title: Reinforcing cerclage for a short cervix at follow-up after the primary cerclage procedure.
abstract: OBJECTIVE
  To determine whether a reinforcing cerclage (RC) for a short cervix measured after the primary cerclage procedure prolonged pregnancy.
  
  
  METHODS
  We conducted a retrospective cohort study of 157 women with singleton gestations who underwent cerclage for standard indications. Women were grouped according to cervical length (CL) at the time of follow-up 1-2 weeks after the initial cerclage placement: ≥25 mm (106 women) and <25 mm with (20 women) or without RC (31 women). Gestational age (GA) at delivery was compared by ANOVA. Survival risk analysis was applied to model GA at delivery adjusted for indication and CL before and after the first cerclage.
  
  
  RESULTS
  Women with CL ≥25mm delivered later than women with CL < 25mm after the first cerclage (p < 0.01). RC did not delay delivery for women with CL < 25 mm (p = 0.17) after the primary procedure. Indication for the primary cerclage (p < 0.01) and CL (p < 0.01) after the primary cerclage were the best predictors for GA at delivery.
  
  
  CONCLUSIONS
  Placement of RC for short cervix did not prolong duration of pregnancy, GA at delivery or modify the probability of preterm birth.
authors.affiliation: a Department of Obstetrics and Gynecology , University of Maryland School of Medicine , Baltimore , MD , USA .
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Contag
authors.affiliation: b Institute for Maternal and Fetal Medicine, Sinai Hospital of Baltimore , Baltimore , MD , USA , and.
authors.forename: Jesse
authors.initials: J
authors.lastname: Woo
authors.affiliation: a Department of Obstetrics and Gynecology , University of Maryland School of Medicine , Baltimore , MD , USA .
authors.forename: David B
authors.initials: DB
authors.lastname: Schwartz
authors.affiliation: b Institute for Maternal and Fetal Medicine, Sinai Hospital of Baltimore , Baltimore , MD , USA , and.
authors.forename: Pedro P
authors.initials: PP
authors.lastname: Arrabal
authors.affiliation: b Institute for Maternal and Fetal Medicine, Sinai Hospital of Baltimore , Baltimore , MD , USA , and.
authors.forename: Geralyn
authors.initials: G
authors.lastname: O'Reilly
authors.affiliation: c Wake Forest University School of Medicine , Winston , Salem , NC , USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Harper
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical / Q000379:methods*; D002584:Cervix Uteri / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D016019:Survival Analysis; D002577:Uterine Cervical Diseases / Q000601:surgery*
keywords: Cerclage; cervical length; gestational age; reinforcing cerclage