Abstract / Summary
Background: Cervical insufficiency is associated with second-trimester pregnancy loss and spon-taneous preterm birth. A three-step cervical cerclage technique has been im-plemented at our center for prophylactic and emergency indications. This study evalu-ated its feasibility and ma-ternal, obstetric, and neonatal outcomes in a real-world ter-tiary-care cohort.
Methods: We con-ducted a retrospective, single-center observational study including 142 pregnancies managed with a three-step cervical cerclage technique between Janu-ary 2015 and March 2026. Women were clas-sified according to cerclage indication as prophylactic (n=80) or emergency (n=62). Pregnancy-level outcomes included gesta-tional latency, gestational age at delivery, preterm birth, preterm prem-ature rupture of membranes before 34 weeks, chorioamnionitis, gestational loss, mode of delivery, and maternal complications. Neonatal outcomes were analyzed at the individual newborn level. Birth weight, Apgar scores, neonatal intensive care unit admission, neonatal sur-vival, and low and very low birth weight were evaluated using newborn-level denom-inators. Multivariable linear and logistic regression models were used to assess the in-dependent associations of gestational duration and cerclage indication with birth weight, low birth weight, neonatal intensive care unit admission, preterm delivery, and preterm premature rupture of membranes.
Results: Prophylactic cerclage was placed earlier than emergency cerclage (mean ges-tational age at placement, 15.28 \pm 2.64 vs. 20.14 \pm 3.33 weeks; p<0.001), and pre-procedure cervical length was greater in the prophylactic group (31.33 \pm 9.98 vs. 14.58 \pm 9.02 mm; p<0.001). Gestational latency was longer after prophylactic cerclage (mean, 20.48 \pm 6.30 vs. 14.34 \pm 6.39 weeks; p<0.001); however, ges-ta-tional age at delivery did not differ significantly between groups (median, 263.5 vs. 263.0 days; p=0.306). Preterm birth before 37 weeks occurred in 33.8% and 43.5% of prophylactic and emergency cases, respectively (p=0.296), whereas preterm birth be-fore 34 weeks occurred in 21.2% and 30.6% (p=0.244). Preterm premature rupture of membranes before 34 weeks occurred in 23.8% of prophylactic cases and 17.7% of emergency cases (p=0.415). Chorioamnionitis was diagnosed in 6 prophylactic cases (7.5%) and 10 emergency cases (16.1%; p=0.118). Cervical cleisis was performed more frequently in emergency cases (25.8% vs. 3.8%; p<0.001). Cesarean delivery rates were similar between groups (26.2% vs. 27.4%; p=0.873). Six pregnancies ended in gestation-al loss before 22 weeks, including three cases in each group. Among 140 newborns with available birth-weight data, mean birth weight was lower after emergency cerclage than after prophylactic cerclage (2485.8 ± 958.8 vs. 2786.1 ± 823.4 g; p=0.049). Low birth weight occurred in 45.0% and 26.3% of newborns, respec-tively (OR 2.30, 95% CI 1.13–4.69; p=0.021). However, after adjustment for gestational age at delivery, cerclage indication was not independently associated with birth weight (β = 22.67 g; p=0.825) or low birth weight (adjusted OR 1.13, 95% CI 0.40–3.16; p=0.824). Each additional gesta-tional day was associated with a 20.10-g increase in birth weight and lower odds of low birth weight. Among 135 newborns with available neonatal in-tensive care data, 20.0% required admis-sion, with no significant difference between emergency and prophylactic groups (23.3% vs. 17.3%; p=0.516). No postnatal neonatal deaths were recorded among newborns with available follow-up.