The Impact of Cervical Cerclage on Live Birth Outcomes in Cervical Incompetence: A Real-World Study

Objective To investigate the effect of cervical cerclage on pregnancy outcomes in cervical incompetence using stabilized inverse probability of treatment weighting and multivariable logistic regression. Method A retrospective analysis was conducted of 756 patients with cervical incompetence who attended our Department of Obstetrics and Gynecology between January 2013 and December 2023. Among these, 243 patients underwent expectant management, while 513 underwent cervical cerclage surgery. Stabilized inverse probability of treatment weighting(sIPTW) was employed to balance multiple confounding variables, including parity, number of previous births, number of late miscarriages, prior history of cerclage, and cervical length. Differences in pregnancy outcomes between the two groups were compared before and after weighting, including miscarriage, preterm birth, live birth. The impact of cervical cerclage on live birth outcomes was explored using multivariate logistic regression. Results Prior to sIPTW, significant differences existed between the cervical cerclage group and the expectant management group in terms of gestational age, parity, number of late miscarriages, cervical length, and BMI ( P  < 0.05). After sIPTW, no statistically significant differences were observed between the two groups in clinical data. Both before and after sIPTW, the cervical cerclage group had higher rates of term delivery and preterm delivery than the expectant group, while the miscarriage rate was lower. The live birth rate in the cerclage group was significantly higher than that in the expectant group ( P  < 0.05). Multivariate logistic regression analysis demonstrated that cervical cerclage showed a positive correlation with live birth outcomes both before and after sIPTW. Subgroup analysis revealed that the efficacy of cervical cerclage varied among different examination groups (interaction term P  < 0.05). Conclusion Cervical cerclage significantly improves the rates of full-term delivery and live birth among patients with cervical incompetence while reducing the miscarriage rate, particularly in those with abnormal cervical examination.