Prior cerclage: to repeat or not to repeat? That is the question.
Our objective was to compare obstetrical outcomes of women with a prior cerclage for nontraditional indications who in the subsequent pregnancy either received a history-indicated cerclage or were followed by transvaginal ultrasound (TVU) cervical length (CL). All women with a history- or ultrasound- indicated cerclage in a prior pregnancy and who had a subsequent pregnancy were retrospectively identified from a preexisting database of women at risk for preterm birth between 1995 and 2002. Only women who reached >or= 12 weeks of gestation were included for analysis. Women with a diagnosis other than classic cervical insufficiency were managed in the subsequent pregnancy either by history-indicated cerclage or by serial TVU CL. The primary outcome was spontaneous preterm birth < 35 weeks. We identified 56 women with a prior cerclage for nontraditional indications. In the subsequent pregnancy, 28 women were followed with TVU and 28 matched controls received history-indicated cerclage. The groups were matched for demographics and risk factors. There were no differences between the two groups in the incidence of preterm labor < 35 weeks (21% versus 11%; P = 0.5), preterm premature rupture membranes < 35 weeks (7% versus 11%; P = 1.0), spontaneous preterm birth < 35 weeks (11% versus 11%; P = 1.0), or the gestational age at delivery (36.3 +/- 6.6 versus 36.5 +/- 5.6; P = 0.5). We concluded that in women with prior cerclage for indications other than classic cervical insufficiency, repeat history-indicated cerclage may not improve outcome compared with management with TVU CL follow-up.
Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Washington Hospital Center, Washington, District of Columbia 20010, USA.
Jacquelyn J
JJ
Pelham
Dawnette
D
Lewis
Vincenzo
V
Berghella
D000328:Adult; D023802:Cerclage, Cervical / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000209:etiology; D005865:Gestational Age; D006801:Humans; D007752:Obstetric Labor, Premature / Q000209:etiology; D011247:Pregnancy; D047928:Premature Birth / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016216:Ultrasonography, Prenatal; D002581:Uterine Cervical Incompetence / Q000000981:diagnostic imaging / Q000601:surgery; D055815:Young Adult