The Outcomes Of Prophylactic Cerclage And Conservative Management In Patients With Cervical Insufficiency:A Retrospective Cohort Study

Objective:To evaluate whether prophylactic cervical cerclage could improve the pregnancy outcome of cervical insufficiency women with a history of late abortion by comparing the pregnancy outcome of cervical cerclage and conservative management. To study and explore the indications for the treatment of prophylactic cervical cerclage of women with singleton pregnancy.Methods:A retrospective cohort study was performed on two groups of patients with singleton gestation at The Second Affiliated Hospital of Soochow University from Jan 2012 to Oct 2015.The first group consisted of 115 patients who were treated with transvaginal cervical cerclage,while the second group including 71 patients who were managed conservatively. All of these patients had been undergoing unexplained second-trimester delivery in the absence of labor at least one time.The two groups were compared with pregnancy outcomes. A subgroup analysis was carried out based on the times of late abortion. A1(n=42):cerclage group with single history of late-term loss;B1(n=55):conservative management group with only one history of late-term loss;A2(n=58):cerclage group with twice late-term losses; B2(n=16):conservative management group with late-term losses twice;A3(n=15):cerclage group with second-trimester pregnancy losses three times or more.Results:(1)cerclage versus conservative management overall( A. vs. B) There was no statistically significant difference in Live births between cerclage group and conservative management group. The same thing was found in gestation age、neonatal survival、preterm birth outcomes and neonate birth weight. Cerclage was associated with significant increase in cesarean delivery outcomes(56.86% versus 31.75%, p=0.002).(2)with one second-trimester pregnancy loss(A1. vs. B1) Live births did not show statistically significant difference between cerclage group and conservative management group. The same thing was found in gestation age、preterm birth outcomes and birth weight of newborn.The incidence of cesarean delivery in the cervical cerclage group(58.97%) was significantly higher than 29.41% observed in the conservative management group(p=0.005).(3)with two times of late-term losses(A2. vs. B2) Live births did not show statistically significant differences between cerclage group and conservative management group. The same thing was found in gestation age、preterm birth outcomes、newborn weight and cesarean delivery.(4)Women in the cervical cerclage groups(A1. vs. A2. vs. A3) There was no significant difference in live births、cesarean delivery、gestation age、preterm birth outcomes、neonate birth weight between the three groups.Conclusion:Prophylactic cervical cerclage do not improve pregnancy outcomes of cervical insufficiency patients. Women with one or two second-trimester pregnancy losses do not have to be treated with transvaginal cervical cerclage. Patients received cerclage are associated with a higher cesarean delivery rate.