Mid-trimester emergent cerclage: a ten year single institution review

To evaluate clinical factors associated with both time gained in utero and gestational age at delivery in patients undergoing placement of emergent cerclages.

Retrospective chart review of 75 patients who underwent nonprophylactic cerclages from 1984 to 1994 at Thomas Jefferson University Hospital was performed. Clinical variables evaluated included gestational age at cerclage, gestational age at delivery, cervical dilation at presentation, and presence or absence of bulging membranes on admission. Presence or absence of clinical symptoms at presentation or historic risk factors for incompetent cervix were also noted. Noncontinuous data were analyzed using chi2 or Fisher's exact test; continuous data were compared with either Student's t or Mann-Whitney U tests.

The mean gestational age at time of cerclage placement was 19.1 +/- 3.8 weeks, with a median of 12 weeks gained in utero. Overall, 65% of patients delivered at > or =28 weeks, with 49% delivering at > or =34 weeks. Patients with bulging membranes were more likely to be >2 cm dilated (58% vs. 0%; p < 0.001) and to present at > or =20 weeks gestational age (69% vs. 28%; p < 0.001). They also gained less time after cerclage placement (median 6.4 vs. 17.0 weeks; p < 0.001) and were less likely to reach either 28 weeks (44% vs. 85%; p < 0.001) or 34 weeks (31% vs. 67%; p = 0.004) at delivery.

The presence of bulging membranes or advanced dilation at presentation was associated with lower cerclage-to-delivery intervals as well as a lower chance of reaching 28 weeks of gestation.