BMC Pregnancy Childbirth. 2025 Sep 25;25(1):945. doi: 10.1186/s12884-025-07942-0.
ABSTRACT
BACKGROUND: Presently, cervical cerclage is regarded as a valid method to treat cervical insufficiency, which could reduce late miscarriage and spontaneous preterm birth (sPTB). Nonetheless, the safety and effectiveness of emergency cervical cerclage (ECC) as a high-risk surgery still remains debatable when the cervix has dilated or the membranes protrude into the vagina during pregnancy at 26-27+6 weeks of gestational age (GA).
OBJECTIVE: To estimate maternal and perinatal outcomes of ECC in singleton pregnancy at 26-27+6 weeks of GA compared with expectant treatment.
METHODS: In this multicenter retrospective cohort study, the study group comprised all singleton pregnancy without signs of labor or chorioamnionitis at 26-27+6 weeks of gestation who had expectant treatment or ECC with transvaginal cervical cerclage for cervical dilation 0.5-4 cm between 1st December 2021 to 31st December 2024 at the Women’s Hospital, Zhejiang University School of Medicine, Huzhou Maternity and Child Health Care Hospital, and Quzhou Maternal and Child Health Hospital. A directed acyclic graph was applied to depict the causality structure for simplifying confounders. The pregnancy latency and GA at delivery were collected as primary outcomes. While the the rates of sPTB before 28, 30, 32, 34 and 36 weeks of GA; and neonatal outcomes (neonatal mortality; birth weight and Apgar score at 5 min > 7) were recorded as secondary outcomes. Population were also stratified into two subgroups based on cervical dilation ≥ 3 cm or < 3 cm for further analysis. Multivariable logistic regression was applied to identify risk factors associated with sPTB with forest plot as a presentation format.
RESULTS: Fifty-four women underwent ECC (ECC group), while 114 were treated with expectant treatment (Control group). Demographic characteristics were similar in two groups. However, the pregnancy latency was significantly longer (66.21 vs 33.53 days, p < 0.001) and the GA at delivery was significantly higher (36 vs 30.45 weeks, p < 0.001) in ECC group compared with control group. The rates of sPTB at different GAs, as well as neonatal related indicators (live births only) also displayed noticeable difference between two groups (p < 0.001). For subgroup analysis, either cervical dilation ≥ 3cm or < 3 cm, ECC group both delineated later GA at delivery and better neonatal outcomes verse Control group (p < 0.05). After adjusting for confounding factors which were represented by a directed acyclic graph (DAG), there were significant differences in the GA at delivery (beta, 5.195; 95% CI, 3.818 – 8.572; p < 0.001), pregnancy latency (beta, 34.160; 95% CI, 17.799 – 50.522; p < 0.001), the rates of sPTB at < 28, < 30, < 32, < 34, < 36 weeks were all significantly lower than those in the control group (all p < 0.001), and neonatal birthweight was significantly increased (beta, 1007.427; 95%CI, 715.300 – 1299.554; p < 0.001), and the rates of 5-min Apgar > 7 was significantly higher in ECC group when compared with the control group, further indicated that ECC in singleton pregnancies with cervical dilation 0.5-4 cm in 26-27+6 weeks of GA may prolong the GA at delivery, reduce the rate of sPTB and improve perinatal and neonatal outcomes compared with expectant management.. Unfortunately, in the ECC group, there were two cases of intraoperative rupture of membranes due to high tension of the amniotic sac, and the operation failed.
CONCLUSION: In singleton pregnant women with cervical dilation 0.5-4 cm at 26-27+6 GA, ECC could associated with extending GA at delivery, decreasing sPTB rate, perinatal mortality compared with conservative treatment, especially for patients cervical dilation < 3 cm, as this subgroup appears to derive greater benefit.
PMID:40999318 | DOI:10.1186/s12884-025-07942-0
