1100: Pregnancies with cerclage at 36 weeks or later: Adverse maternal and neonatal outcomes

Abstract

There is a paucity of data to counsel women regarding maternal and neonatal outcomes for those with cerclages that reach 36 weeks, the time ACOG recommends its removal. We hypothesized that adverse outcomes among women at 36 weeks or later with cerclage would be higher than those without. Our objective was to compare the composite maternal and neonatal adverse outcomes among women at 36 weeks or later with and without cerclage. The retrospective cohort study utilized the U.S. vital statistics datasets from 2011-2013. Inclusion criteria were singletons, with and without cerclage placement, non-anomalous, without diabetes or hypertensive disorders, and delivery at 36-41 weeks. The primary outcome was composite maternal adverse outcome (CMAO). The secondary outcomes were: chorioamnionitis, cesarean delivery, and composite neonatal adverse outcome (CNAO). Multivariable Poisson regression models with error variance were used, while adjusting for confounders. Adjusted relative risk (aRR) with 95% confidence intervals (CI) were calculated. Of the 8,508,228 women that met inclusion criteria, 0.22% (18,471) women had a cerclage. The rate of chorioamnionitis was significantly higher in women with cerclage than without (aRR 1.36; 95% CI 1.20-1.55) as was the rate of cesarean delivery (aRR 1.09; 95% CI 1.07-1.11). The composite maternal adverse outcome was significantly increased in those with cerclage (aRR 2.15; 95% CI 1.86-2.49) as were all 5 individual components (Table 1). The composite neonatal adverse outcome was significantly increased (aRR 1.48; 95% CI 1.29-1.69). However, only 2 of 5 individual components of CNAO were significantly increased (Table 2). Among women with cerclage at 36 weeks or later, the adverse outcomes for mother-newborn dyad are significantly higher than those without cerclage. Birth injuries, seizures, and neonatal mortality, however, are similar in the two groups.View Large Image Figure ViewerDownload Hi-res image Download (PPT)