Outcomes of history indicated cerclage compared with cervical length screening in patients with cervical insufficiency

Abstract

To evaluate pregnancy outcomes of history-indicated cerclage compared with ultrasound cervical length screening in patients with a history of cervical insufficiency defined as prior spontaneous preterm delivery from 14 0/7 to 23 6/7 weeks’ of gestation. This was a retrospective cohort study of patients with singleton gestations with a history of cervical insufficiency. We excluded patients who started prenatal care after 24 weeks, who delivered before 24 weeks, and who declined both a history-indicated cerclage or cervical length screening. The primary outcome was preterm delivery < 37 weeks’ gestation. Secondary outcomes included gestational age at delivery, spontaneous preterm birth < 37 weeks, spontaneous preterm birth < 34 weeks, preterm premature rupture of membranes, cesarean delivery, birthweight, and neonatal intensive care (NICU) admissions. Adjusted odds ratios (aOR) with 95th confidence intervals (95%CI) were calculated, controlling for confounders. Of 376 singleton gestations included, 177 (47.1%) underwent history-indicated cerclage and 199 (52.9%) underwent cervical length screening. Of 199 who underwent cervical length screening, 92 (46%) underwent ultrasound-indicated or physical exam-indicated cerclage. Compared to cervical length screening, history-indicated cerclage was not associated with increased odds of preterm delivery less than 37 weeks (37.7% vs. 29.4%; aOR 0.75 [95%CI 0.48-1.18]). However, compared to cervical length screening, history-indicated cerclage was associated with decreased odds of spontaneous preterm delivery less than 34 weeks (18.1% vs. 9.0%; aOR 0.47 [95%CI 0.23-0.97]). History-indicated cerclage compared with cervical length screening was associated with decreased odds of spontaneous preterm delivery less than 34 weeks. Given that approximately half of the patients undergoing cervical length screening required cerclage, history-indicated cerclage should be considered for patients with a history of cervical insufficiency.View Large Image Figure ViewerDownload Hi-res image Download (PPT)