Introduction: Mothers with a short cervix have been shown to have increased risk of spontaneous preterm delivery (PTD) and newborn morbidity. Those who require an ultrasound-indicated cerclage experience the highest rates of morbidity. Inflammation has been linked to a short cervix, and it has been linked to pregnancies affected by small for gestational age (SGA) newborns. To date, there are no studies that have investigated an association between a short cervix, with or without an ultrasound-indicated cerclage, and a SGA newborn. Methods: This was a case-control study examining all pregnancies with a transvaginal cervical length <25 mm found at their second trimester anatomy scan. Cases were subdivided into those who received an ultrasound-indicated cerclage (Group 1, n ¼ 52) and those who did not (Group 2, n ¼ 139). Controls were defined as pregnancies with a transvaginal cervical length >25 mm with no cerclage (Group 3, n ¼ 186) whose due date was within 2 months of the case pregnancy. Each short cervix case was matched with a control from group 3 in a 1:1 ratio. The primary outcome was birthweight <10% (SGA). Unadjusted data was analyzed with simple odds ratios. A logistic regression was used to control for confounding variables and provide an adjusted odds ratios (aOR). Results: The incidence of SGA among cases overall (group 1 þ group 2) was 13.6% (26/191). In group 3, the SGA incidence was 4.3% (8/186). The adjusted odds ratio (aOR) for a SGA infant was significant, 2.8 (95% CI 1.2, 6.6). Subgroup analysis showed that Group 1 had an increased risk for an SGA infant [aOR 4.9 (95% CI 1.8, 13.7)], but Group 2 did not show a significant finding [aOR 2.3 (95% CI 0.9, 5.7)]. Conclusion: Pregnancies complicated by a short cervical length <25mm, with or without a cerclage, were associated with an increased risk for a SGA newborn. Most of this significance was due to the pregnancies which received an ultrasound-indicated cerclage for a mid-trimester short cervix.

INTRODUCTION: Studies comparing the Shirodkar vs McDonald technique for an ultrasound indicated cerclage are limited, but suggest improved outcomes with Shirodkar. We sought to compare our real-world experiences using either technique with reported outcomes from clinical trials. We specifically compared these 2 techniques in the context of a ultrasound indicated cerclage for short cervix. METHODS: A retrospective study at 2 hospitals was conducted. IRB approval was obtained. A query for patients with a short cervix (<25 mm) diagnosed by TVUS before 24w0d was conducted. (KUMC between 1/1/2008 - 6/1/2016, and VMC-UW Medicine between 1/2016 - 5/2018). Patients who underwent an ultrasound-indicated cerclage were then analyzed and grouped by surgical technique. Primary outcome was length of time from cerclage until delivery (days). Data was analyzed by T-tests. RESULTS: A total of 51 patients were analyzed. There were demographic and clinical differences between the groups. The Shirodkar group was white and Asian, and did not include Hispanic or African American ethnicity. The gestational age at diagnosis was later (154 vs 139 days), and the TVCL was longer (11.4 vs 7.7 mm). The Shirodkar group had better outcomes. The length of time from cerclage until delivery was longer (109 vs 90 days), the gestational age at delivery was older (263 vs 228 days), and the newborn birthweight was larger (2990 vs 2155 gm). CONCLUSION: The Shirodkar group had better outcomes, but they also appeared to be a fundamentally lower risk pregnancy. The benefit of Shirodkar technique remains unclear. Analysis by multiple regression is pending.