Effectiveness and perinatal outcomes of history-indicated, ultrasound-indicated and physical examination-indicated cerclage: a retrospective study.

OBJECTIVE: To evaluate the effectiveness and perinatal outcomes of cerclage procedure according to indication. METHODS: The pregnancy and neonatal outcomes of the patients who underwent cerclage with the diagnosis of cervical insufficiency between January 2016 and December 2020 were retrospectively analyzed. Patients were categorized into three groups: a history-indicated group, an ultrasound-indicated group and a physical examination-indicated group. RESULTS: Seventy-three patients who underwent cerclage were included in the study. Of these, 41 (56.2%) had history-indicated, 17 (23.3%) had ultrasound-indicated and 15 (20.5%) had physical examination-indicated cerclages. Compared to history- and ultrasound-indicated cerclage group, duration from cerclage to delivery (18.6 ± 6.9 weeks vs 17.8±5.9 weeks vs 11 ± 5.3 weeks, p = 0.003) was significantly lower and delivery < 28 weeks (9.8% vs 5.9% vs 33.3%, p = 0.042) and delivery < 34 weeks of gestation (26.8% vs 11.8% vs 60%, p = 0.009) were significantly higher in physical examination-indicated cerclage group. In physical examination-indicated cerclage, compared with history- and ultrasound-indicated cerclage low birth weight, low APGAR score, neonatal intensive care unit admission and neonatal mortality were higher, although not statistically significant (p > 0.05). CONCLUSION: Pregnant women who underwent physical examination-indicated cerclage had higher risks for preterm delivery < 28 weeks and < 34 weeks than history- and ultrasound-indicated cerclage.

Cerclaje cervical de emergencia: nuestra experiencia / Emergency cervical cerclage: our experience

Objetivo: Analizar la efectividad del procedimiento a través de los resultados perinatales obtenidos, mediante un estudio descriptivo y retrospectivo. Material y métodos: Se han revisado los casos de cerclaje cervical de emergencia aplicados en nuestro servicio entre los años 2000 y 2007, ambos incluidos, estableciendo criterios de selección que determinan a las pacientes susceptibles beneficiarse de este método. Resultados: Hemos obtenido una supervivencia neonatal libre de secuelas en el 87,5 % de los casos. Las complicaciones asociadas fueron menores, entre las que destacan la amenaza de parto prematuro y la rotura prematura pretérmino de membranas. Conclusión: Pese a la escasa bibliografía acerca de este tipo de cerclaje y sus resultados, a veces contradictorios, en nuestro centro optamos por éste como una alternativa eficaz a la actitud expectante en los casos de incompetencia cervical tardía como los descritos (AU)

Objective: To analyze the effectiveness of emergency cervical cerclage through a descriptive and retrospective analysis of our perinatal results.
Material and method: We reviewed cases in which emergency cervical cerclage was applied in our department between 2000 and 2007, both inclusive. During this review we established the necessary criteria to select the female patients likely to benefit from this method. Results: In the patients studied, we achieved a sequel-free neonatal survival rate of 87.5%. The associated complications were minor, mainly threatened preterm labor and preterm premature rupture of membranes. Conclusion: Despite the scarce literature about emergency cervical cerclage and its results (which are sometimes contradictory), we have chosen this technique as an effective alternative to expectant management in cases of late cervical incompetence, such as those described above (AU)

Predicting outcome after emergent cerclage using classification tree analysis.

We sought to develop a predictive model for gestational age at delivery after placement of an emergent cerclage in the second trimester. Data were obtained for women undergoing emergent cerclage in response to documented cervical change on physical examination at a university hospital between 1980 and 2000. Hierarchically optimal classification tree analysis (CTA) was used to predict delivery prior to 24 weeks, between 24 and 27 6/7 weeks, or after 27 6/7 weeks. One hundred sixteen women were available for analysis. Delivery prior to 24 weeks was best predicted by presence of prolapsed membranes and gestational age at cerclage placement; delivery between 24 and 27 6/7 weeks was best predicted by parity alone; delivery of at least 28 weeks was best predicted by cervical dilation and length, presence of prolapsed membranes, and parity. When choosing a single model to predict delivery at the three different gestational age periods, the last model yielded the most accurate results. CTA can be used to construct a predictive model for outcome after emergent cerclage that may be informative for both patients and physicians.

Does cerclage prevent preterm birth?

Cerclage procedures can be classified according to timing, (elective, urgent, emergent), and anatomic approach (transvaginal and transabdominal). The most current clinical data and the evidence-based recommendations for each type of cerclage procedure are listed.