Emergent cervical cerclage: experience from a tertiary center

Cervical insufficiency (CI) is a significant cause of late miscarriage and preterm birth (PTB) before 27 weeks. In the presence of cervical dilation without associated symptoms, between 14 and 24 weeks, performing an emergent cerclage has shown effectiveness in prolonging pregnancy and improving neonatal outcomes. The aim of this study was to evaluate the obstetric and neonatal outcomes of pregnancies complicated by cervical insufficiency requiring emergent cerclage placement.

This was a retrospective cohort study conducted at a European tertiary care university hospital, which included women with singleton pregnancies who underwent emergent cerclage. Inclusion criteria were painless midtrimester cervical dilation > 1 cm with visible membranes, gestational age between 14 + 0 and 24 + 6 weeks, and absence of clinical or laboratory signs of chorioamnionitis at time of presentation. In cases of membrane exposure or sludge on ultrasound, amniocentesis was performed to assess for subclinical infection using lactate dehydrogenase (LDH) and glucose levels in the amniotic fluid. The primary outcome was delivery after 28 weeks. Secondary outcomes included pregnancy prolongation, overall survival rate, neonatal survival rate, fetal survival rate, neonatal intensive care unit (NICU) admission, preterm chorioamnionitis, and preterm prelabour rupture of membranes (PPROM).

During the study period, 18 women were included in the analysis, of whom 8 (44 %) delivered after 28 weeks of gestation. Median pregnancy prolongation following cerclage placement was 49.3 days. The overall survival rate was 66.7 %, while the viable fetal survival rate was 72.2 %, and the neonatal survival rate was 92.3 %. Women who delivered before 28 weeks of gestation were diagnosed with cervical insufficiency at an earlier gestational age (20 vs. 22.3 weeks, p = 0.023), had a shorter latency period (13 vs. 87 days, p < 0.001), and a higher rate of preterm chorioamnionitis (50 % vs. 0 %, p = 0.036).

Women diagnosed at an earlier gestational age seem to exhibit a significantly shorter latency period and higher rates of preterm chorioamnionitis, emphasizing the importance of infection screening and individualized management strategies. Future studies should focus on optimizing patient selection criteria and adjunctive therapies to improve pregnancy outcomes in this high-risk population.