Abstract: Objective: To explore the application of transvaginal cervical cerclage-MacDonald operation in those women with twin pregnancy combined with cervical insufficiency, and follow-up visit the pregnancy outcomes. Methods：Ninety-seven women with twin pregnancy combined with cervical dysfunction who had a regular pregnancy test were included from January 2014 to June 2019. According to their medical history and follow-up results, they were divided into 2 groups. The surgical group (n=57) was treated by cervical cerclage, and the conservative group (n=40) was treated by bed-rest and symptomatic drug. Then according to different surgical timing, the surgical group was divided into 2 subgroups: the preventive cerclage subgroup (n=39) and the emergency cerclage subgroup (n=18). The mother-infant outcomes and clinical effects were compared. Results：The prolonged gestational age and delivery gestational age of the operation group were significantly higher than those of the conservative group (P＜0.05). The length of cervical before ligation, prolonged gestation week, weeks of delivery, and birth weight of newborns in the preventive cerclage subgroup were higher than those in the emergency cerclage subgroup (P＜0.05). The gestational age of circumcision in the preventive cerclage subgroup was lower than that in the emergency cerclage subgroup (P＜0.05). The operation group′s preterm birth rate ＜35 weeks, ≥35 weeks delivery rate and live birth rate were higher than the conservative group (P＜0.05). The conservative group had a higher abortion rate than the surgical group (P＜0.05). Compared with the emergency ligation group, the miscarriage rate and preterm birth rate in the preventive cerclage group were not statistically significant (P＞0.05). However, the preventive cerclage group had a higher delivery rate and live birth rate at 35 weeks. In the emergency circumcision group, the differences were statistically significant (P＜0.05). Conclusions：Compared with conservative treatment, the transvaginal cervical cerclage for pregnant women with twin pregnancies and cervical insufficiency has positive significance for improving pregnancy outcomes, and for choosing the right timing of surgery so as to prolong the gestational weeks.

Key words: Uterine cervical incompetence；, Pregnancy, twin；, Cerclage, cervical；, Pregnancy outcome；, Therapy