title: Does a History-Indicated Cerclage Affect Gestational Age at Delivery in Women with Evidence of Recurrent Cervical Insufficiency?
abstract: OBJECTIVE
  To determine whether women with recurrent evidence of cervical insufficiency (CI) and with a history-indicated cerclage (HIC) placed at the beginning of the second trimester will deliver later than the index case.
  
  
  METHODS
  Retrospective case-control study of singleton pregnancy with history-consistent CI. Patients had a cerclage placed between 12 and 16 weeks of gestation. Transvaginal cervical measurement was done between 18 and 24 weeks. Those with a cervical measurement 25 mm were considered to have recurrent CI (Group A). Gestational age at delivery of the index case (Group C) and the cerclage patients (Groups A and B), which are the same patients as Group C, was compared using Student's t test. They have the same genetics and anatomy.
  
  
  RESULTS
  A total of 124 women had an HIC. Sixteen (13%) had recurrent CI (Group A). Comparing cases, the proximate average age at delivery was 22 weeks as compared with 33 weeks and 3 days for those with a cerclage (p < 0.001) (Group A vs. B). In those with a cervical length > 25 mm (Group B), 96 (89%) had a term delivery. In the index cases 64% delivered at 22 weeks or less (Group C).
  
  
  CONCLUSIONS
  Cerclage in those patients with recurrent CI has a significantly improved outcome as compared with the index case. This minimizes pregnancy loss.
authors.forename: Norman A
authors.initials: NA
authors.lastname: Ginsberg
authors.forename: Emily
authors.initials: E
authors.lastname: Miller
authors.forename: Sue
authors.initials: S
authors.lastname: Gerber
authors.forename: Jeffery S
authors.initials: JS
authors.lastname: Dungan
authors.forename: Lee P
authors.initials: LP
authors.lastname: Shulman
mesh_terms: D000022:Abortion, Spontaneous / Q000517:prevention & control*; D000328:Adult; D016022:Case-Control Studies; D023802:Cerclage, Cervical; D054791:Cervical Length Measurement; D036861:Delivery, Obstetric; D005260:Female; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D047928:Premature Birth / Q000517:prevention & control*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D002581:Uterine Cervical Incompetence / Q000601:surgery*