Implementation of a Three-Step Cervical Cerclage…

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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.

Implementation of a Three-Step Cervical Cerclage Technique in Prophylactic and Emergency Settings: Maternal and Perinatal Outcomes in Clinical Practice

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Background

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