Analysis of Characteristics Associated With Pregnancy Duration After Cervical Cerclage Placement in Singleton Gestations [ID: 1378088

Abstract

INTRODUCTION: Cervical cerclage technique and perioperative interventions vary widely among providers because of lack of evidence to inform management. Our aim was to identify factors independently associated with pregnancy duration in singleton gestations after cerclage placement. METHODS: This was a retrospective cohort analysis from 2008 to 2020 at an academic tertiary care center. Because of the inclusion of one or more pregnancies for ∼37% of the cohort, a linear mixed-effects model was utilized to evaluate the association between various factors and pregnancy duration. Variables with P<.2 on unadjusted analysis were considered for incorporation into a multivariable model. Model fit was assessed using Akaike’s information criterion (AIC). RESULTS: Out of 762 pregnancies, 42% underwent history-indicated, 22% ultrasound-indicated, and 36% physical exam-indicated cerclage placement. Mean gestational age (GA) at delivery was 35.0±5.8 weeks. 22% occurred less than 32 weeks and 7% resulted in previable delivery. Mean duration of pregnancy after cerclage placement was 17.1±7.0 weeks. An 8-covariate multivariable analysis revealed adjusted differences (β) in weeks of GA at delivery (95% CI): nulliparity +1.61 (0.57, 2.64), multiparity with most recent delivery 34 weeks or greater +1.31 (0.53, 2.10), married +0.94 (0.18, 1.70), concomitant progesterone use +1.06 (0.35, 1.76), preoperative cervical dilation 0.5 cm or higher −1.26 (−2.10, −0.41), utilization of Foley balloon for membrane elevation −2.27 (−3.53, −1.01), postoperative cervical length less than 20 mm −6.34, (−7.37, −5.32), and requiring cerclage revision −3.79 (−5.40, −2.18). CONCLUSION: Apart from use of a Foley balloon for membrane elevation and concomitant progesterone, we did not find any modifiable factors associated with pregnancy duration after cervical cerclage placement. However, this information may inform counseling as well as management for those with a postoperative cervical length less than 20 mm.