]></surname>
<given-names><![CDATA[EJ]]></given-names>
</name>
<name>
<surname><![CDATA[Derks]]></surname>
<given-names><![CDATA[JB]]></given-names>
</name>
<name>
<surname><![CDATA[Visser]]></surname>
<given-names><![CDATA[GH]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Effects of antenatal betamethasone administration on fetal heart rate and behavior in twin pregnancy]]></article-title>
<source><![CDATA[Pediatr Res]]></source>
<year>2004</year>
<volume>56</volume>
<page-range>35-9</page-range></nlm-citation>
</ref>
<ref id="B20">
<label>20</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Al-Yatama]]></surname>
<given-names><![CDATA[MK]]></given-names>
</name>
<name>
<surname><![CDATA[Al Essa]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Omu]]></surname>
<given-names><![CDATA[AE]]></given-names>
</name>
<name>
<surname><![CDATA[Al-Shamali]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Egbase]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Rashwan]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Effect of repeated doses of dexamethasone on the incidence and severity of respiratory distress syndrome in multifetal gestation between 24 and 34 weeks]]></article-title>
<source><![CDATA[Gynecol Obstet Invest]]></source>
<year>2001</year>
<volume>52</volume>
<page-range>26-33</page-range></nlm-citation>
</ref>
<ref id="B21">
<label>21</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mildenhall]]></surname>
<given-names><![CDATA[LF]]></given-names>
</name>
<name>
<surname><![CDATA[Battin]]></surname>
<given-names><![CDATA[MR]]></given-names>
</name>
<name>
<surname><![CDATA[Morton]]></surname>
<given-names><![CDATA[SM]]></given-names>
</name>
<name>
<surname><![CDATA[Bevan]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Kuschel]]></surname>
<given-names><![CDATA[CA]]></given-names>
</name>
<name>
<surname><![CDATA[Harding]]></surname>
<given-names><![CDATA[JE]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Exposure to repeat doses of antenatal glucocorticoids is associated with altered cardiovascular status after birth]]></article-title>
<source><![CDATA[Arch Dis Child Fetal Neonatal Ed]]></source>
<year>2006</year>
<volume>91</volume>
<page-range>F56-60</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
