Prior cerclage: to repeat or not to repeat? That is the question.

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 >or= 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.

Uterine contractions in asymptomatic pregnant women with a short cervix on ultrasound.

OBJECTIVE: To estimate the incidence of uterine contractions in asymptomatic pregnant women with a short cervix on transvaginal ultrasound. METHODS: Asymptomatic women with a short cervix on transvaginal ultrasound between 14 and 23(6/7) weeks of pregnancy were instructed to undergo uterine monitoring immediately. Women without available tracings were excluded. Women with and without contractions were compared with regard to demographics, risk factors, and outcomes. RESULTS: One hundred and one women with a short cervix and available tracings were identified. Eighty-six (85%) had contractions and 15 (15%) did not have contractions immediately after identification of the short cervix. The median number of contractions per hour per woman was 4 (range 0-31). These two groups did not differ in demographics, risk factors, or outcomes, except for the fact that 33% of women with contractions versus 73% of women without uterine contractions had a prior second trimester loss (p = 0.004). CONCLUSIONS: In this study, 85% percent of pregnant women with a short cervix on transvaginal ultrasound between 14 and 24 weeks of pregnancy are having asymptomatic uterine contractions. This information is important for further investigation of the short cervix and preterm delivery.