Cervical cerclage: an aggressive approach to threatened or recurrent pregnancy wastage.

Patients at high risk for recurrent pregnancy wastage may not always provide a typical history of cervical incompetence. Seventy-five pregnancies were managed with a cervical cerclage, with tocolytic agents used adjunctively in some. The pregnancies were divided into three groups on the basis of past obstetric history and statistically analyzed with respect to outcome. Patients in categories 1 and 2 showed significant improvement in mean birth weight and maximum gestational age attained with a shift in the ratio of term to premature births after intervention. In category 3, a trend of improvement in mean birth weight and maximum gestational age was seen but fetal salvage was not improved. Maternal morbidity was low with a cerclage-related cesarean section rate of 6.8% and only 8% infectious morbidity. It is concluded that cervical cerclage should be considered in the management of recurrent pregnancy wastage even if the obstetric history is atypical.