Category: Prematurity
Poster Session III
Of 542 cases performed in our study timeframe, 137 met criteria and were analyzed: 120 (88%) vaginal and 17 (12%) abdominal. Of the 137 who had a prior PTB < 37 wks despite cerclage, 114 had PTB < 34 wks and 84 a PTB < 28 wks. The abdominal cerclage group had more prior midtrimester losses (1 [IQR 0-1] vs 2 [IQR 0-2], p=0.003) and LEEPs (Table 1). Birth GA in the vaginal and abdominal cerclage groups was similar (32.5 ± 6.8 vs 31.4 ± 8.3 wks, p=0.58, Table 2). Abdominal cerclages had higher rates of intraoperative composite morbidity (1.7 vs 35%, p< 0.01), longer operative times (26 vs 91 min, p< 0.01), and longer postoperative stays (5.5 vs 49 hrs, p< 0.01). Rates of PTB, at all GA ranges, or GA at membrane rupture were similar. Cesarean was higher in the abdominal cohort, but there were no differences in delivery indications, fetal outcomes, and neonatal composite morbidity (Table 2).
Conclusion: Patients undergoing abdominal cerclage given a history of prior failed vaginal cerclage had higher operative morbidity and longer length of stay compared to those with repeat vaginal cerclage, with no difference in birth GA, PTB, or selected neonatal outcomes. Differences in baseline characteristics, patient selection, and power considerations might explain our findings. Larger future studies are warranted.
Gabriella D. Cozzi, MD (she/her/hers)
Fellow/Instructor
Center for Women's Reproductive Health, University of Alabama at Birmingham
Birmingham, Alabama, United States
John Owen, MD,MSPH
Professor
Center for Women's Reproductive Health, University of Alabama at Birmingham
Birmingham, Alabama, United States
Claire A. McIlwraith, MD
Resident
Center for Women's Reproductive Health, University of Alabama at Birmingham
Birmingham, Alabama, United States
Rebecca Fleenor, MD
Resident Physician
University of Alabama at Birmingham
Birmingham, Alabama, United States
Joseph T. Edwards, Jr., MD (he/him/his)
Resident Physician
Center for Women’s Reproductive Health, University of Alabama at Birmingham
Birmingham, Alabama, United States
Dhong-Jin Kim, BS
Center for Women's Reproductive Health, University of Alabama at Birmingham
Birmingham, Alabama, United States
Victoria C. Jauk, RN
Statistician
Center for Women’s Reproductive Health, University of Alabama at Birmingham
Birmingham, Alabama, United States
Alan T. Tita, MD, PhD
Professor
University of Alabama at Birmingham
Birmingham, Alabama, United States
Akila Subramaniam, MD,MPH
Associate Professor
Center for Women’s Reproductive Health, University of Alabama at Birmingham
Birmingham, Alabama, United States