Is Cerclage Height Associated with the Incidence of Preterm Birth in Women with a History-Indicated Cerclage?

Abstract

This study was performed to determine if cerclage height is associated with spontaneous preterm birth in patients with a history-indicated cerclage. We performed a retrospective cohort study of women with a history-indicated cerclage. Functional cervical length and the cerclage height (distance from cerclage to the external cervical os) were obtained. The cohort was grouped into thirds, based on cerclage height percentile. Our primary outcome was spontaneous preterm birth <35 weeks. There were 21 women in group 1 (cerclage height <10 mm), 53 in group 2 (cerclage height 10 to 19 mm), and 31 in group 3 (cerclage height ≥20 mm). The rates of spontaneous preterm birth <35 weeks were similar between each group: 24, 17, and 10%, respectively ( P = 0.38). Cerclage height is not associated with a reduction in spontaneous preterm birth for women with a history-indicated cerclage. The association between longer cerclage height and decrease in preterm birth was nonsignificant possibly due to the small sample size.

Cerclage position, cervical length and preterm delivery in women undergoing ultrasound indicated cervical cerclage: A retrospective cohort study

“…Miroshnichenko et al assessed cerclage position in 105 women undergoing cerclage secondary to poor obstetric history in the absence of cervical shortening [13]. Consistent with our findings, this study reported the incidence of spontaneous PTB reduced as the percentile height of cerclage increased.…”

Association Between Sonographic Cervical Appearance and Preterm Delivery After a History‐Indicated Cerclage

“…Women with a history‐indicated cerclage have been excluded from many of these trials, but they clearly remain a cohort at high risk for preterm birth. A prior study demonstrated an absence of an association between proximal cervical length and preterm birth in women with a history‐indicated cerclage 8 . However, whether early parturitional changes occur as distal cervical shortening or whether dilatation of the internal os (ie, funneling) is the harbinger of preterm birth in this cohort has not been previously examined.…”

“…Women in the latter groups are likely at the highest risk of both continuing cervical changes after cerclage as well as preterm delivery. Whether cervical shortening and funneling proximal to the stitch continue to pose an increased risk of preterm delivery in women with a history‐indicated cerclage has been studied by one group, who did not find a statistically significant association between proximal cervical length and preterm birth; however, the study was limited by a small sample size 8 …”

“…Whether cervical shortening and funneling proximal to the stitch continue to pose an increased risk of preterm delivery in women with a history-indicated cerclage has been studied by one group, who did not find a statistically significant association between proximal cervical length and preterm birth; however, the study was limited by a small sample size. 8 The purpose of this study was to assess the relationship between the transvaginal sonographic characteristics of the cervix in the second trimester and the risk of preterm birth before 34 weeks. Specifically, the objectives were to quantify the relationship between cervical length (total, proximal to the cerclage, and distal to the cerclage) and the risk of preterm birth and assess whether funneling is associated with preterm birth.…”

Cervical Cerclage

“…43 The stitch should be placed as high as possible. 44 Each pass should be deep enough to capture enough stroma to close the cervical canal and avoid pull through of the suture. The suture is commonly tied anteriorly after removing any slack with gentle traction on the suture and counter traction on the stroma; successive knots are tied, and the ends are left long enough (2 to 3 cm) to allow easy identification and removal.…”