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Better Pregnancy Outcomes Seen With Elective Cerclage


 

WASHINGTON — Patients who received emergent cerclage had higher rates of premature birth, spontaneous premature rupture of membranes, and chorioamnionitis, compared with those receiving elective cerclages, Chi P. Dola, M.D., reported in a poster presentation at the annual meeting of District VII of the American College of Obstetricians and Gynecologists.

Dr. Dola, of Tulane University, New Orleans, and her colleagues performed a retrospective chart review of data from 140 pregnant women who presented with an incompetent cervix.

The women were separated into three groups: 91 asymptomatic patients who received an elective cerclage based on a history suggestive of cervical incompetence; 29 asymptomatic patients who received an urgent cerclage after an ultrasound exam brought to light an abnormal finding, and 20 patients who received an emergent cerclage after presenting with typical symptoms of cervical incompetence.

The percentage of patients whose pregnancy lasted beyond 36 weeks was the highest, at 73%, in those who received an elective cerclage, followed by 62% in the asymptomatic patients who received urgent cerclage and 21% in the symptomatic patients who had an urgent cerclage.

Spontaneous premature rupture of membranes was 21% in the asymptomatic patients who received elective cerclage, versus 40% and 71% in the other two groups, respectively.

The incidence of chorioamnionitis was only 2% in the asymptomatic patients who received elective cerclage, compared with 9% and 50% in the other two groups, respectively.

All differences between groups were significant.

The researchers' findings show that patients with urgent cerclages had poor outcomes compared with those receiving elective cerclages. This finding led the researchers to conclude “that by awaiting abnormal cervical findings on ultrasound exam prior to placement of an urgent cerclage, the potential for poor pregnancy outcomes increases.”

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