Observational studyActa obstetricia et gynecologica Scandinavica2026
History-indicated cerclage versus ultrasound cervical length screening in women with a history of one extremely preterm birth: A comparative observational cohort study.
Observational study in Acta obstetricia et gynecologica Scandinavica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionIn women with a history of one extremely preterm birth, the current literature suggests that ultrasound cervical length screening offers a more favorable risk-benefit ratio than history-indicated cerclage. However, some of the women included in previous studies were at a low risk of cervical insufficiency. Therefore, the efficacy of history-indicated cerclage may have been underestimated. Our objective was to compare history-indicated cerclage with ultrasound cervical length screening in women with a history of one second-trimester loss or extremely preterm birth suggestive of cervical insufficiency. MATERIAL AND
methodsWe conducted a retrospective cohort study comparing two centers with different management strategies for women with a history of one second-trimester loss or extremely preterm birth suggestive of cervical insufficiency. This study was conducted from January 1, 2015 to December 31, 2022 in two French tertiary care maternity units. In the first center, women were offered a cerclage in the first trimester (cerclage center). In the second center, women were offered an ultrasound screening with cerclage only for women with cervical shortening (ultrasound center). To target a population at high risk for cervical insufficiency, we included women with a history of one second-trimester loss or spontaneous preterm birth before 28 weeks of gestation. We excluded women who had any of the following complications in their previous pregnancy: bleeding from placenta previa or placental abruption, intrauterine fetal death, or delivery after invasive prenatal testing. We also excluded women with a history of more than one preterm delivery. Our primary outcome was delivery before 34 weeks. A multivariable analysis was performed.
resultsThe rate of delivery before 34 weeks was significantly lower in the cerclage center compared with that in the ultrasound center (26/165 (15.8%) vs. 38/149 (25.5%), p = 0.032). After adjusting for confounding factors, history-indicated cerclage was associated with a twofold decreased risk of delivery before 34 weeks compared with ultrasound cervical length screening (aOR 0.46, 95% CI 0.23-0.95).
conclusionsIn women with a history of one second-trimester loss or extremely preterm birth suggestive of cervical insufficiency, history-indicated cerclage is associated with a lower risk of delivery before 34 weeks compared with ultrasound cervical length screening.
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