Pregnancy outcomes after ultrasound- and physical examination-indicated cervical cerclage: a retrospective cohort study.

OBJECTIVE

To compare pregnancy outcomes after emergency cervical cerclage according to indication: ultrasound-indicated versus physical examination-indicated cerclage.

METHODS

This retrospective cohort study included singleton pregnancies that underwent emergency cerclage using the McDonald technique at 18-23.6 weeks of gestation at a single tertiary center between 2017 and 2023. Cases were classified according to indication: ultrasound-indicated cerclage (cervical length ≤ 25 mm with a closed cervix) or physical examination-indicated cerclage (painless cervical dilation ≥ 1 cm with visible membranes). The primary outcome was early preterm birth, defined as delivery before 34 weeks of gestation. Secondary outcomes included pregnancy prolongation following cerclage and other obstetric outcomes.

RESULTS

Among 52 emergency cerclage cases, 39 patients underwent ultrasound-indicated cerclage and 13 underwent physical examination-indicated cerclage. Maternal characteristics and gestational age at the time of the procedure were similar between groups. Previous hysteroscopy was more common in the physical examination-indicated cerclage group (p = 0.035). Overall, 84.6% of patients (44/52) delivered after 34 weeks of gestation, with no significant difference in gestational age at delivery between groups (p = 0.886). Pregnancy prolongation did not differ significantly between groups (15.5 ± 4.2 vs. 13.3 ± 6.2 weeks; p = 0.168). In multivariable analysis, cerclage indication was not independently associated with early preterm birth, whereas pre-cerclage cervical length remained an independent predictor (aOR 0.73, p = 0.02).

CONCLUSION

Emergency cervical cerclage was associated with substantial pregnancy prolongation. No statistically significant differences were observed between indications, and pre-cerclage cervical length was the only independent predictor of early preterm birth. These findings support, but do not confirm, a potential pathophysiologic continuum of cervical insufficiency.