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.
KEYWORDS
Cerclage - cervical insufficiency - cervical incompetence - transvaginal ultrasound
- cervical length
REFERENCES
Abnormal cervical competence . In: Creasy R, Resnik R Maternal Fetal Medicine. 5th ed. Philadelphia; WB Saunders
2004: 603
