Cervical cerclage in early pregnancy

image of cervival-cerclage-suture
A cerclage in early pregnancy should be a strong consideration for some DES Daughters only ; routine cerclage placement is not recommended for all the DES affected.

Abstract

Cervical cerclage in early pregnancy, Journal of perinatology : official journal of the California Perinatal Association, NCBI PubMed PMID: 1919825, 1991 Sep.

A retrospective review of 33 patients who underwent transvaginal cervical cerclage for the treatment of an incompetent cervix from June 1984 through July 1987 was conducted. A total of 38 transvaginal cerclages were placed.

For the purposes of comparison, the patients were divided into three groups according to gestational age at the time of cerclage:

  1. group 1 less than or equal to 13 weeks;
  2. group 2 greater than 13 weeks, but less than 18 weeks;
  3. group 3 greater than or equal to 18 weeks.

There was no difference among groups in mean age, gravidity, history of diethylstilbestrol exposure (DES), prior pregnancy loss at or before 20 weeks, or prior dilation and curettage procedure. There were 24 modified McDonald and 14 modified Shrodkar procedures performed.

The mean gestational age of cerclage placement in group 1 was earlier than in group 2 and group 3 by 3.5 and 10.5 weeks, respectively. There were no major surgical complications in any of the three groups.

The overall incidence of preterm labor and preterm birth were 48.6% and 37.8%, respectively. Analysis of variance demonstrated a trend toward differences in the incidence of preterm labor, preterm birth, and estimated gestational age at delivery, with the earlier group favored. None of these, however, reached the level of statistical significance.

Estimated blood loss, obstetric complications, mean birthweight, and mean gestational age at delivery were not statistically different for the three study groups.

The above data are discussed and support given for the safety and efficacy of cervical cerclage placement in early pregnancy when compared with the more standard recommendations of placement at from 14 to 17 weeks’ gestational age.

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