Pregnancy outcome after placement of ‘rescue’ Shirodkar cerclage

Abstract

Mid-trimester painless cervical dilation is associated with high rates of perinatal morbidity and mortality. 'Rescue' cerclage is one option in managing these patients. We evaluated pregnancy outcomes of women in whom we placed Shirodkar cerclage. We analyzed the pregnancy outcome of a retrospective cohort of women carrying singleton pregnancies who experienced late mid-trimester cervical dilation in whom we placed Shirodkar cerclage. Exclusion criteria were uterine contractions, bleeding, premature rupture of membranes and chorioamnionitis. Primary outcomes were gestational age at delivery, maternal, fetal and neonatal outcomes and surgical complications. Between January 2003 and December 2005, 68 patients met our inclusion criteria. The average maternal age was 26.4+/-8.3 years and the mean gestational age at the time of surgery was 19.6+/-3.2 weeks. Seven women opted for expectant management and 5 more were followed up by their referring physicians; the 12 of them were used as a comparison group. Fifty-six women underwent placement of Shirodkar cerclage. We were unable to place a cerclage in three women (5.1%) and all three delivered before 23 weeks. Of the 56 women who had cerclage, 14 (23.7%) delivered at term, 20 (33.9%) delivered between 34 and 36.9 weeks, 13 (22%) between 30 and 33.9 weeks, 6 (10.2%) between 24 and 29.9 weeks and 3 (5.1%) before 24 weeks. Median time from diagnosis to delivery was longer in the cerclage group (9.1 weeks) than in the comparison group (3.3 weeks P<0.01). When pregnancies are complicated by late mid-trimester cervical dilation, placement of Shirodkar cerclage in appropriately selected patients has the potential to be a beneficial therapeutic option.