Archives of gynecology and obstetrics · 2026
Cervical length following cerclage as a predictor of spontaneous preterm birth.
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Wolf Maya Frank, Kinog Liron, Tuma Ruba, Lowenstein Lior, Odeh Marwan, Sgayer Inshirah
Аннотация
OBJECTIVE: We aimed to evaluate the association between serial transvaginal cervical length measurements following McDonald cerclage and spontaneous preterm birth (PTB).
METHODS: This retrospective study included singleton pregnancies with cerclage performed during 2010-2024. Cerclage was placed prophylactically (n = 109) based on obstetric history, or emergently (n = 46) due to ultrasound findings. Cervical length was measured by transvaginal ultrasound before and after cerclage, and at 2-week intervals until 32 weeks.
RESULTS: For the prophylactic group, the median cervical length was shorter among those who delivered PTB < 37 weeks (n = 23) than term: at 21-22 + 6 weeks (2.5 vs. 3.9 cm, p = 0.042), 23-24 + 6 weeks (2.0 vs. 3.4 cm, p = 0.016), 25-26 + 6 weeks (3.0 vs. 3.8 cm, p = 0.042), and 31-32 + 6 weeks (2.4 vs. 3.4 cm, p = 0.015). In multivariable analysis adjusted for history of PTB, progesterone use, and gestational age at cerclage placement, shorter cervical length, at 23-24 + 6 weeks (adjusted odds ratio [aOR] 4.13, 95% confidence interval [CI] 1.23-13.89, p = 0.021) and at 25-26 + 6 weeks (aOR 3.39, 95% CI 1.08-10.64, p = 0.037), was independently associated with PTB < 37 weeks. Cervical length at 25-26 + 6 weeks was associated with PTB < 32 weeks (aOR 4.76, 95% CI 1.20-19.60, p = 0.027). For the emergency group, the median cervical length was shorter among those who delivered < 32 weeks than later, at 23-24 + 6 weeks (1.4 vs. 3.2 cm, p = 0.049) and 25-26 weeks (1.5 vs. 2.3 cm, p = 0.041).
CONCLUSION: Serial cervical length monitoring after cerclage provides a clinically relevant prediction of spontaneous PTB.
METHODS: This retrospective study included singleton pregnancies with cerclage performed during 2010-2024. Cerclage was placed prophylactically (n = 109) based on obstetric history, or emergently (n = 46) due to ultrasound findings. Cervical length was measured by transvaginal ultrasound before and after cerclage, and at 2-week intervals until 32 weeks.
RESULTS: For the prophylactic group, the median cervical length was shorter among those who delivered PTB < 37 weeks (n = 23) than term: at 21-22 + 6 weeks (2.5 vs. 3.9 cm, p = 0.042), 23-24 + 6 weeks (2.0 vs. 3.4 cm, p = 0.016), 25-26 + 6 weeks (3.0 vs. 3.8 cm, p = 0.042), and 31-32 + 6 weeks (2.4 vs. 3.4 cm, p = 0.015). In multivariable analysis adjusted for history of PTB, progesterone use, and gestational age at cerclage placement, shorter cervical length, at 23-24 + 6 weeks (adjusted odds ratio [aOR] 4.13, 95% confidence interval [CI] 1.23-13.89, p = 0.021) and at 25-26 + 6 weeks (aOR 3.39, 95% CI 1.08-10.64, p = 0.037), was independently associated with PTB < 37 weeks. Cervical length at 25-26 + 6 weeks was associated with PTB < 32 weeks (aOR 4.76, 95% CI 1.20-19.60, p = 0.027). For the emergency group, the median cervical length was shorter among those who delivered < 32 weeks than later, at 23-24 + 6 weeks (1.4 vs. 3.2 cm, p = 0.049) and 25-26 weeks (1.5 vs. 2.3 cm, p = 0.041).
CONCLUSION: Serial cervical length monitoring after cerclage provides a clinically relevant prediction of spontaneous PTB.