Recommended Citation
Esterquest D, Holmgren C, Harrison R. Factors Contributing to Delivery Less Than 32 Weeks in Patients With a History-Indicated Cerclage. Presented at Scientific Day; May 21, 2025; Park Ridge, IL.
Abstract
Background/Significance:
History-indicated cerclages are typically placed between 13-14 weeks gestational age with the intention of prolonging pregnancy; however, variations in timing of placement and operative practices may impact fetal and maternal outcomes, requiring further evaluation.
Purpose:
Evaluation of factors contributing to delivery at less than 32 weeks in patients who underwent a history-indicated cerclage placement.
Methods:
Retrospective case-control study of singleton pregnancies with history-indicated cerclage placement at multiple hospitals within a large U.S. hospital system between 2020-2023. Subjects were included if they met criteria for history-indicated cerclage placement. They were excluded if maternal and neonatal outcomes were not available. Patients were separated into two groups: those delivering at 32 weeks or greater and those delivering less than 32 weeks. Maternal characteristics, timing of cerclage, and surgical approach were compared between groups. Student’s t-test, chi-squared, and logistic regression were used for statistical analysis, and p-value <0.05 was considered statistically significant.
Results:
201 subjects were identified who underwent history-indicated cerclage. Of these, 26 (12.9%) delivered < 32 weeks and 175 (87.1%) ≥ 32 weeks. Patients across both cohorts were similar in terms of age, parity, race, BMI, and type of insurance. Additionally, use of indomethacin, antibiotics, suture type, and vaginal prep used did not vary significantly. Timing of cerclage was later by approximately 3 days in those who delivered <32 weeks; however, this was not statistically significant in the univariable analysis. In the adjusted analysis, controlling for baseline characteristics, timing of cerclage, and surgical approach, those who delivered < 32 weeks were more likely to be single (aOR 4.58, 95% CI 1.34-14.60). Additionally, earlier cerclage placement was associated with lower rates of delivery <32 weeks (aOR 0.62, 95%CI 0.39-0.99).
Conclusion:
In patients having a history-indicated cerclage placed, earlier gestational age at placement decreased likelihood of delivery at less than 32 weeks. Type of suture and the use of prophylactic antibiotics was not associated with increased rates of delivery > 32 weeks.
Presentation Notes
Presented at Scientific Day; May 21, 2025; Park Ridge, IL.
Full Text of Presentation
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Document Type
Poster
Factors Contributing to Delivery Less Than 32 Weeks in Patients With a History-Indicated Cerclage
Background/Significance:
History-indicated cerclages are typically placed between 13-14 weeks gestational age with the intention of prolonging pregnancy; however, variations in timing of placement and operative practices may impact fetal and maternal outcomes, requiring further evaluation.
Purpose:
Evaluation of factors contributing to delivery at less than 32 weeks in patients who underwent a history-indicated cerclage placement.
Methods:
Retrospective case-control study of singleton pregnancies with history-indicated cerclage placement at multiple hospitals within a large U.S. hospital system between 2020-2023. Subjects were included if they met criteria for history-indicated cerclage placement. They were excluded if maternal and neonatal outcomes were not available. Patients were separated into two groups: those delivering at 32 weeks or greater and those delivering less than 32 weeks. Maternal characteristics, timing of cerclage, and surgical approach were compared between groups. Student’s t-test, chi-squared, and logistic regression were used for statistical analysis, and p-value <0.05 was considered statistically significant.
Results:
201 subjects were identified who underwent history-indicated cerclage. Of these, 26 (12.9%) delivered < 32 weeks and 175 (87.1%) ≥ 32 weeks. Patients across both cohorts were similar in terms of age, parity, race, BMI, and type of insurance. Additionally, use of indomethacin, antibiotics, suture type, and vaginal prep used did not vary significantly. Timing of cerclage was later by approximately 3 days in those who delivered <32 weeks; however, this was not statistically significant in the univariable analysis. In the adjusted analysis, controlling for baseline characteristics, timing of cerclage, and surgical approach, those who delivered < 32 weeks were more likely to be single (aOR 4.58, 95% CI 1.34-14.60). Additionally, earlier cerclage placement was associated with lower rates of delivery <32 weeks (aOR 0.62, 95%CI 0.39-0.99).
Conclusion:
In patients having a history-indicated cerclage placed, earlier gestational age at placement decreased likelihood of delivery at less than 32 weeks. Type of suture and the use of prophylactic antibiotics was not associated with increased rates of delivery > 32 weeks.
Affiliations
Advocate Lutheran General Hospital, Advocate Christ Medical Center