A multicenter analysis of 1364 elective/rescue cerclages in Brazil: Perinatal outcomes, complications, and the role of vaginal progesterone.

OBJECTIVE

To evaluate perinatal outcomes in women undergoing cervical cerclage for prevention of preterm birth in Brazilian maternity hospitals.

METHODS

This retrospective cohort study included 1364 women with singleton pregnancies who underwent elective or rescue cervical cerclage between December 2003 and November 2025. Permanent cerclages were excluded. Primary outcomes included perinatal results and early (≤7 days) and late (>7 days) cerclage-related complications. Analyses were stratified by type of cerclage and use of vaginal progesterone.

RESULTS

Elective cerclage was performed in 986 women and rescue cerclage in 378. Preterm birth was significantly less frequent in the elective group (35.7% vs 47.6%; P < 0.001). Cervical dilatation at the time of procedure influenced outcomes, with a longer latency period between cerclage and delivery when dilatation was <2 cm (21.26 ± 4.8 vs 14.71 ± 4.9 weeks). Early complications were uncommon (0.9% vs 2.9%; P = 0.006), while late complications were more frequent after rescue cerclage (22.5% vs 28.6%; P = 0.019), mainly preterm labor and preterm premature rupture of membranes. Adjuvant vaginal progesterone was not associated with a reduction in cerclage-related complications overall. However, in the rescue cerclage group, progesterone use was associated with higher rates of term birth and live birth, and lower rates of miscarriage and stillbirth.

CONCLUSION

Both elective and rescue cerclages performed favorable perinatal outcomes and low rates of early complications. The benefit of adjuvant vaginal micronized progesterone in perinatal outcomes should be considered hypothesis-generating and warrants confirmation in prospective studies. Our findings highlight the importance of early identification of cervical insufficiency and timely intervention to optimize outcomes.