(849) Does A Change In Cervical Dilation After Anesthesia Impact Latency After Cerclage Placement?

Pregnant individuals with early cervical dilation are at risk for preterm birth. The authors had cases where women are more dilated in the operating room.The primary objective was to assess if a change in cervical dilation after anesthesia administration for a cerclage was associated with a shorter latency to delivery.


Study Design:

This was a retrospective chart review of pregnancies from 1/1/11 to 12/31/21 who had a cerclage and delivered at our institution.Maternal demographics, obstetrical history, operative details, and delivery information were collected. Multi-fetal gestations, un-indicated cerclages, and abdominal cerclages were excluded.The primary outcome was the difference in cervical dilation between the office and the operating room after spinal anesthesia administration.A multivariable regression was performed.


Results:

A total of 183 pregnancies were included across the cerclage groups.The mean gestational age at cerclage placement was 18 weeks (STDEV 3.6).Twenty-nine percent (53/183) were more dilated in the operating room compared to the office with 10 cases in the physical-exam indicated group, 24 in the ultrasound indicated, and 19 in the history indicated.Differences in cervical dilation ranged from 0.5 to 2.0 centimeters.The latency between cerclage and delivery was not different if there was cervical change between these settings (p = 0.655).There was an increased risk for preterm delivery with dilation in the office (OR 1.01, CI 1.01 to 2.5), but not with dilation in the operating room (OR 1.4, CI 0.9 to 2.0).A regression analysis showed that delivery occurred 3 weeks earlier for each centimeter dilation in the office (p = 0.004, R² 13.3%) and 2.2 weeks earlier for each centimeter dilation in the operating room (p = 0.005, R² 8.2%).


Conclusion:

Cervical dilation between the office and the operating room is different.Pregnancies with more dilation delivered at earlier gestations.However, a change in dilation between the office and operating room was not associated with a shorter latency.