Category: Clinical Obstetrics
Poster Session I
This was a retrospective cohort study of patients undergoing urgent cervical cerclage from 2004-2018 at a single academic institution. Patients with singleton pregnancies undergoing urgent cervical cerclage (ultrasound or physical exam-indicated) before 24 0/7 weeks were included. Patients were categorized based on the degree of cervical dilation at the time of cervical cerclage (closed vs. 1-2.5 cm vs. 3 cm or greater). Our primary outcome was preterm delivery at less than 37 weeks gestation. Multivariable logistic regression was performed to calculate adjusted odds ratios (aOR) with 95th confidence intervals (95%CI), controlling for predefined covariates.
Results:
Of 147 patients undergoing urgent cervical cerclage, 90 (61%) had a closed cervix at the time of cerclage placement, 45 (31%) had a cervical dilation of 1cm to 2.5cm, and 12 (8%) had a cervical dilation of 3cm to 4cm at the time of placement. Patients with a cervical dilation of 1cm to 2.5cm compared to patients who had a closed cervix did not have increased odds of preterm delivery (58% vs. 42%; aOR 1.95; 95% CI 0.93-4.07). However, patients with a cervical dilation of 3cm to 4cm compared to patients who had a closed cervix had significantly increased odds of preterm delivery (75% vs. 42%; aOR 4.33; 95% CI 1.05-17.77) and preterm delivery at less than 28 weeks gestation (aOR 11.34, 95% CI 2.81-45.79).
Conclusion: Patients who had a cerclage placed with a cervical dilation of ≥ 3cm are at significantly increased odds of preterm delivery at < 37 weeks and in the extremely premature period ( < 28 weeks). However, patients with a cervical dilation of 1cm to 2.5cm at the time of cerclage placement had similar outcomes compared to those who had a closed cervix at the time of cerclage placement.
Alyssa Savelli Binsted, MD, MS (she/her/hers)
MFM Fellow
Eastern Virginia Medical School
Norfolk, Virginia, United States
Alfred Abuhamad, MD
President, Provost and Dean
Eastern Virginia Medical School
Norfolk, Virginia, United States
Tetsuya Kawakita, MD, MS, FACOG
Assistant professor
Eastern Virginia Medical School
Norfolk, Virginia, United States