(724) Preterm delivery rate and latency period in asymptomatic patients undergoing cerclage for very short cervix

Friday, February 10, 2023

10:30 AM – 12:00 PM

Objective: There is a paucity of data on delivery outcomes in asymptomatic patients with very short cervices not on vaginal progesterone therapy. This study aims to estimate the rate of preterm delivery < 37 weeks and mean latency period in women undergoing a cerclage versus expectant management for a cervical length <10mm.

Study Design: In this retrospective review 78 patients over a 12-year period were identified with an incidental cervical length of <10mm on screening transvaginal ultrasound during the mid trimester exam (17w5d-23w6); 48 underwent cerclage placement and 30 were expectantly managed. Differences in prevalence of preterm birth, mean gestational age at delivery, and mean latency from cervical length measurement to delivery between the two groups were estimated using Fisher’s exact test and two tailed unpaired t test.

Results: The median (range) gestational age at time of cervical length in the cerclage group was 20.8 weeks (17.7 – 23.4) compared to 22.2 (17.9 – 23.9) weeks the expectant management group (p = 0.01). Of those who had a cerclage placed, 43.8 % (n=21) delivered at term versus 20.0 % (n=6) in the expectant management group (p = 0.0495, OR 3.1, 95% CI 1.10 – 9.17). The median (range) latency period from time of cervical length measurement in the cerclage group was 99.5 (8-144) days versus 50 (1-146) days in the expectant management group (p = 0.005). The median (range) gestational age at delivery was 35.4 (21.3 – 40.1) weeks for the cerclage group and 28.1 (19.4 – 40.7) weeks for the expectant management group (p = 0.07).

Conclusion: Cerclage in asymptomatic women with a very short cervix (≤10 mm) not treated with vaginal progesterone did lengthen the latency period and did decrease the rate of preterm birth less than 37 weeks. No differences were seen between groups for delivery < 34 or < 28 weeks; most probably due to the reduced number of cases delivered at these gestational ages. Further prospective studies with a larger number of participants are needed for continued appraisal of cerclage impact on very short cervices.

Primary & Presenting Author(s)

Erin S. Huntley, DO (she/her/hers)
MFM Fellow
University of Texas Houston / MCGovern Medical School Department of Obstetrics, Gynecology and Reproductive Sciences McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States

Coauthor(s)

ES
Eleazar E. Soto Torres, MD
Department of Obstetrics, Gynecology and Reproductive Sciences McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Baha M. Sibai, MD
Professor
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
EH
Edgar Hernandez Andrade, MD
Department of Obstetrics, Gynecology and Reproductive Sciences McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States