A retrospective study analyzing indications and outcomes of mid-trimester emergency cervical cerclage in a tertiary care perinatal centre over half a decade

Abstract

We studied the indications, success rate, perinatal outcomes and maternal complications following mid-trimester emergency cervical cerclage. All women undergoing mid-trimester emergency cerclage at our centre during 2014–2019 were included in this retrospective study. There were 46 women in our cohort. Mean cervical length was 1.5 cm (SD ± 0.7), and 52.1% of them had bulging membranes. The mean gestational age at cerclage was 23.35 weeks (SD ± 3.341). Three were loss to follow up. Out of 43 pregnancies (23 singletons and 20 twins) analyzed, 37/43, 86.4% had livebirths. Success rate in the singletons and twins were 91.3% and 80% respectively. Maternal complications were seen in 56.5% of patients. Composite neonatal morbidity was significantly more in the twin group (p-value 0.04). Overall live birth rate was 86.4% with similar success rates in singleton and multiple pregnancies. Although, evidence for beneficial effect of prophylactic cerclage in multiple gestation is lacking, emergency cerclage may have a role in twin gestation.

Role of cerclage in twin and singleton pregnancy: evidence from systematic review and meta‐analysis

“…Thirteen studies [7][8][9][10][11][12][13][14][15][16][17][18][19] comparing 312 twin and 1045 singleton pregnancies undergoing cervical cerclage for short CL or cervical dilatation were included in the systematic review (Tables 1, S1 and S2, Figure S1). There was no significant difference in the gestational age at cerclage placement (pooled MD, −0.19 (95% CI, −0.57 to 0.19) weeks; P = 0.337) or mean cervical dilatation (pooled MD, 0.02 (95% CI, −0.32 to 0.36) cm; P = 0.911).…”