Indications for and pregnancy outcomes of cervical cerclage: 11-year comparison of patients undergoing history-indicated, ultrasound-indicated, or rescue cerclage.

OBJECTIVES

To review and compare pregnancy outcomes of patients undergoing history-indicated, ultrasound-indicated, or rescue cerclage.

DESIGN

Case series with internal comparison.

SETTING

A regional obstetric unit in Hong Kong.

PATIENTS: Women undergoing cervical cerclage at Kwong Wah Hospital between 1 January 2001 and 31 December 2011.

INTERVENTIONS: Cervical cerclage.

MAIN OUTCOME MEASURES: Pregnancy outcomes including miscarriage, gestational age at delivery, birth weight, and duration of pregnancy prolongation.

RESULTS

Overall, 47 patients were included. Nine (19.1%) pregnancies resulted in miscarriage. The median gestational age at delivery was 35.7 weeks. Among the 23 patients who had history-indicated cerclage, only four (17.4%) had three or more previous second-trimester miscarriages or preterm deliveries. Among the 15 patients who had ultrasound-indicated cerclage, preoperative cervical length of ≤1.5 cm was associated with shorter prolongation of pregnancy, compared with that of >1.5 cm (median, 12.1 vs 18.4 weeks; P=0.009). Among the nine women who had rescue cerclage, those who underwent the procedure before 20 weeks of gestation delivered earlier than those underwent cerclage later (median, 22.5 vs 34.1 weeks; P=0.048).

CONCLUSIONS

Patients eligible for the Royal College of Obstetricians and Gynaecologists-recommended history-indicated cerclage remain few. The majority of patients may benefit from serial ultrasound monitoring of cervical length with or without ultrasound-indicated cerclage.