Short cervical length after history-indicated cerclage: is a reinforcing cerclage beneficial?

ABSTRACT

OBJECTIVE: The purpose of this study was to determine if a reinforcing cerclage improves outcome in women with a history-indicated cerclage who develop a short cervix on ultrasound. STUDY DESIGN: The management of women with a history-indicated transvaginal cerclage who subsequently developed a short cervix (< or = 25 mm) on transvaginal ultrasound before 24 weeks was retrospectively reviewed. Exposed subjects that received a reinforcing cerclage were compared with similar unexposed subjects that were followed with expectant management. The primary outcome was preterm delivery <35 weeks. RESULTS: Twenty-four eligible women were identified, of which 5 received a reinforcing cerclage and 19 were managed expectantly. There was no difference in patient demographics and risk factors between the exposed and unexposed groups. Reinforcing cerclage was associated with a significantly earlier gestational age at delivery (20.8 vs 32.9 weeks, P = .002) as well as higher rates of both preterm delivery <35 weeks (100% vs 32%, P = .01) and previable delivery <24 weeks (80% vs 16%, P = .01). CONCLUSION: In pregnancies with a history-indicated cerclage and subsequently diagnosed ultrasound cervical shortening before 24 weeks, placement of a reinforcing cerclage is associated with earlier delivery than expectant management.