Predictors of cerclage failure in singleton pregnancies with a history of preterm birth and a sonographic short cervix

Perinatal outcomes in patients undergoing repeat cerclage: A retrospective case series study

OBJECTIVE

This study aimed to describe the pregnancy outcomes of a case series of patients with probable cerclage failure who received repeat cerclage (RC) with potential indications.

METHODS

We retrospectively collected a case series of 55 singleton pregnancies with RC from 2019 to 2022 in Shanghai, China. All included women provided written informed consent, and the study was approved by the ethics committees of the two hospitals. We compared pregnancy outcomes between pregnancies with RC for different indications.

RESULTS

Among the case series, nine patients underwent RC for the indication of protruding membranes below the previous suture loop (group A), and the other 46 patients for painless cervix dilation (group B). Gestational age at delivery was shorter in group B than in group A (30.7 vs 37.6 weeks, P = 0.009). Rates of preterm birth <32 weeks (63.0% vs 22.2%, P = 0.033) and < 37 weeks (76.1% vs 33.3%, P = 0.002) were significantly higher in group B than in group A. Of the 46 patients who underwent RC for painless cervical dilation, 28 had cervical dilation of 1 to 2 cm (group C) and the other 18 had cervical dilation of 3 to 6 cm (group D). The gestational age at delivery was shorter in group D than in group C (27.4 vs 31.5 weeks, P = 0.037). However, rates of preterm birth <32 or <37 weeks were similar between the groups.

CONCLUSION

RC may constitute a rescue strategy for patients with probable cerclage failure. Protrusion of membranes below the cerclage loop or cervical dilation <3 cm may be an indicator of better pregnancy outcome.

Efficacy of emergency cervical cerclage in twin pregnancies and factors affecting the clinical effects of emergency cerclage

OBJECTIVES

To estimate clinical effects of emergency cervical cerclage in twin pregnancies with cervical dilation ≥1.0 cm in mid-trimester of gestation and to identify risk factors after cerclage.

METHODS

This retrospective cohort study included 99 twin pregnancies with cervical dilation ≥1cm in the mid-trimester of gestation at three institutions, from December 2015 through December 2021. The cases were treated with emergency cervical cerclage (52 cases) or expectant management (47 cases). Compare the pregnancy and neonatal outcomes of the two groups. Multiple logistic regression analysis was used to determine the independent risk factors associated with cerclage.

RESULTS

Cerclage placement was associated with significantly longer gestation age and prolongation of the gestational latency (p < .05). In the cases, compared to expectant treatments, spontaneous preterm birth (sPTB) at <26, <28, <30, <32 weeks was significantly less frequent (p < .05). Pre-operation WBC > 11.55 × 10⁹/L, CRP > 10.1 and cervical dilation >3.5 cm were found to be independent risk factors for delivery 28 weeks after cerclage.

CONCLUSIONS

Cervical cerclage in twin pregnancies with cervical dilation ≥1.0 cm in mid-trimester of gestation may prolong pregnancy and gestation age, and improve pregnancy and neonatal outcomes compared with expectant management. The strongest predictor of sPTB before 28 weeks after ECC were pre-operation WBC >11.55 × 10^9/L, CRP > 10.1 and cervical dilation >3.5 cm.

Factors Associated with Spontaneous Preterm Birth after Ultrasound-Indicated Cerclage

Ultrasound-indicated cerclage (UIC) is recommended to prevent spontaneous preterm birth (sPTB) in women with a short cervix at mid-trimester and a history of PTB. We assessed the factors related to sPTB after UIC and determined the corresponding risks. This retrospective cohort study was conducted at a university hospital. UIC was performed between 15 and 26 weeks of gestation in women with a cervical length of <2.5 cm. Univariate and multivariate analyses were used to examine factors associated with sPTB after UIC. An earlier gestational age and shorter cervical length at UIC were associated with sPTB after UIC. While PTB history was not associated with an increased risk of sPTB, it did increase the risk of repeat cerclage after UIC. Higher levels of preoperative serum inflammatory markers and obesity significantly increased the risk of sPTB after UIC. These findings provide helpful guidance for patient counseling and management in predicting the delivery timing after UIC in women with a short cervix in the mid-trimester.

The Association of Inflammatory Markers with Maternal-Neonatal Outcome After Cervical Cerclage

Objective

Cervical cerclage is effective in prolonging the number of weeks gestation in patients with cervical insufficiency(CI). However, valuable predictors with successful cervical cerclage remain limited. It aimed to evaluate the value of the systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) to predict the outcomes of cervical cerclage.

Methods

This study analyzed 374 participants. Inflammatory markers were calculated using maternal peripheral blood. The association of inflammatory markers and the outcome of cervical cerclage were analyzed. And the optimal cut-off values of inflammatory markers were calculated. Also, the Chi-square test and logistic and linear regression analyses were performed to evaluate inflammatory markers with the maternal outcome and neonatal outcomes.

Results

374 pregnancies were included in this study. Finally, 268 (71.7%) participants suffered successful cervical cerclage. This study demonstrated that the baseline BMI (cm²/kg), the bulging membrane, cervical dilation (≥2cm), the amniotic sac herniation, the neutrophils counts, the systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) were significant difference between the successful and unsuccessful groups (all P<0.05). Additionally, maternal blood inflammatory markers, such as WBC, lymphocyte, neutrophils, monocyte, platelet counts, SII, and SIRI, were significantly associated with maternal-neonatal outcomes. Furthermore, the results demonstrated that the SII level had the highest OR (OR=4.626; 95% CI (2.500-8.560)), as well as the following: SIRI level (OR = 3.795; 95% CI (1.989-7.242)), cervical dilation (≥2cm) (OR =3.477; 95% CI (1.458-10.844)), and amniotic sac herniation (OR = 1.796; 95% (0.473-4.975)).

Conclusion

This study demonstrated that the baseline SII level and SIRI level are important biochemical markers for predicting the outcome of cervical cerclage and maternal-neonatal outcomes with non-invasive procedures. They can help to provide personalized treatment before surgery and enhance postoperative surveillance.