Indications for Cervical Cerclage in Pregnant Women: Obstetric and Perinatal Outcomes in a Tertiary Public Hospital

Abstract

Aims: This study aims to assess the impact of cervical cerclage on gestational and perinatal outcomes at a tertiary hospital, considering various surgical indications. Preterm labor (PTL) is a major cause of neonatal and perinatal morbidity and mortality, affecting about 15 million newborns globally each year. Cervical insufficiency (CI) contributes significantly to PTL, particularly in women with a history of spontaneous preterm births or second-trimester losses. This research examines how cervical cerclage, a standard treatment for CI, influences these outcomes. Study Design: This is an observational, analytical, retrospective cohort study based on documentary research. Place and Duration of Study: The study was conducted at a tertiary public hospital in Cascavel, Paraná, Brazil, from January 1, 2020, to March 20, 2024. Methodology: A database review was performed for pregnant women who received cervical cerclage using the McDonald technique. Participants were divided into three groups based on the indication for the procedure: obstetric history only, ultrasound only, and both. The study analyzed gestational and perinatal outcomes. Comparisons were made using ANOVA, Kruskal-Wallis, and Chi-square tests, with P < 0.05 considered significant. Results: Out of 41 women studied, 19 (46.3%) had cervical cerclage based solely on obstetric history, 16 (39.0%) based on a combination of obstetric history and ultrasound, and 6 (14.6%) based only on ultrasound. Significant differences were noted in maternal age, history of premature births and miscarriages, cervical length, and nulliparity. Despite these differences, no statistically significant variations were observed in obstetric and perinatal outcomes, including gestational age at cerclage removal and delivery, delivery type, neonatal weight, APGAR score, NICU admission, and neonatal morbidity and mortality. Notably, 76.3% of births occurred at term (> 37 weeks), and the average pregnancy length post-cerclage was 21 weeks (IQR: 5.00). Additionally, 90.3% of neonatal outcomes were favorable. Conclusion: All three indications for cervical cerclage were associated with extended gestation, increased rates of full-term births, and favorable neonatal outcomes.