A Novel Preoperative Cervical Cerclage Staging and the Outcomes Accordingly at a Tertiary Center

Abstract

Aim To present a novel preoperative staging for cervical cerclage and the outcomes of the procedure according to this staging. The second aim is to identify the predictors of cerclage failure. Methods This was a retrospective monocentric cohort study including 136 singleton pregnancies with cervical insufficiency who had undergone cervical cerclage. Preoperative examination findings, ultrasound results, and demographic data were obtained from hospital records. The patients were assigned to four main stages and seven substages according to their ultrasound and examination findings. Cerclage failure rates were detected, and the pregnancy outcomes and the factors that affect operation outcomes were evaluated in each stage. Results The mean gestational age at birth was 34.1 +/- 5.7 for the entire cohort. The mean cerclage-to-delivery interval was 15.4 +/- 6.7 weeks. Shorter cervical length, sludge, cervical dilatation, prolapsed membranes into the cervical canal or vagina, and need for long-term tocolysis (> 3 days) were associated with cerclage failure. No significant difference in pregnancy outcomes was detected between dilated and non-dilated cervix, as long as the membranes were not prolapsed. Pregnancy outcomes differed significantly between the cases with prolapsed membranes above and below the external os. Conclusion This staging system can assist obstetricians in preoperative counseling about individualized success chances for the operation and the risk factors that increase the risk of operation failure. As the stage advances, clinical factors related to infection seem to have more impact on outcomes.