title: Effectiveness of elective cervical cerclage according to obstetric history.
abstract: OBJECTIVE
  To assess the effectiveness of elective history-indicated cervical cerclage according to obstetrical history.
  
  
  METHODS
  We analyzed pregnancy outcome of a retrospective cohort of women who have had history-indicated McDonald's cerclage. Principal outcome was gestational age (GA) at delivery.
  
  
  RESULTS
  Between January 2003 and December 2013, 205 women were included. We analyzed population in two risk groups: 1- Low-risk (≤2 prior preterm birth (PTB)/second trimester loss (STL), or prior success of cerclage), 2- High risk (≥3 prior PTB/STL, or prior failure of cerclage). In the high-risk group, there was a higher frequency of deliveries before 37 weeks (47.5% vs. 24.5%, P=0.001, OR=2.79, 95% CI [1.49-5.23]). Fifty percent of women (n=6/12) delivered before 37 weeks in case of three or more prior PTB/STL, and 51% (n=24/47) in case of prior failure of cervical cerclage.
  
  
  CONCLUSIONS
  Elective cervical cerclage may be indicated for women with≤2 prior PTB/STL, or prior successful cerclage. For women with≥3 prior PTB/STL, trachelorraphy or cervico-isthmic cerclage could be possible alternatives to cervical cerclage.
authors.affiliation: Service de gynécologie obstétrique, hôpital Robert-Debré, AP-HP, 48, boulevard Serrurier, 75019 Paris, France. Electronic address: diane.korb@aphp.fr.
authors.forename: D
authors.initials: D
authors.lastname: Korb
authors.affiliation: Service de gynécologie obstétrique, hôpital Robert-Debré, AP-HP, 48, boulevard Serrurier, 75019 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Marzouk
authors.affiliation: Service de gynécologie obstétrique, hôpital Robert-Debré, AP-HP, 48, boulevard Serrurier, 75019 Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Deu
authors.affiliation: Service de gynécologie-obstétrique, maternité Port-Royal, Cochin, 123, boulevard de Port-Royal, 75014 Paris, France.
authors.forename: J-F
authors.initials: JF
authors.lastname: Oury
authors.affiliation: Service de gynécologie-obstétrique, maternité Port-Royal, Cochin, 123, boulevard de Port-Royal, 75014 Paris, France.
authors.forename: O
authors.initials: O
authors.lastname: Sibony
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical; D015331:Cohort Studies; D017558:Elective Surgical Procedures; D005260:Female; D005602:France / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D055502:Secondary Prevention; D002581:Uterine Cervical Incompetence / Q000601:surgery*; D055815:Young Adult
keywords: Cervical cerclage; Cervical insufficiency; Preterm birth; Second trimester loss; Trachelorraphy