Title: Maternal factors associated with cerclage failure
Abstract: ObjectiveTo determine maternal factors associated with failure of cerclage in singleton gestations.Study designWe reviewed charts of all patients from 2000 through 2005 who underwent cerclage placement at our institution. Only the first pregnancy with a cerclage during the study period was included in the analysis. Cerclage failure was defined as delivery prior to 26 weeks. Maternal characteristics were tested for association with cerclage failure.ResultsOf 193 cases, after exclusions, 150 patients were available for this analysis. No difference was observed between the groups with successful or failed cerclage for any of the demographic variables or the mean gestational age at the time of placement. Indications for cerclage were similar. Overall, 5 (3%) were placed for gynecologic risk factors, 104 (69%) for poor obstetric history, 18 (12%) for ultrasound findings, 18 (12%) for combination of poor obstetric history and ultrasound findings and 5 (3%) for other indications. 49 (33%) delivered prior to 33 weeks, 25 (17%) delivered prior to 26 weeks and 43 of 137 (31%) pregnancies resulting in a live birth were <2500g. The mean gestational age at cerclage placement was significantly earlier for infants with birthweights >2500 g. (15.2±3.2 v. 17.1±4.4 weeks, respectively, p<0.0064), A prior full term delivery without a cerclage was associated with failed cerclage in the current pregnancy (OR=3.2, 95% CI 1.2, 8.5) despite similar indications for cerclage in the current pregnancy. Of the 43 women with a cerclage placed in a prior pregnancy, failure of that prior cerclage was associated with delivery before 26 weeks of gestation in the current pregnancy (33% v. 6%, p<0.04).ConclusionThe observation that a prior full term delivery without a cerlcage is associated with a greater risk of cerclage failure suggest that etiology of pregnancy loss in this group may be other than cervical incompetence. ObjectiveTo determine maternal factors associated with failure of cerclage in singleton gestations. To determine maternal factors associated with failure of cerclage in singleton gestations. Study designWe reviewed charts of all patients from 2000 through 2005 who underwent cerclage placement at our institution. Only the first pregnancy with a cerclage during the study period was included in the analysis. Cerclage failure was defined as delivery prior to 26 weeks. Maternal characteristics were tested for association with cerclage failure. We reviewed charts of all patients from 2000 through 2005 who underwent cerclage placement at our institution. Only the first pregnancy with a cerclage during the study period was included in the analysis. Cerclage failure was defined as delivery prior to 26 weeks. Maternal characteristics were tested for association with cerclage failure. ResultsOf 193 cases, after exclusions, 150 patients were available for this analysis. No difference was observed between the groups with successful or failed cerclage for any of the demographic variables or the mean gestational age at the time of placement. Indications for cerclage were similar. Overall, 5 (3%) were placed for gynecologic risk factors, 104 (69%) for poor obstetric history, 18 (12%) for ultrasound findings, 18 (12%) for combination of poor obstetric history and ultrasound findings and 5 (3%) for other indications. 49 (33%) delivered prior to 33 weeks, 25 (17%) delivered prior to 26 weeks and 43 of 137 (31%) pregnancies resulting in a live birth were <2500g. The mean gestational age at cerclage placement was significantly earlier for infants with birthweights >2500 g. (15.2±3.2 v. 17.1±4.4 weeks, respectively, p<0.0064), A prior full term delivery without a cerclage was associated with failed cerclage in the current pregnancy (OR=3.2, 95% CI 1.2, 8.5) despite similar indications for cerclage in the current pregnancy. Of the 43 women with a cerclage placed in a prior pregnancy, failure of that prior cerclage was associated with delivery before 26 weeks of gestation in the current pregnancy (33% v. 6%, p<0.04). Of 193 cases, after exclusions, 150 patients were available for this analysis. No difference was observed between the groups with successful or failed cerclage for any of the demographic variables or the mean gestational age at the time of placement. Indications for cerclage were similar. Overall, 5 (3%) were placed for gynecologic risk factors, 104 (69%) for poor obstetric history, 18 (12%) for ultrasound findings, 18 (12%) for combination of poor obstetric history and ultrasound findings and 5 (3%) for other indications. 49 (33%) delivered prior to 33 weeks, 25 (17%) delivered prior to 26 weeks and 43 of 137 (31%) pregnancies resulting in a live birth were <2500g. The mean gestational age at cerclage placement was significantly earlier for infants with birthweights >2500 g. (15.2±3.2 v. 17.1±4.4 weeks, respectively, p<0.0064), A prior full term delivery without a cerclage was associated with failed cerclage in the current pregnancy (OR=3.2, 95% CI 1.2, 8.5) despite similar indications for cerclage in the current pregnancy. Of the 43 women with a cerclage placed in a prior pregnancy, failure of that prior cerclage was associated with delivery before 26 weeks of gestation in the current pregnancy (33% v. 6%, p<0.04). ConclusionThe observation that a prior full term delivery without a cerlcage is associated with a greater risk of cerclage failure suggest that etiology of pregnancy loss in this group may be other than cervical incompetence. The observation that a prior full term delivery without a cerlcage is associated with a greater risk of cerclage failure suggest that etiology of pregnancy loss in this group may be other than cervical incompetence.