Is There Utility in Transvaginal Cervical Length Surveillance After Cerclage Placement for the Prediction of Spontaneous Preterm Birth?

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2024 Jul 19

PMID 39026572

Authors

Elizabeth Cochrane

Chloe Getrajdman

Nicola F Tavella

Ana Capi

Tahera Doctor

Manasa G Rao

Elianna Kaplowitz

Guillaume Stoffels

Joanne Stone

Noel Strong

Chelsea DeBolt

Affiliations

Soon will be listed here.

Abstract

Introduction: Transvaginal cervical length (TVCL) surveillance post-transvaginal cerclage placement is not universally performed, despite the correlated risk of short TVCL with spontaneous preterm birth (sPTB). This study evaluated if patients with a TVCL <2.5 cm after cerclage placement had higher odds of sPTB than those with a TVCL ≥2.5 cm after cerclage placement.

Methods: This retrospective cohort study included patients with a singleton, non-anomalous gestation with a transvaginal cerclage who had TVCL surveillance post-cerclage placement. The primary outcome was the odds of sPTB among patients with TVCL <2.5 cm vs TVCL ≥2.5 cm after cerclage placement. Transvaginal cerclage placement indications included history indicated, physical exam indicated, and ultrasound indicated. Outcomes were assessed using univariate and multivariate analysis while adjusting for progesterone use, TVCL before cerclage placement, and cerclage indication.

Results: The analysis included 210 patients, and the sPTB rate was 46.7%. Those with sPTB underwent cerclage placement at later gestational ages, had higher rates of exam-indicated cerclage, and were more likely to be prescribed vaginal progesterone. Patients with a TVCL of <2.5 cm after cerclage placement did not have significantly increased odds of sPTB (OR: 2.8, 95% CI: 0.9-8.7, p=0.07); however, patients with a TVCL <2.0 cm had significantly increased odds of sPTB (OR: 6.3, 95% CI: 2.2-18.8, p<0.001).

Conclusion: In patients with transvaginal cerclage, there does not appear to be increased odds of sPTB with TVCL <2.5 cm after cerclage placement; however, there does appear to be an increased odds of sPTB in patients with a TVCL of <2.0 cm after cerclage placement.

References

Hoffman M . Prediction and Prevention of Spontaneous Preterm Birth: ACOG Practice Bulletin, Number 234. Obstet Gynecol. 2021; 138(6):945-946. PMC: 8607754. DOI: 10.1097/AOG.0000000000004612. View

Funai E, Paidas M, Rebarber A, ONeill L, Rosen T, Young B . Change in cervical length after prophylactic cerclage. Obstet Gynecol. 1999; 94(1):117-9. DOI: 10.1016/s0029-7844(98)00568-7. View

Osterman M, Hamilton B, Martin J, Driscoll A, Valenzuela C . Births: Final Data for 2021. Natl Vital Stat Rep. 2023; 72(1):1-53. View

Harris P, Taylor R, Minor B, Elliott V, Fernandez M, ONeal L . The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019; 95:103208. PMC: 7254481. DOI: 10.1016/j.jbi.2019.103208. View

Ridout A, Carter J, Seed P, Chandiramani M, David A, Tribe R . Longitudinal change in cervical length following vaginal or abdominal cervical cerclage: a randomized comparison. Am J Obstet Gynecol MFM. 2023; 5(7):100987. DOI: 10.1016/j.ajogmf.2023.100987. View

. AIUM Practice Parameter for the Performance of Limited Obstetric Ultrasound Examinations by Advanced Clinical Providers. J Ultrasound Med. 2018; 37(7):1587-1596. DOI: 10.1002/jum.14677. View

Baxter J, Airoldi J, Berghella V . Short cervical length after history-indicated cerclage: is a reinforcing cerclage beneficial?. Am J Obstet Gynecol. 2005; 193(3 Pt 2):1204-7. DOI: 10.1016/j.ajog.2005.06.076. View

Battarbee A, Ellis J, Manuck T . Beyond Cervical Length: Association between Postcerclage Transvaginal Ultrasound Parameters and Preterm Birth. Am J Perinatol. 2019; 36(13):1317-1324. PMC: 7008975. DOI: 10.1055/s-0039-1688480. View

Harris P, Taylor R, Thielke R, Payne J, Gonzalez N, Conde J . Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2008; 42(2):377-81. PMC: 2700030. DOI: 10.1016/j.jbi.2008.08.010. View

10.

Dijkstra K, Funai E, ONeill L, Rebarber A, Paidas M, Young B . Change in cervical length after cerclage as a predictor of preterm delivery. Obstet Gynecol. 2000; 96(3):346-50. DOI: 10.1016/s0029-7844(00)00924-8. View

11.

. ACOG Practice Bulletin No.142: Cerclage for the management of cervical insufficiency. Obstet Gynecol. 2014; 123(2 Pt 1):372-379. DOI: 10.1097/01.AOG.0000443276.68274.cc. View