title: The predictive value of sequential cervical length screening in singleton pregnancies after cerclage: a retrospective cohort study.
abstract: BACKGROUND
  There are few valid predictors for preterm delivery after cerclage. Experience with a screening program that included four sequential cervical length measurements in singleton pregnancies after cerclage is reviewed.
  
  
  METHODS
  In this retrospective cohort study, 88 singleton pregnancies after cerclage were included. Cervical length (CL) measurements were performed perioperatively and at weeks 16 + 0, 18 + 0, 20 + 0, and 22 + 0 by transvaginal ultrasound. Predictive factors for early preterm delivery included patient characteristics, obstetric history and CL measurements and were analyzed separately for women with ultrasound-indicated cerclage and those with history-indicated cerclage. Women with emergency cerclage were excluded.
  
  
  RESULTS
  In women with delivery <35 weeks, CL declined from the 16 + 0 to the 22 + 0 weeks of gestation (p = 0.009). In univariate analysis, all CL measurements were predictive for delivery <35 weeks in women who underwent ultrasound-indicated cerclage and in women who received a history-indicated cerclage, whereas in multivariate analysis only CL three to six days after cerclage remained significant (odds ratio 0.85, 95% CI 0.73-0.98). In women with ultrasound-indicated cerclage, optimized cut-off was ≤ 20 mm (specificity 83.8%, sensitivity 84.2%).
  
  
  CONCLUSIONS
  CL measured three to six days after cerclage placement provides the best information about the risk for delivery <35 weeks.
authors.affiliation: Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: Sophie
authors.initials: S
authors.lastname: Pils
authors.affiliation: Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Eppel
authors.affiliation: Department of Obstetrics and Gynecology, Krankenhaus Hietzing, Vienna, Austria.
authors.forename: Regina
authors.initials: R
authors.lastname: Promberger
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Max-Paul
authors.initials: MP
authors.lastname: Winter
authors.affiliation: Department of Craniomaxillofacial and Oral Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Seemann
authors.affiliation: Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. johannes.ott@meduniwien.ac.at.
authors.forename: Johannes
authors.initials: J
authors.lastname: Ott
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical; D054791:Cervical Length Measurement; D002584:Cervix Uteri / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007752:Obstetric Labor, Premature / Q000175:diagnosis* / Q000209:etiology; D016017:Odds Ratio; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology; D011237:Predictive Value of Tests; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal; D002581:Uterine Cervical Incompetence / Q000601:surgery
keywords: Cerclage; Cervical insufficiency; Cervical length; Delivery; Preterm delivery