The Effect on Latency Beyond 24 Weeks of Gestation Based on Cerclage Indication

Abstract

INTRODUCTION: Cervical insufficiency is characterized by recurrent painless cervical dilation and spontaneous midtrimester delivery. Diagnosis is clinical and retrospective, often ending in poor obstetric outcomes. Management involves cerclage, which is placed based on history of recurrent spontaneous preterm birth or midtrimester loss. Other indications are evidence of cervical shortening and midtrimester dilation determined by sonographic or physical examination. Although previous studies demonstrate the benefits of history-indicated cerclages, there are few studies defining outcomes of ultrasound examination–indicated and physical examination–indicated cerclages as compared with history-indicated cerclages. METHODS: We reviewed records of patients undergoing cerclage at a single center between January 1, 2008 and January 1, 2013. Cases consisted of women with ultrasound examination–indicated or physical examination–indicated cerclages and women in a control group compromised women with history-indicated cerclages. The primary outcome measured was latency beyond 24 weeks of gestation. Statistical analysis was done using commercially available software. Categorical variables were analyzed using χ2 test and continuous variables were analyzed using Student's t test or Fisher's exact test where appropriate. P=.05 was considered significant. RESULTS: Sixty patients were included. There were no differences in maternal demographics among the women in the case group and those in the control group. The women in the control group were more likely to have had a cerclage in a prior pregnancy. Mean latency beyond 24 weeks of gestation in women in the case group and those in the control group was 7 and 8 weeks, respectively (P=.49). CONCLUSIONS: In pregnancies that reach 24 weeks of gestation, there is no difference in latency between those with history-indicated cerclages and ultrasound examination–indicated or physical examination–indicated cerclages. This information can be used to better counsel women with cervical insufficiency on expected outcomes.