Obstet Gynecol Sci.  2018 Jan;61(1):23-29. 10.5468/ogs.2018.61.1.23.

History-indicated cerclage: the association between previous preterm history and cerclage outcome

• Lee KN
• Whang EJ
• Chang KH
• Song JE
• Son GH
• Lee KY

• KMID: 2420148
• DOI: http://doi.org/10.5468/ogs.2018.61.1.23

Abstract

OBJECTIVE
Our hospital's policy is to perform history-indicated cerclage (HIC) for pregnant patients with 1 or more second-trimester pregnancy losses. Recently, the American College of Obstetricians and Gynecologists (ACOG) guideline regarding indications for HIC was changed from 3 or more previous second-trimester fetal losses to one or more. In this study, we aimed to evaluate the efficacy of the revised guideline and to investigate the association between previous preterm history and cerclage outcome.
METHODS
We conducted a retrospective observational study of cases of HIC in singleton pregnancies performed at our hospital between January 2007 and June 2016. We compared the perioperative complications and incidences of preterm delivery in patients with one previous second-trimester pregnancy loss against those in patients with ≥2 losses.
RESULTS
The incidence of preterm delivery (< 32 weeks) was significantly lower in patients with one previous second-trimester pregnancy loss than in those with ≥2 losses (15/194 [8%] vs. 28/205 [14%]). In the 1 loss and ≥2 losses groups, the rates of preterm premature rupture of membranes (PPROM) were 7% and 8%, the rates of PPROM at < 32 weeks 2.1% and 3.4%, and the ratios of neonatal intensive care unit admission 10% and 17%, respectively.
CONCLUSION
Comparison of HIC in one previous second-trimester pregnancy loss group with HIC in the 2 or more previous second-trimester pregnancy loss group found no difference in pregnancy outcome. This finding supports the amended ACOG guideline for HIC indications. Based on our results, we also propose development of a new protocol for HIC-related complications.

Keyword

Cervix incompetence; Cervical cerclage; Preterm birth

MeSH Terms

Cerclage, Cervical
Female
Humans
Incidence
Infant, Newborn
Intensive Care, Neonatal
Membranes
Observational Study
Pregnancy
Pregnancy Outcome
Premature Birth
Retrospective Studies
Rupture
Uterine Cervical Incompetence

Figure

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  Fig. 1 Patient distribution and management of history-indicated cerclage. TVCL, transvaginal sonogram of cervical length; OPD, outpatient department.

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  Fig. 2 Algorithm for history-indicated cerclage. TVCL, transvaginal sonogram of cervical length; CL, cervical length.

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