Prior Ultrasound-Indicated Cerclage

Abstract

INTRODUCTION: To evaluate pregnancy outcomes of women with a history of ultrasound-indicated cerclage for a short cervix who in subsequent pregnancy either were followed by transvaginal ultrasound cervical length screening or received a history-indicated cerclage. METHODS: Retrospective cohort study was performed from 1993 to 2012 involving women with an index singleton pregnancy and history of ultrasound-indicated cerclage. Prior ultrasound-indicated cerclage was defined as cerclage placed for cervical length less than 25 mm before 24 weeks of gestation in women at high risk for preterm birth. At our institution, women with a history of ultrasound-indicated cerclage were managed in their subsequent pregnancy either by transvaginal ultrasound cervical length screening or by history-indicated cerclage, at the physician's discretion (Fig. 1). In the transvaginal ultrasound cervical length group, if cervical length became less than 25 mm before 24 weeks of gestation, an ultrasound-indicated cerclage was performed. In the history-indicated cerclage group, history-indicated cerclage was placed at approximately 12–15 weeks of gestation. Primary outcome was spontaneous preterm birth at less than 35 weeks (Table 1).RESULTS: Twenty-eight women met the inclusion criteria. Of these 28 women, 13 were in the transvaginal ultrasound cervical length group and 15 in the history-indicated cerclage group. Demographics were similar in both the groups, except earliest gestational age of prior spontaneous preterm birth (Table 1). The odds of spontaneous preterm birth at less than 35 weeks of gestation for the two groups was similar (odds ratio 0.54, 95% confidence interval 0.04–6.77). Secondary outcomes were also similar in two groups except birth weight (Table 1). CONCLUSION: Women with prior ultrasound-indicated cerclage have similar outcomes if they are managed in the next pregnancy by either transvaginal ultrasound cervical length screening and ultrasound-indicated cerclage placement if cervical length is less than 25 mm before 24 weeks of gestation or by history-indicated cerclage. Our study results are limited by small sample size. There are currently no other studies evaluating this clinical dilemma.