Abstract
A retrospective cohort study was conducted including 45 patients who received cerclage between 13 to 26 weeks for cervical insufficiency. The 14 women (cases) delivering before 34 weeks were compared with control group including those who delivered after 32 weeks. Our study identified 4 risk factors associated with preterm birth at less than 34 weeks period of gestation : cervical length 20 mm prior to cerclage placement, emergency placement of cerclage, period of gestation of placement of cerclage 21-26 weeks, history of ?4 losses. The positive predictive value calculated using the prediction model was 100% with a risk score of ?3, 93% with score 2 and 80% with score 1. The utility of the prediction model as a tool for identifying patients at a higher risk for PTD 32 weeks and could be a useful tool for counselling high risk patients prior to cerclage and for identifying those women with cerclage who require increased surveillance.
Highlights
Cervical insufficiency is primarily a clinical diagnosis, characterised by recurrent painless dilation and spontaneous mid trimester loss
Evaluation of the risk factors contributing to preterm delivery in women receiving cerclage is of utmost importance, as the most common cause of perinatal mortality is preterm birth
The aims of this study are to evaluate the risk factors associated with preterm birth in women receiving cervical cerclage and to develop a scoring system for preterm birth in these women
Summary
Cervical insufficiency is primarily a clinical diagnosis, characterised by recurrent painless dilation and spontaneous mid trimester loss. The indications for and efficacy of cervical cerclage still remains controversial[1,2,3]. Analysis of clinical history and various risk factors is essential to judge the indications and timing of placement of cervical cerclage. The aims of this study are to evaluate the risk factors associated with preterm birth in women receiving cervical cerclage and to develop a scoring system for preterm birth in these women. This prediction model can be used as a tool for indentifying women likely to develop preterm birth and can be offered frequent surveillance
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