Advanced dilation at time of cerclage placement

Area of Science:

• Maternal-Fetal Medicine
• Obstetrics
• Perinatal Research

Background:

• Cervical insufficiency is a leading cause of preterm birth.
• Cerclage placement is a common intervention to prevent preterm delivery.
• The relationship between cervical dilation at cerclage and delivery outcomes requires further elucidation.

Purpose of the Study:

• To examine the association between cervical dilation at the time of cerclage placement and subsequent gestational age at delivery.
• To assess the impact of cervical dilation on rates of extreme prematurity and latency to delivery.

Main Methods:

• Retrospective cohort study of 290 singleton pregnancies undergoing cerclage placement (2014-2024).
• Patients stratified by cervical dilation: < 1 cm, 1-2 cm, and ≥ 3 cm.
• Logistic regression used to calculate adjusted relative risks (aRR) for delivery outcomes.

Main Results:

• Cervical dilation ≥ 3 cm was associated with the lowest median gestational age at delivery (27.3 weeks) compared to < 1 cm (37.0 weeks) and 1-2 cm (35.1 weeks) (p=0.001).
• Patients with dilation ≥ 3 cm had significantly increased odds of delivery at all gestational age cut points, particularly delivery < 28 weeks (aRR 8.0).
• Despite increased risk, 26% of patients with dilation ≥ 3 cm delivered at term.

Conclusions:

• Cervical dilation of ≥ 3 cm at cerclage placement is a significant risk factor for preterm delivery.
• These findings highlight the critical impact of cervical status on pregnancy outcomes following cerclage.