Prior Exam-Indicated Cerclage: Cervical Length Screening or History-Indicated Cerclage in the Next Pregnancy? [36R

Abstract

INTRODUCTION: To evaluate pregnancy outcomes of women with prior physical exam indicated cerclage (PEIC), who in the subsequent pregnancy were either followed by transvaginal ultrasound cervical length (TVU CL) screening or received a planned history-indicated cerclage (HIC). METHODS: This was a multicenter cohort study of singleton gestations with prior PEIC. We evaluated two pregnancies in the study subjects: first pregnancy with PEIC for membranes visible or cervical dilatation ≥1.0 cm at speculum exam in asymptomatic women and the subsequent pregnancy in which women received either TVU CL screening with ultrasound-indicated cerclage (UIC) if CL shortened to ≤25mm or planned HIC. The primary outcome was incidence of preterm birth (PTB) <37weeks. RESULTS: Of 32 singletons with PEIC in a prior pregnancy who met the inclusion criteria, 8 (25%) were followed with TVU CL screening, while 24 (75%) received HIC. Of the 8 women in the TVU CL group, 7 (87.5%) underwent UIC for CL≤25mm. There was no significant difference between the two groups in the incidence of PTB <37 weeks (37.5% vs 29.2%; aOR 1.46, 95% CI 0.27 to 7.82) and in the secondary outcomes in the TVU CL screening versus the HIC groups, respectively. CONCLUSION: Women with prior PEIC have similar outcomes if they receive either TVU CL screening with UIC for CL ≤25mm or planned HIC in the subsequent pregnancy. 87.5% of the women in TVU CL screening require a repeat UIC in the subsequent pregnancy.