Cervical Length and Delivery Outcomes in Patients with Prophylactic Cervical Cerclage

ABSTRACT

We sought to determine the relationship between cervical length and delivery outcome in patients who received prophylactic cervical cerclage. We performed a retrospective cohort study of patients with singleton gestations who underwent cerclage during calendar years 1999 to 2008. A total of 78 patients were included in the study. Multiple clinical characteristics and their relationships to delivery outcome were analyzed using multivariable logistic regression analysis. Cervical length at the time of surgery and history of one or more prior second-trimester losses were strongly associated with delivery at or after 32 weeks gestation (p = 0.005 and p = 0.01, respectively). In fact, a cervical length greater than 2 cm at the time of surgery was associated with delivery at 32 weeks or greater (odds ratio 5.74, 95% confidence interval 1.78 to 18.5; p = 0.003). Cervical length was associated with the delivery outcome of patients with prophylactic cerclage and may be helpful in selection of surgical candidates.

KEYWORDS

Cerclage - cervical length - preterm delivery

REFERENCES

• 1 Stromme W B, Haywa E W. Intrauterine fetal death in the second trimester.  Am J Obstet Gynecol. 1963;  85 223-233
• 2 Mann E C, McLarn W D, Hayt D B. The physiology and clinical significance of the uterine isthmus. I. The two-stage intrauterine ballon in the diagnosis and treatment of cervical incompetence.  Am J Obstet Gynecol. 1961;  81 209-222
• 3 Shirodkar V N. A new method of operative treatment for habitual abortions in the seconds trimester of pregnancy.  Antiseptic. 1955;  52 299-300
• 4 McDonald I A. Suture of the cervix for inevitable miscarriage.  J Obstet Gynaecol Br Emp. 1957;  64 346-350
• 5 Marshall B R, Evans T N. Cerclage for cervical incompetence.  Obstet Gynecol. 1967;  29 759-763
• 6 Turrentine M A, Stewart D J, Ramirez M M. Use of the cervical cerclage: comparison of a community and university hospital setting.  Obstet Gynecol. 2007;  109 (2 Pt 1) 320-325
• 7 Wong G P, Farquharson D F, Dansereau J. Emergency cervical cerclage: a retrospective review of 51 cases.  Am J Perinatol. 1993;  10 341-347
• 8 Rust O A, Atlas R O, Jones K J, Benham B N, Balducci J. A randomized trial of cerclage versus no cerclage among patients with ultrasonographically detected second-trimester preterm dilatation of the internal os.  Am J Obstet Gynecol. 2000;  183 830-835
• 9 Althuisius S M, Dekker G A, Hummel P, Bekedam D J, van Geijn H P. Final results of the Cervical Incompetence Prevention Randomized Cerclage Trial (CIPRACT): therapeutic cerclage with bed rest versus bed rest alone.  Am J Obstet Gynecol. 2001;  185 1106-1112
• 10 Terkildsen M F, Parilla B V, Kumar P, Grobman W A. Factors associated with success of emergent second-trimester cerclage.  Obstet Gynecol. 2003;  101 565-569
• 11 Fellman V, Hellström-Westas L, Norman M EXPRESS Group et al. One-year survival of extremely preterm infants after active perinatal care in Sweden.  JAMA. 2009;  301 2225-2233
• 12 Ouzounian J G, Goodwin T M. Preterm labor: diagnosis and management. In: Goodwin T M, ed. Management of Common Problems in Ob/Gyn. West Sussex, UK: Blackwell Scientific Publishing; 2010: 9-11
• 13 Bisulli M, Suhag A, Arvon R, Seibel-Seamon J, Visintine J, Berghella V. Interval to spontaneous delivery after elective removal of cerclage.  Am J Obstet Gynecol. 2009;  201 163 e1-e4
• 14 Harger J H. Cerclage and cervical insufficiency: an evidence-based analysis.  Obstet Gynecol. 2002;  100 1313-1327
• 15 Latta R A, McKenna B. Emergency cervical cerclage: predictors of success or failure.  J Matern Fetal Neonatal Med. 1996;  5 22-27
• 16 Lipitz S, Libshitz A, Oelsner G et al.. Outcome of second-trimester, emergency cervical cerclage in patients with no history of cervical incompetence.  Am J Perinatol. 1996;  13 419-422
• 17 MRC/RCOG Working Party on Cervical Cerclage . Final report of the Medical Research Council/Royal College of Obstetricians and Gynaecologists multicentre randomised trial of cervical cerclage.  Br J Obstet Gynaecol. 1993;  100 516-523
• 18 Lazar P, Gueguen S, Dreyfus J, Renaud R, Pontinnuer G, Papiernik E. Multicentred controlled trial of cervical cerclage in moderate risk women.  Br J Obstet Gynaecol. 1984;  91 731-735
• 19 Olatunbosun O A, al-Nuaim L, Turnell R W. Emergency cerclage compared with bed rest for advanced cervical dilatation in pregnancy.  Int Surg. 1995;  80 170-174
• 20 Drakeley A J, Roberts D, Alfirevic Z. Cervical cerclage for prevention of preterm delivery: meta-analysis of randomized trials.  Obstet Gynecol. 2003;  102 621-627
• 21 Aarnoudse J G, Huisjes H J. Complications of cerclage.  Acta Obstet Gynecol Scand. 1979;  58 255-257