Cervical Insufficiency After Prior Term Delivery

Abstract

OBJECTIVE: Our objective was to examine the relationship between obstetric and gynecologic procedures and the development of secondary cervical insufficiency, a term we coined for patient who had a history of birth(s) at term and developed cervical insufficiency in a subsequent pregnancy. The primary objective was to determine whether previous cesarean delivery increases the likelihood of secondary cervical insufficiency. Our secondary objective was to look at other obstetrics and gynecologic factors and the development of secondary cervical insufficiency. STUDY DESIGN: This was a case–control study. All deliveries occurring between 2011 and 2014 in our center were reviewed. Participants were defined as having clinical characteristics suggestive of cervical insufficiency and having had a history of at least delivery at term, before the index pregnancy. Parity-matched participants for the control group were selected as the next patient who had a term delivery immediately after the case. The obstetric and gynecologic characteristics of the participants in the case and control groups were compared. RESULTS: Thirty-seven patients had clinical characteristics suggesting of secondary cervical insufficiency. Women in the case group delivered at a mean gestational age of 24.3 weeks compared with 39.0 weeks of gestation for women in the control group. Women in the case group were not more likely to have had a history of prior cesarean delivery(s) than those in the control group, eight of 37 (22%) compared with 11 of 37 (30%). However, women in the case group were more likely to have had an interpregnancy dilatation and curettage (D&C) (nine of 37 compared with one of 37, P=.01) and to have multiple prior D&C procedures (seven of 37 compared with one of 37, P=.03). CONCLUSION: There does not seem to be an association between cesarean delivery and the subsequent development of secondary cervical insufficiency. However, there was an association between secondary cervical insufficiency and history of multiple D&Cs and interpregnancy D&Cs.