Should ultrasound-indicated cerclage be placed in low-risk pregnancies: Retrospective Cohort Study

Background Management of pregnancies with a short cervix £ 25 mm and no prior history of preterm birth remains uncertain. We compared ultrasound-indicated cerclage vs expectant management in these pregnancies. Methods This was a retrospective cohort study of patients from a single academic tertiary care center. Inclusion criteria were singleton pregnancy with transvaginal cervical length (TVCL) £ 25 mm. Exclusion criteria were prior history of preterm birth or past cerclage. In addition, cervices dilated ³ 1 cm were specifically excluded.  The primary outcome was latency. Results 227 patients (cerclage 78, no-cerclage 149) were studied. The cerclage group had characteristics that suggested increased risk: shorter cervical length, higher rate of funneling, less use of vaginal progesterone, lower incidence of multiparity. Multivariable regression showed that cerclage was not associated with any differences in clinical outcomes. Conclusion Ultrasound-indicated cerclage in low-risk women should be utilized with caution. Outcomes appear to be unchanged compared to expectant management.