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Determine the pregnancy outcome after placement of a reinforcing transvaginal cerclage for ultrasound confirmed cervical shortening among women whom underwent an initial prophylactic, therapeutic or rescue cerclage.
This is a retrospective cohort study. We included patients who underwent a primary cerclage placement between January of 2006 and May of 2012 at Sinai Hospital of Baltimore. The pregnancy outcomes including cervical length, placement of a subsequent reinforcing cerclage and gestational age at delivery were abstracted from electronic medical records. The time to delivery after initial cerclage placement was compared between women who received one or two cerclage using Kaplan Meier survival analysis. Student T-test and chi square was used to compare continuous and non-continuous variables. A P-value of 0.05 was used to establish a statistically significant difference.
We identified a total of 158 women with singleton pregnancies who underwent cerclage placement. Prophylactic cerclage was placed in 66, therapeutic cerclage in 31 and rescue cerclage in 61 women. The average gestational age from initial cerclage to delivery was 20.5, 15.7 and 12.5 weeks gestation for prophylactic, therapeutic and rescue cerclage respectively. The main indication for placement of a reinforcing cerclage was ultrasound diagnosed cervical shortening. The median cervical length prior to placement of reinforcing cerclage was 1.0 cm. At 24 weeks gestational age the median cervical length among 87 of 138 patients who did not receive a reinforcing cerclage was 2.7 cm. (41% had a cervical length less than 2.5 cm.) The difference in gestational age at delivery was not significant between patients who received (30.4 ± 7.0 wk) and did not receive (34.4 ± 6.4 wk) a reinforcing cerclage regardless of the indication for the cerclage (P= 0.19) (Figure and Table).
Placement of a reinforcement cerclage after initial cerclage did not prolong the pregnancy regardless of the indication for the initial cerclage.