Prior ultrasound-indicated cerclage: what should the management be in next pregnancy?

Authors

Anju Suhag, MD, Thomas Jefferson University Hospital, Philadelphia, PAFollow
Jordana Reina, MD, Albert Einstein Medical Center, Philadelphia, PA
Laura Sanapo, MD, Thomas Jefferson University Hospital, Philadelphia, PAFollow
Maria Giraldo, Albert Einstein Medical Center, Philadelphia, PA
Sushma Potti, MD, Thomas Jefferson University Hospital, Philadelphia, PAFollow
Vincenzo Berghella, MD, Thomas Jefferson University Hospital, Philadelphia, PAFollow

Document Type

Poster

Publication Date

4-29-2014

Comments

Presented at: ACOG Annual Meeting, Chicago, Illinois.

Abstract

Abstract

Objective: To evaluate pregnancy outcomes of women with prior history of ultrasound-indicated cerclage (UIC) for short cervix who in subsequent pregnancy either were followed by transvaginal ultrasound cervical length(TVU CL)screening or received a history-indicated cerclage (HIC).

Materials and Methods: Retrospective cohort study was performed from 1993-2012, involving women with an index singleton pregnancy and history of UIC. Prior UIC was defined as cerclage placed for CLinstitution, women with prior history of UIC were managed in their subsequent pregnancy either by TVU CL screening or by HIC, at the physician's discretion(Figure). In the TVU CL group, if CL became24wks, an UIC was performed. In the HIC group, HIC was placed around 12-15wks. Primary outcome was spontaneous PTB (sPTB) at <35wks.

Results: 28 women met the inclusion criteria. Of these 28 women, 13 were in TVU CL group and 15 in HIC group. Demographics were similar in both the groups, except earliest GA of prior sPTB (Table). The odds of sPTB(OR 0.54, 95%CI 0.04-6.77). Secondary outcomes were also similar in two groups except birth weight (Table).

Conclusion: Women with prior UIC have similar outcomes if they are managed in the next pregnancy by either TVU CL screening and UIC placement if CL is24wks, or by HIC. Our study results are limited by small sample size. There are currently no other studies evaluating this clinical dilemma.

Recommended Citation

Suhag, MD, Anju; Reina, MD, Jordana; Sanapo, MD, Laura; Giraldo, Maria; Potti, MD, Sushma; and Berghella, MD, Vincenzo, "Prior ultrasound-indicated cerclage: what should the management be in next pregnancy?" (2014). Department of Obstetrics and Gynecology Presentations and Grand Rounds. Paper 2.
https://jdc.jefferson.edu/obgyngrandrounds/2