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Published on: September 12, 2025
Risk factors for failure of transvaginal cervico-isthmic cerclage: a retrospective cohort study
Maeva Renck1, Célia Maheut2, Nora Brouard Daudignon1
1AP-HP, GHU-Sud, Hospital Bicêtre, Department of Gynecology and Obstetrics, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France.
Introduction:
Cervical incompetence is a major cause of preterm birth. The primary treatment is cerclage (McDonald, Shirodkar or cervico-isthmic one). First recommended cerclage is the McDonald one. In case of an unsuccessful Mc Donald cerclage, a cervico-isthmic cerclage is recommended, which can be performed through different approaches. This study specifically focuses on transvaginal cervico-isthmic cerclage.
Objective:
To identify risk factors associated with failure of transvaginal cervico-isthmic cerclage (defined as a birth before 30 weeks of gestation), in a population of women at high risk of preterm birth or late miscarriage. Outcomes such as success rate, occurrence of complications and outcome of pregnancies of this historical cohort are also reported.
Materials And Methods:
This retrospective study was conducted between 2009 and 2023, including 251 women who underwent transvaginal cervico-isthmic cerclage for failure of previous McDonald cerclage. Statistical analyses, including univariate and multivariate analysis, were performed to identify factors associated with cerclage failure, defined as birth before 30 weeks of gestation.
Results:
After exclusion of 41 women lost to follow-up (16.3 %), we included 210 women. Failure rate of the cerclage was 10.7 %, with rare intraoperative complications (2.5 %). Multivariate analysis revealed that gestational age at cerclage (OR = 0.49 [0.29-0.82]; p < 0.01) and having 4 or more previous fetal loss (OR = 9.54 [1.01-90.09]; p = 0.05) were significantly associated with failure of transvaginal cervico-isthmic cerclage.
Conclusion:
Transvaginal cervico-isthmic cerclage is an effective technique for preventing preterm birth and late miscarriage, with a low complication rate in women with previous unfavorable obstetrical issues.
