Elective cerclage vs. ultrasound-indicated cerclage in high-risk pregnancies.
OBJECTIVE
To compare pregnancy outcome after elective vs. ultrasound-indicated cervical cerclage in women at high risk of spontaneous mid-trimester loss or early preterm birth.


METHODS
This was a retrospective study comparing two management strategies in women with singleton pregnancies who had at least one previous spontaneous delivery at 16-33 weeks of gestation. One group was managed by the placement of an elective cerclage at 12-16 weeks and the other group had transvaginal ultrasound examinations of the cervix at 12-15+6, 16-19+6, and 20-23+6 weeks and cervical cerclage was carried out if the cervical length was 25 mm or less.


RESULTS
A total of 90 patients were examined, including 47 that were managed expectantly and 43 treated by elective cerclage. In the expectantly managed group, 59.6% (28/47) required a cervical cerclage. We excluded from further analysis three patients who were lost to follow-up and three because of fetal death or iatrogenic preterm delivery. Miscarriage or spontaneous delivery before 34 weeks' gestation occurred in 14.6% (6/41) of the elective cerclage group, compared with 20.9% (9/43) in the expectantly managed group (chi2 = 0.219, P = 0.640).


CONCLUSIONS
In women at increased risk of spontaneous mid-trimester or early preterm delivery, a policy of sonographic surveillance followed by cervical cerclage in those with a short cervix reduces the need for surgical intervention without significantly increasing adverse pregnancy outcome.
To
M S
MS
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
Palaniappan
V
V
Skentou
C
C
Gibb
D
D
Nicolaides
K H
KH
D023802:Cerclage, Cervical / Q000379:methods*; D016009:Chi-Square Distribution; D017558:Elective Surgical Procedures; D005260:Female; D005865:Gestational Age; D006801:Humans; D007752:Obstetric Labor, Premature / Q000517:prevention & control*; D011247:Pregnancy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D016216:Ultrasonography, Prenatal / Q000379:methods; D002581:Uterine Cervical Incompetence / Q000000981:diagnostic imaging* / Q000601:surgery*