New Data on Largest Reported Group of “High” Cerclage in Patients With Mid-Trimester Sonographically Short Cervix [1L

Abstract

INTRODUCTION: There is operator variation in cerclage technique impacting effectiveness in improving pregnancy outcome. Previously we reported high success rate of cerclage on mid-trimester short cervix (Cx). We aim to find if addition of 23 patients (pts) to previously reported 54 changes the results. METHODS: We studied 77 consecutive pts with ultrasound (US) Cx <25 mm, at 16–24 6/7 weeks (wks) with a high MacDonald cerclage performed or supervised by a single operator (FB) between 2007–2015. High cerclage was defined; cerclage placement 5 cm above external os, intracervical-Foley (balloon filled above internal os) and amnioreduction in pts with short Cx (0–2 cm). Patients received pre-op antibiotics, pre, post-op indomethacin and regional anesthesia. Cx US images obtained immediately and 2 wks post-op to evaluate Cx length and cerclage quality. RESULTS: 64/77 pts had amnioreduction. Pre and post-op Cx were: Preop Cx: 23 pts (30%) >15 mm, 54 (70%) <15 mm, 29 (38%) <10 mm, 18 (23%) <5 mm (mean 11, median 11, range 0–25 mm). Post-op Cx: 39 pts (51%) 40–50 mm and 38 (44%) 30–40 mm (mean 41, median 41, range 30–55 mm). Outcome: 4 pts (5.3%) delivered at <24 wks, 4 (5.3%) at 24–25, 2 (2.6%) at 26–28, 8 (10.5%) at 28–32, 7 (9.2%) at 33–34, 10 (13%) at 35–36, and 41 pts (54%) at ≥37 wks. 67% and 76% delivered at >34 and >32 wks, respectively. CONCLUSION: Under appropriate conditions, an optimally placed high cervical cerclage by an experienced operator, in pts with short Cx is safe and associated with excellent pregnancy outcomes.