(180) Is there utility in cervical length surveillance after cerclage placement for prediction of preterm birth?

Thursday, February 9, 2023

10:30 AM – 12:00 PM

Objective: Transvaginal cervical length (TVCL) surveillance (TVCL every 2 weeks until 28 weeks) post cervical cerclage placement is not universally performed despite the risk of preterm birth (PTB) among these patients. This study’s aim was to evaluate if short TVCL post cerclage has increased odds of PTB ( < 37 weeks) after cerclage placement.

Study Design: This retrospective cohort study included patients with a singleton, non-anomalous gestation with a transvaginal cerclage who had TVCL surveillance post placement. The primary outcome was the odds of PTB among patients with TVCL < 2.5cm after cerclage placement. We additionally examined the association between PTB and differing TVCL measurements at differing times post cerclage placement. Outcomes were assessed using univariate and multivariate analysis adjusting for progesterone use, gestational age at cerclage placement, TVCL prior to cerclage placement and cerclage indication.

Results: Among the 229 patients included in the analysis, PTB rate was 48.5%. Those with PTB underwent cerclage placement at later gestational ages, had higher rates of exam-indicated cerclage, were more likely to be prescribed vaginal progesterone and less likely to be prescribed intramuscular progesterone (Table 1). Patients with a TVCL of < 2.5cm after cerclage placement did not have increased odds of PTB (OR 1.4 [0.4, 4.6] Table 2). Additionally, when a TVCL < 2cm at any gestational age post cerclage was assessed, there was no association with increased odds of PTB. Neither patients with a TVCL < 2.5cm between 20-24wks nor patients with a TVCL < 2.0cm between 20-24wks had increased odds of PTB (Table 2). Compared to patients with full-term births, patients with PTB did not have a statistically significant difference in percent change from shortest TVCL pre cerclage to shortest TVCL post cerclage (37.8% vs 30.8%, p=0.97).

Conclusion:

In patients with cervical cerclage, there does not appear to be increased odds of PTB with TVCL < 2.5cm or < 2.0cm post cerclage. Future research is needed to determine the utility of TVCL surveillance after cerclage placement.

Primary & Presenting Author(s)

Elizabeth Cochrane, MD (she/her/hers)
Mount Sinai Hospital
New York, New York, United States

Coauthor(s)

CG
Chloe Getrajdman, MD
Icahn School of Medicine at Mount Sinai
New York, New York, United States
A�
Ana Çapi, MD
Icahn School of Medicine at Mount Sinai
New York, New York, United States
TD
Tahera Doctor, BS
Icahn School of Medicine at Mount Sinai
New York, New York, United States
Manasa G. Rao, BS
Icahn School of Medicine at Mount Sinai
New York, New York, United States
Camila Cabrera, MD (she/her/hers)
MFM Fellow
Mount Sinai Hospital
New York, New York, United States
EK
Elianna Kaplowitz, MPH
Icahn School of Medicine at Mount Sinai
New York, New York, United States
GS
Guillaume Stoffels, PhD
Statistician
Icahn School of Medicine at Mount Sinai
New York, New York, United States
JP
Jessica Peterson, MD
Icahn School of Medicine at Mount Sinai
New York, New York, United States
Joanne Stone, MD,MS
professor
Mount Sinai Hospital
New York, New York, United States
Noel Strong, MD
Assistant Professor, Obstetrics, Gynecology and Reproductive Science
Icahn School of Medicine at Mount Sinai
New York, New York, United States
Chelsea A. DeBolt, MD
MFM Fellow
Icahn School of Medicine at Mount Sinai
New York, New York, United States