Abstract
Objectives The aims of this study were to clarify the following: (1) how often does prolonged pregnancy ≥34 weeks occur in patients with emergent cerclage without progesterone and (2) the risk factors preventing such pregnancy continuation. Materials and Methods This retrospective observational study was performed using medical records of patients for whom emergent cerclage had been performed between April 2006 and December 2018 in our institute. Results Emergent cerclage was performed in 123 patients (median age: 34, interquartile range: 31–36). Primiparous patients numbered 44 (36%). A history of spontaneous preterm birth (SPTB) was present in 30 (24%). The median presurgical cervical length (CL) was 16 (8–21) mm at surgery. Of the 123, 20 (16%) were delivered at 33 + 6 weeks or less (<34 weeks). We conducted logistic regression analysis of the risk factors of SPTBs <34 weeks after cerclage. Three risk factors were identified that increased the risk of SPTB <34 weeks: presurgical CL 0 mm (odds ratio (OR): 5.30; 95% confidence interval (CI): 1.58–17.7), a history of SPTB (OR: 4.65; 95% CI: 1.38–15.7), and the presence of sludge (OR: 4.14; 95% CI: 1.20–14.3). Conclusion Three risk factors predicted SPTB <34 weeks after emergency cerclage without progesterone administration: unmeasurable CL (CL 0 mm), a history of SPTB, and the presence of sludge on ultrasound. SPTB <34 weeks occurred after emergency cerclage in 16% of patients, being comparable with the recent data with progesterone.
Highlights
Treatment and prophylaxis for spontaneous preterm birth (SPTB) are challenging: administration of progesterone [1], tocolytic agents [2], antibiotics [3], and their combination [4, 5] have been reported to reduce SPTB incidence
ART, assisted reproductive technology; CL, cervical length; IQR, interquartile range; SPTB, spontaneous preterm birth. ∗Not examined in 37 patients, ∗∗not examined in 2 patients,∗∗∗ not examined in 28 patients
SPTB
Summary
Treatment and prophylaxis for spontaneous preterm birth (SPTB) are challenging: administration of progesterone [1], tocolytic agents [2], antibiotics [3], and their combination [4, 5] have been reported to reduce SPTB incidence. Cervical cerclage has been attempted in some patients. Cerclage is divided into two types: elective and emergent cerclage. E former is performed at 12–14 weeks’ gestation for patients with historical indications. E latter, referred to as rescue cerclage, is usually performed at 15–24 weeks for patients with an ultrasound-detectable shortened cervical length (CL) and patients with this latter cerclage, compared with those with the former clearly show poorer perinatal outcomes, especially PTB. Us, patients after emergent cerclage require special attention, especially for PTB. Progesterone has been widely recommended as a treatment for threatened PTB in global guidelines [6,7,8].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
