Category: Prematurity
Poster Session II
Retrospective cohort study in women who had cerclage (McDonald technique) due to cervical incompetence between 2014 and 2021. UiC was indicated at periviability in women with history of pregnancy loss in second trimester or cervical injury, and cervical shortening despite vaginal progesterone. Cervical length was measured fortnightly and cervical cultures were collected monthly. Cerclage was removed at 37 weeks or before in case of spontaneous labor or preterm premature rupture of membranes. The primary outcome was gestational age (GA) at birth. Secondary outcomes included intraoperative complications, maternal morbidity, perinatal outcomes and latency to removal.
Results:
86 women were included, 37 had UiC, 24 HiC and 25 PhiC. Cervical length at placement was 8.5mm (4–11) versus 28mm in HiC and 4mm in PhiC. Gestational age at placement was longer than in other indications (23+0w (21+5–25) versus 14+6 (13+5–16+0) and 22+1 (19+3–24+2), p=0.000). No significant differences in maternal morbidity were observed (Table 1). Mean GA at removal was 36+5 (34+5–37+1) with a cerclage duration of 86 days, longer than PhiC but shorter than HiC (p=0.000). GA at delivery was 38+6 (36+0–40+4), similar to HiC and longer than PhiC (38+3 (37+1–40+1) vs 30+1 (26+3–37.2), p=0.000) with 70.3% of term deliveries. Latency between cerclage removal and delivery was longer than in other indications (15.5 days (1–26.5) vs 6.5 (1.5–22.2) and 1 (0–11), p=0.022). Neonatal morbidity was statistically higher in UiC than HiC, but lower than PhiC (Table 2).
Conclusion: Pregnant women with UiC achieved full-term delivery in 70% of cases, with a longer gestational age at delivery than in the other types of cerclage, without increasing maternal complications. Neonatal outcomes were similar to those with HiC and better than PhC).
Ana Lucia Contreras Vergara, MD (she/her/hers)
3rd year resident
Hospital Sant Joan de Deu - BCNatal
Barcelona, Catalonia, Spain, Spain
Aida Diaz Lozano, MD
Hospital Sant Joan de Deu - BCNatal
Barcelona, Catalonia, Spain, Spain
Maria Pastor Lorca, MD
Hospital Sant Joan de Deu - BCNatal
Barcelona, Catalonia, Spain, Spain
Montserrat Izquierdo, MD, PhD
Hospital Sant Joan de Deu - BCNatal
Barcelona, Catalonia, Spain, Spain
Maria Dolores Gomez-Roig, MD, PhD
Hospital Sant Joan de Deu - BCNatal
Barcelona, Catalonia, Spain, Spain
Montse Palacio, MD, PhD
Hospital Clinic Barcelona-BCNatal
Barcelona, Spain, Spain
Teresa Cobo, MD, PhD
Hospital Clinic Barcelona-BCNatal
Barcelona, Spain, Spain
Silvia Ferrero, MD, PhD
Hospital Sant Joan de Deu - BCNatal
Barcelona, Catalonia, Spain, Spain