Outcomes of ultrasound-indicated cerclage in low-risk pregnancies: a retrospective observational study.

BACKGROUND

Management of pregnancies with a sonographically short cervix ≤ 25 mm and no prior history of preterm birth remains uncertain. We compared ultrasound-indicated cerclage vs. expectant management in these pregnancies.

METHODS

This was a retrospective observational study of patients from a single academic tertiary care center. Inclusion criteria were singleton pregnancy with transvaginal cervical length (TVCL) ≤ 25 mm. Exclusion criteria were prior history of preterm birth or past cerclage. In addition, cervices dilated ≥ 1 cm were specifically excluded. The primary outcome was latency.

RESULTS

Two hundred twenty-seven patients (cerclage 78, no-cerclage 149) were studied. The cerclage group had characteristics that suggested increased risk: shorter cervical length, higher rate of funneling, less use of vaginal progesterone, lower incidence of multiparity. Survival curves and multivariable regression showed that cerclage was not associated with any differences in clinical outcomes.

CONCLUSION

Ultrasound-indicated cerclage in low-risk women should be utilized with caution. Our data are limited by its retrospective nature and persistent bias, but cerclage was not associated with different outcomes compared to expectant management.