875 Cerclage in singletons with a short cervix (≤10mm) and no history of spontaneous preterm birth

Abstract

To determine whether cervical cerclage is associated with an increased time interval to delivery in women with an asymptomatic short cervical length (CL ≤10mm) and no history of spontaneous preterm birth (sPTB). Multicenter retrospective cohort of women with CL ≤10mm between 16 and 23 weeks’ gestation from January 2014 to December 2019. Women with prior sPTB, symptoms of preterm labor, cervical dilation > 1cm, pessary or missing data were excluded. The primary outcome was time interval from diagnosis to delivery. Secondary outcomes included various PTB cut-offs and adverse neonatal outcomes. A sub-group analysis of all outcomes on patients already treated with vaginal progesterone in each group was also performed. Statistical analysis included Chi-squared and Wilcoxon rank-sum tests, as well as a multivariate Cox proportional hazard regression for time interval to delivery. Of the 90 patients included, 52 (57.8%, 35 already treated with progesterone) had cervical cerclage and 38 (42.2%, 21 already treated with progesterone) did not. Baseline characteristics of the two groups are displayed in Table 1. Cervical cerclage was associated with a longer time interval to delivery (14.5 weeks vs. 12.4 weeks; P = 0.02; Table 2) and lower likelihood of delivery (aHR 0.61, 95% CI 0.38-0.99; P = 0.04) compared to no cerclage, after accounting for gestational age and CL at diagnosis. In patients already treated with progesterone, cervical cerclage was also associated with a longer time interval to delivery (15.1 weeks vs. 11.3 weeks, P = 0.01; Table 2) and lower likelihood of delivery (aHR 0.47, 95% CI 0.26-0.87, P = 0.01) compared to no cerclage. Cervical cerclage was also associated with a lower rate of late PTB compared to no cerclage (11.5% vs. 31.6%, P = 0.03) (Table 2). Cervical cerclage should be considered in asymptomatic women with an extremely short CL (≤10mm) and no history of sPTB.View Large Image Figure ViewerDownload Hi-res image Download (PPT)