Pregnancy outcomes and prognostic factors after history- and ultrasound-indicated cerclage in women with cervical insufficiency and/or short cervix: A retrospective cohort study

Objective This study evaluated pregnancy outcomes after history- and ultrasound-indicated cerclage and predictors of gestational age at delivery and pregnancy prolongation. Method 11-year retrospective cohort study in a tertiary center in the Netherlands. Women were included with singleton pregnancies receiving history- or ultrasound-indicated cerclage for suspected cervical insufficiency and/or short cervix <24+0 weeks. Analyses were stratified by cerclage indication. Ultrasound-indicated group was subdivided by obstetric history (with suspected prior cervical insufficiency [UIC-A] or without [UIC-B]). Kaplan–Meier analysis and univariable linear regression were used to assess associations between pre-/post-cerclage factors and gestational outcomes. Results A total of 272 women received history-indicated and 79 ultrasound-indicated cerclage (UIC-A: 36, UIC-B: 43). Median gestational age at delivery was comparable (37.9-38.4 weeks). Among women with suspected prior cervical insufficiency, spontaneous preterm birth <34 weeks was significantly less frequent after history-indicated than ultrasound-indicated cerclage (12% vs 25%), with comparable perinatal survival. Among ultrasound-indicated cases, UIC-A showed higher rates of spontaneous preterm birth <34 weeks (25% vs 7%) and preterm premature rupture of membranes (31% vs 9%). Greater post-cerclage distance between external os and cerclage was associated with higher gestational age at delivery and pregnancy prolongation, whereas pre-cerclage measures showed little association. Conclusions Pregnancy outcomes after cerclage differ according to clinical context and cerclage indication. In women with suspected prior cervical insufficiency, ultrasound-indicated cerclage after cervical shortening identified a subgroup at higher risk of spontaneous preterm birth and pregnancy complications. Post-cerclage cervical parameters were the strongest predictors. Optimizing cerclage placement height may be associated with improved outcomes.