Prior Cerclage: To Repeat or Not to Repeat? That Is the Question

A previous study suggested that women who have had a cerclage in a prior pregnancy for nontraditional indications should avoid repeat cerclage in a subsequent pregnancy because of complications of cerclage placement that are deleterious to both the pregnancy and the health of the woman. The investigators evaluated this recommendation by accessing a database containing clinical information from pregnancies between 1995 and 2002, to identify 56 women ≥12 weeks of gestation who had a history of prior cerclage for nontraditional indications and had a subsequent pregnancy. Twenty-eight women who underwent a history-indicated cerclage (HIC) were matched by demographics and risk factors with 28 women who were managed by serial transvaginal ultrasound cervical length measurements. Spontaneous birth >35 weeks was the primary outcome. No differences were found between the 2 groups in the incidence of spontaneous preterm labor <35 weeks (21% vs. 11%; P = .5), spontaneous preterm rupture of the membranes <35 weeks (7% vs. 11%; P = 1.0), or spontaneous preterm birth <35 weeks (11% vs 11%; P = 1.0). The mean gestational age at delivery was 36.5 ± 5.6 for the prophylactic HIC group and 36.3 ± 6.6 in the transvaginal ultrasound (TVU) group (P = 0.5). The investigators concluded that, for women with history of prior cerclage for nontraditional indications, HIC did not improve outcome in the subsequent pregnancy compared with TVU CL.