Prior Cerclage: To Repeat or Not to Repeat? That Is the Question

 

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ABSTRACT

Our objective was to compare obstetrical outcomes of women with a prior cerclage for nontraditional indications who in the subsequent pregnancy either received a history-indicated cerclage or were followed by transvaginal ultrasound (TVU) cervical length (CL). All women with a history- or ultrasound- indicated cerclage in a prior pregnancy and who had a subsequent pregnancy were retrospectively identified from a preexisting database of women at risk for preterm birth between 1995 and 2002. Only women who reached ≥ 12 weeks of gestation were included for analysis. Women with a diagnosis other than classic cervical insufficiency were managed in the subsequent pregnancy either by history-indicated cerclage or by serial TVU CL. The primary outcome was spontaneous preterm birth < 35 weeks. We identified 56 women with a prior cerclage for nontraditional indications. In the subsequent pregnancy, 28 women were followed with TVU and 28 matched controls received history-indicated cerclage. The groups were matched for demographics and risk factors. There were no differences between the two groups in the incidence of preterm labor < 35 weeks (21% versus 11%; p = 0.5), preterm premature rupture membranes < 35 weeks (7% versus 11%; p = 1.0), spontaneous preterm birth < 35 weeks (11% versus 11%; p = 1.0), or the gestational age at delivery (36.3 ± 6.6 versus 36.5 ± 5.6; p = 0.5). We concluded that in women with prior cerclage for indications other than classic cervical insufficiency, repeat history-indicated cerclage may not improve outcome compared with management with TVU CL follow-up.

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Jacquelyn Pelham M.D. 

Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Washington Hospital Center

106 Irving Street, NW, Suite 3800N, Washington, DC 20010; reprints are not available from the authors.