Spontaneous preterm birth (sPTB) remains a leading cause of perinatal morbidity. Recent data have demonstrated that the risk of recurrent sPTB differs significantly between patients based upon symptoms at the time of presentation. Our primary objective was to evaluate cervical cerclage efficacy based upon clinical presentation of prior sPTB. This is a retrospective cohort study of women with a history of preterm birth and cervical cerclage placement at a large academic center from 2011-2016. Included were women with a history of singleton sPTB who received progesterone and underwent ultrasound or history-indicated cerclage placement in the current pregnancy. Women with a multifetal gestation and those with a previously placed abdominal cerclage were excluded. Women were divided into groups based upon the presenting symptom that preceded their first sPTB. Those groups included painless dilation, preterm premature rupture of membranes (PPROM), and painful dilation (preterm labor or PTL). The primary outcome was delivery after 34 weeks. Secondary outcomes included delivery after 28 and 37 weeks. Rates of sPTB in the 3 groups were compared using the Chi-square test. Multivariable logistic regression was used to adjust for race and cerclage indication. A total of 121 women were included. Of those, 34 presented with painless dilation, 51 with PPROM, and 36 with PTL in their first preterm delivery. The painless dilation group had the highest proportion of history-indicated cerclages (53%) placed in the index pregnancy whereas the preterm labor group had the highest proportion of ultrasound-indicated cerclages (89%). PTL was significantly associated with earliest sPTB after 32 weeks, as was painless dilation with earliest sPTB before 24 weeks [Table 1]. After adjusting for race and cerclage indication, and using the PTL group as referent, rates of delivery after 28, 34, and 37 weeks were similar among the 3 groups [Table 2]. Though limited by sample size, our study found no significant association between clinical presentation of prior sPTB and gestational latency after cerclage placement. With this data we cannot conclude that the clinical presentation of preterm birth predicts the outcome of subsequent cerclage. Our findings support current recommendations surrounding cerclage candidacy and may aid in the counseling and management of these high -risk patients.View Large Image Figure ViewerDownload Hi-res image Download (PPT)