title: Short cervical length after history-indicated cerclage: is a reinforcing cerclage beneficial?
abstract: OBJECTIVE
  The purpose of this study was to determine if a reinforcing cerclage improves outcome in women with a history-indicated cerclage who develop a short cervix on ultrasound.
  
  
  METHODS
  The management of women with a history-indicated transvaginal cerclage who subsequently developed a short cervix (< or = 25 mm) on transvaginal ultrasound before 24 weeks was retrospectively reviewed. Exposed subjects that received a reinforcing cerclage were compared with similar unexposed subjects that were followed with expectant management. The primary outcome was preterm delivery <35 weeks.
  
  
  RESULTS
  Twenty-four eligible women were identified, of which 5 received a reinforcing cerclage and 19 were managed expectantly. There was no difference in patient demographics and risk factors between the exposed and unexposed groups. Reinforcing cerclage was associated with a significantly earlier gestational age at delivery (20.8 vs 32.9 weeks, P = .002) as well as higher rates of both preterm delivery <35 weeks (100% vs 32%, P = .01) and previable delivery <24 weeks (80% vs 16%, P = .01).
  
  
  CONCLUSIONS
  In pregnancies with a history-indicated cerclage and subsequently diagnosed ultrasound cervical shortening before 24 weeks, placement of a reinforcing cerclage is associated with earlier delivery than expectant management.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Jason K
authors.initials: JK
authors.lastname: Baxter
authors.forename: James
authors.initials: J
authors.lastname: Airoldi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Berghella
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical; D005260:Female; D005865:Gestational Age; D006801:Humans; D007752:Obstetric Labor, Premature / Q000517:prevention & control*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors