Residency Experience With Physical Examination- and Ultrasound-Indicated Cerclage: A Single Center Retrospective...

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Surgical Procedures

Background:

• Cervical insufficiency, characterized by cervix dilation without contractions, can lead to second-trimester pregnancy loss or preterm birth.
• Cervical cerclage is a standard treatment for cervical insufficiency, with indications including patient history, physical examination findings, and ultrasound measurements.
• Comparing outcomes based on the indication for cerclage placement is crucial for optimizing patient care.

Purpose of the Study:

• To compare pregnancy and birth outcomes between cervical cerclage indicated by physical examination versus ultrasound.
• To evaluate the effectiveness of resident-performed transcervical cerclage in a tertiary care setting.

Main Methods:

• Retrospective observational descriptive review of second-trimester obstetric patients who underwent transcervical cerclage.
• Data collected from January 1, 2006, to January 1, 2020, at a single tertiary care medical center.
• Comparison of outcomes between patients receiving physical examination-indicated cerclage and those receiving ultrasound-indicated cerclage.

Main Results:

• A total of 43 patients received cervical cerclage at a mean gestational age of 20.4 weeks.
• Fetal/neonatal survival rates were comparable (80% for physical exam group vs. 82.6% for ultrasound group).
• No significant differences were observed in gestational age at delivery or preterm birth rates (<37 weeks) between the two groups. Maternal and neonatal morbidity rates were also similar.

Conclusions:

• Pregnancy outcomes following physical examination- and ultrasound-indicated cerclage are similar when performed by residents.
• Both indications demonstrated favorable fetal/neonatal survival and preterm birth rates.
• The findings suggest that both methods are effective in managing cervical insufficiency, with comparable results in this tertiary academic medical center setting.