Objective: Few cases have been reported on  Laproscopic Transabdominal Cervicoisthemic Cerclage (LTCC) performed during pregnancy in twin gestation. We cited 1 case report of successful twin pregnancy following LTCC performed pre-pregnancy with failed vaginal cerclage but that patient had a Septate Uterus and underwent concomitant metroplasty so the cause of preterm labor being cervical incompetence was not certain. This is the first case report to our knowledge of LTTC performed pre-pregnancy preceding twin pregnancy with previous failed vaginal cerclage on twin gestation. 

Case Report: 29 year old patient with twin gestation after IVF underwent high vaginal cerclage at 14 weeks followed by pregnancy loss at 24 weeks.The patient went on to have two failed single embryo transfers. She underwent a LTCC with mercilene tape. She then had a twin pregnancy following double embryo transfer. She underwent cervical length surveillance throughout her pregnancy. Her cervix remained longer than 3cm and closed till term. Her cervical length as per surveillance scans was as follows: 10 weeks 3.5 cm, 15 weeks 4 cm, 22 weeks 3.7cm, 28 weeks 3.5cm, 32 weeks 3.5 cm and at 35 weeks 3.5 cm. She underwent an elective Ceserean section at 37 weeks with successful outcome of both twins. The cerclage was left insitu for future pregnancies.

Discussion: With increasing use of ART for conception, more and more cases with multiple pregnancy are seen in clinical practice now. Pre-pregnancy LTCC is effective in preventing preterm birth in twin pregnancies with previous history of twin mid-trimester loss. This case highlights how the length of the cervix was conserved despite a well growing twin pregnancy. 

Conclusion: There has been much study on efficacy of LTTC versus vaginal cerclage during and pre-pregnancy. This case report is the first with successful twin pregnancy outcome after LTTC on a patient with history of cervical incompetence in previous twin gestation despite vaginal cerclage. Detailed cervical length surveillance was done in pregnancy to demonstrate the efficacy of the cerclage. This should be followed by a case series in which multiple patients undergoing the same intervention are assessed for outcomes. Future research should also focus on comparison on efficacy of high vaginal versus Laproscopic cerclage in preservation of cervical length specifically for twin gestations.