Factors Affecting Prophylactic Cervical Cerclage Success

Abstract

Aim: We aimed to determine the factors affecting the success of prophylactic cerclage the role of which is controversial in preventing preterm labor in singleton pregnant women. Material and Method: In this study main criterion of which for the failure of cerclage was early preterm delivery before the 32 week cases with prophylactic cerclage in one center were examined retrospectively. As an indication for prophylactic cerclage, patients with two or more late miscarriage history or in patients with story of early preterm delivery while the ultrasound scan of the cervix was shorter than 25 mm in the current pregnancy. Age, BMI, uterine intervention story, miscarriage story in second trimester, history of the conization, positive vaginal culture before cerclage, gestational week during cerclage, CRP levels one week after cerclage and changes in cervical length in ultrasonography two weeks after cerclage were tested. Descriptive statistics and binary logistic regression analyzes were performed. Results: Cervical cerclage was applied to 152 women between 2011 and 2018.54 singleton pregnancies whose clinical follow-up was regular, McDonald's prophylactic cerclage was administered and thus meet the study criteria were included in the study. The multivariate analyzes in our study showed that following factors were independent prognostic factors for the failure of cerclage; history of cerclage in previous pregnancy [OR=2.124 (1.846-4.111) p=0.016], administration of cerclage after the 20th gestational week [OR=1.126 (1.020-1.232) p=0.04] and the uterus instrumentation story [OR=1.342 (1.214, 7.873) p=0.015]. Conclusion: This study showed that past uterine interventions, presence of cerclage anamnesis and intervention after 20 weeks of gestation were independent risk factors for cerclage success. Uterine instrumentation has significant clinical consequences therefore, women who are considered for surgical curettage should be informed about potential risks and medical management or cervical ripening should be considered.