History- or ultrasound-based cerclage placement and adverse perinatal outcomes.
OBJECTIVE
To determine whether cerclage based on serial transvaginal ultrasound (STVUS) vs. cerclage based on obstetric history (prior multiple midgestation losses) is superior for treatment of cervical insufficiency.


METHODS
This retrospective study evaluated all history-based or ultrasound-based cerclages in singleton pregnancies over a 5-year period at the University of Mississippi Medical Center. Demographic statistics, interval from cerclage placement to delivery, and gestational age at delivery were recorded, as were neonatal factors such as birthweight, morbidity, and mortality.


RESULTS
No significant difference was found in regard to gestational age at delivery between the history-based cerclage and the ultrasound-based groups. The number of patients delivered before 24 weeks or after 34 weeks was similar. Birth weights, Apgar scores, and the number with growth restriction were similar between the two groups, as were perinatal loss and significant morbidity. In the ultrasound-based cerclage group, 52.1% did not require cerclage placement despite a history consistent with cervical insufficiency.


CONCLUSIONS
There were no statistical differences between history-based and ultrasound-based cerclage in regard to obstetric or neonatal outcome. Using STVUS instead of cerclage procedures based on obstetric history, unnecessary procedures can be avoided in more than half the patients.
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Jacob A
JA
Brown
Amanda W
AW
Pearson
Edward W
EW
Veillon
Orion A
OA
Rust
Suneet P
SP
Chauhan
Everett F
EF
Magann
John C
JC
Morrison
D000328:Adult; D023802:Cerclage, Cervical; D005260:Female; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D017584:Reproductive History; D012189:Retrospective Studies; D012307:Risk Factors; D016216:Ultrasonography, Prenatal; D002581:Uterine Cervical Incompetence / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D055815:Young Adult