Cervical Incompetence Prevention Randomized Cerclage Trial (CIPRACT): Effect of Therapeutic Cerclage With Bed Rest vs. Bed Rest Only on Cervical Length

Abstract

Cervical cerclage and bed rest, by themselves or in combination, are common approaches to pregnant women having an incompetent cervix. Transvaginal cerclage is known to increase cervical length, but it is possible that bed rest alone has the same effect. This study of 35 women was an attempt to compare combined cerclage and bed rest with management by bed rest alone, using as the primary outcomes delivery before 34 weeks' gestation and neonatal morbidity. Women whose cervical length was less than 25 mm before 27 weeks' gestation, as estimated by transvaginal sonography, were randomly assigned to one of the two treatment conditions. Cervical length was subsequently measured at weekly intervals. Cervical incompetence was diagnosed from painless, progressive cervical dilation when, without intervention, preterm delivery seemed inevitable. Cerclage was performed using a single purse-string suture of braided polyester Nineteen women were assigned to cerclage and bed rest, and 16 were assigned to bed rest only. Mean initial cervical length and gestational age were comparable in these groups (averaging 19.8 mm and 20.7 weeks, respectively). At a mean gestational age of 22 weeks, cervical length was significantly greater in the cerclage group (31 vs. 19 mm). In 22 of 35 women, cervical length was 25 mm or greater; 16 had undergone cervical cerclage. Only 1 of these 22 women delivered before 34 weeks, significantly fewer than the 6 women among 13 whose cervical length did not reach 25 mm. In addition to rest in bed, cerclage ensuring a cervical length of at least 5 mm significantly lowers the likelihood of preterm delivery in women diagnosed as having cervical incompetence.