Cervical Cerclage vs. Pessary in Women with a Short Cervix on Ultrasound

Abstract

Purpose: In the present study we sought to compare the efficacy of cervical pessary to that of cerclage in terms of reducing preterm birth rates among women with a short (<25 mm) and ultra-short (<15 and <10 mm) cervix during the ultrasonographic second trimester assessment. Method: We retrospectively searched the hospital records for singleton pregnancies diagnosed with cervical insufficiency during the second trimester of pregnancy. The McDonald cerclage was used in all women with the use of a 5mm Mersilene tape. Arabin pessary was used uniformly. In all cases 80 mg of vaginal progesterone gel was administered daily, until 37 weeks of gestation. Results: Overall, 294 women were selected for analysis of whom 124 (42.2%) had a McDonald cerclage and 170 (57.8%) had placement of an Arabin pessary. Preterm birth rates <37 weeks were similar in both groups (C: 30/122 vs P: 35:165, p=.581) as well as PTB <34 weeks (C: 16/122 vs 15/150, p=.278). Admission to the NICU and need for CPAP were more prevalent in the cerclage group (p<.001). Analysis of cases with a cervix <15 mm and <10 mm indicated that preterm birth rates remained equal among groups whereas an increased risk of NICU admission in cases with cervical length <10 mm that were treated with cerclage. Discussion and conclusion: Cervical pessary may be an alternative to cervical cerclage for women with second trimester cervical shortening and its effect may persist even among cases with an ultra-short cervix. Future randomized trials are needed to ascertain these findings.

Early Magnetic Resonance Imaging Measurements and Prediction of Second Trimester Pregnancy Loss: a Nomogram Model Analysis

“…These studies suggested that sonographic cervical shortening is a marker for CI. 7 , 8 However, only 27% of the women with short cervix in the preterm prediction research gave birth before 37 weeks, and less than 18% of women gave birth before 35 weeks. 9 CL exhibited little predictive efficacy as a single indicator, with extremely short cervix less than 15 mm only conferring a 50% chance of delivery prior to 33 weeks.…”