Background: This study aimed to evaluate the clinical efficacy and prognostic factors associated with McDonald cervical cerclage in pregnant women with cervical incompetence. Methods: We retrospectively reviewed medical records of 100 pregnant women with cervical incompetence who underwent prophylactic or therapeutic McDonald cervical cerclage between January 2021 and December 2022. The participants were divided into two groups: good prognosis (n = 37) and poor prognosis (n = 63). Baseline characteristics and pregnancy outcomes were compared between the two groups, and multivariate logistic regression was used to identify associated prognostic factors. Results: The good prognosis group showed lower rates of miscarriage and preterm birth and higher rates of full-term birth compared to the poor prognosis group, but these differences were not statistically significant. Multivariate logistic regression identified various independent risk factors influencing clinical outcomes of McDonald cerclage, including gravidity (odds ratio [OR] = 1.75), having more than two previous births (OR = 2.44), assisted reproductive technology (OR = 1.52), history of cervical conization (OR = 1.88), complete uterine cavity curettage (OR = 1.67), prolonged second stage of labor (OR = 2.19), cesarean section (OR = 1.48), cervical laceration (OR = 1.80), polycystic ovarian syndrome (OR = 1.60), and prophylactic cerclage (OR = 0.73). These factors demonstrated good predictive performance for the prognosis of patients with cervical incompetence, with an area under the curve of 0.793 and sensitivity and specificity values of 0.750 and 0.850, respectively. Conclusions: The identified risk factors, particularly having more than two previous births, prolonged second stage of labor, and a history of cervical conization, should be considered in the clinical management of pregnant women with cervical incompetence. The protective effect of prophylactic cerclage emphasizes the importance of early detection and timely intervention to improve pregnancy outcomes.
