Efficacy of ultrasound-indicated cerclage without prior preterm birth

Aim: Our study aimed to evaluate the effectiveness of ultrasound-indicated cerclage in singleton pregnancies with cervical shortening (<25 mm), excluding those with a history of preterm birth (PTB) and infection/inflammation.

Materials and methods: Among the 1556 women admitted for a cervix measuring <25 mm via transvaginal ultrasound at Juntendo University Urayasu Hospital between January 2001 and December 2023, our study focused on 47 singleton patients with no prior history of PTB. After receiving information on both risks and benefits, 25 patients opted for ultrasound-indicated cerclage (cerclage group), while 22 chose expectant management (expectant management group). All participants underwent screening for infection/inflammation of the lower genital tract. The primary outcome, the rate of PTB (<37 weeks', <34 weeks', and <28 weeks' gestation), was assessed in both groups.

Results: The cerclage group demonstrated a significantly lower rate of PTB before 37 and 34 weeks' gestation. Although there was no statistically significant difference, the cerclage group exhibited a delay of 3.6 weeks in the average week of gestation compared to the expectant management group. Notably, the hospitalization period in the cerclage group was significantly reduced by 42 days.

Conclusion: Performing an ultrasound-indicated cerclage in cases of a short cervical length <25 mm without a prior history of PTB and infection/inflammation reduces the rates of PTB (<37 and <34 weeks' gestation) and hospitalization period.