948: Is the prior placement of cervical cerclage associated with adverse outcomes in subsequent term labor?

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Theoretically the placement of a cervical cerclage in early pregnancy could influence subsequent labor outcomes at term. Prior studies have yielded conflicting results regarding the potential association with adverse labor outcomes such as Cesarean delivery (CD), cervical laceration and prolonged labor. Our objective was to evaluate term labor outcomes in women with and without a cerclage within the Consortium on Safe Labor (CSL) cohort. We hypothesize that women with a cerclage in the incident pregnancy will have increased adverse term labor outcomes. A retrospective cohort study was performed using data from the CSL. Women with live non-anomalous singleton gestations > 37 weeks with induced or spontaneous labor were identified. The risk of CD and other maternal and neonatal outcomes were compared between women with and without cerclage placement during pregnancy. Univariable and multivariable analyses were performed with adjustment for confounding factors (all covariates with p < 0.05 in univariable analysis). Planned subgroup analysis by history of CD was performed. 374 of the 147,463 in the CSL (0.25%) had a cerclage. In univariable analysis, cerclage placement was associated with a significant increase in the frequency of CD (p = 0.016, OR 1.4, 95% CI 1.07-1.84), cervical lacerations, infectious morbidity, and blood loss (Table 1). The association with cesarean delivery persisted in multivariable regression (Table 2). In subgroup analysis cerclage placement was associated with an increased risk of CD only for women without a history of CD. Cerclage placement was not associated with an increased risk of neonatal morbidity. Cerclage placement in pregnancy is associated with an increased risk of cesarean delivery, cervical laceration, and infectious morbidity among women delivering at term. These findings suggest that cerclage placement may alter cervical biomechanical properties that may impact labor progression and outcomes. However, the magnitude of the association may not alter clinical decisions regarding cerclage placement in appropriate candidates.View Large Image Figure ViewerDownload Hi-res image Download (PPT)