Pregnancy outcomes following history- and ultrasound-indicated cervical cerclage: a 10-year retrospective cohort study from a tertiary center.

Abstract

Introduction: Cervical cerclage is a method used to prevent preterm delivery in pregnant women diagnosed with cervical insufficiency or a short cervix. This study aimed to compare pregnancy outcomes between cervical cerclage procedures performed due to history- and ultrasound-based indications.

Material and methods: This retrospective cohort study was conducted at the Department of Obstetrics and Perinatology of the University Hospital in Cracow, Poland, a tertiary healthcare center. The study included women with singleton pregnancies who underwent cervical cerclage placement and subsequently gave birth in our department between 2013-2023.

Results: Among 136 participants, 89 (65.4%) received history-indicated cerclage, and 47 (34.6%) underwent an ultrasound-indicated procedure. No statistically significant differences were found regarding miscarriage rates (3.4% vs. 2.1%) or preterm birth rates before 32 (9.0% vs. 14.9%), 34 (11.2% vs. 14.9%), and 37 (22.5% vs. 38.3%) gestational weeks between the history- and ultrasound-indicated groups (p ≥ 0.05). The median gestational age at delivery was 38.4 weeks for history-indicated cerclage and 38.3 weeks for ultrasound-indicated cerclage (p ≥ 0.05).

Conclusions: Pregnancy outcomes following history-indicated cervical cerclage are comparable to those of ultrasound-indicated procedures. Consequently, emphasis should shift from predominantly performing prophylactic procedures to systematic cervical length screening and selective cerclage placement in cases of cervical shortening. Cervical cerclage remains an effective intervention for prolonging pregnancy in women with cervical insufficiency and a short cervix.