Elective cerclage versus cervical sonography in the management of women with prior midtrimester loss

Abstract

Objective: To compare the outcome of women with a history of midtrimester loss (MTL) when managed with elective cerclage (EC) versus serial cervical sonography (CS). Methods: Over a 7-year period, we identified 199 women with a prior MTL carrying singleton gestations. We compared pregnancy outcomes between 114 women managed with serial CS between 15 and 24 weeks of gestation and 85 women who received EC. In the group who were followed with serial CS, a rescue cerclage or restricted physical activity as the only treatment was considered when the cervical length shortened to 2.0 cm or less. Values were reported as median (range). Results: Results are reported in the following table. Elective cerclage (N = 85) Cervical sonography (N = 114) Cerclage rate 100% 35% Gestational age (GA) at delivery (weeks) 37 (23–41) 38 (18–42) GA less than 37 weeks 44.1% 25.4% ( P = 0.009) GA less than 33 weeks 21.0% 17.5% Preoperative cervical length — 0.88 (0.0–2.0) Conclusion: Women with prior midtrimester loss managed with serial cervical sonography have equal or better perinatal outcomes with lower utilization of cerclage than those treated with elective cerclage.