Prematurity
Poster Session 4
Amir Snir, MD
Soroka University Medical Center
Beer-Sheva, HaDarom, Israel, Israel
Polina Schwarzman, MD
Soroka
Beer-Sheva, HaDarom, Israel
Tamar Wainstock, PhD (she/her/hers)
Ben Gurion University
Beer-Sheva, HaDarom, Israel
Eyal Sheiner, MD, PhD
Head of department of Obstetrics and Gynecology B, Soroka University Medical Center
Soroka University Medical Center
Beer-Sheva, HaDarom, Israel
Cervical cerclage is considered as an effective procedure for patients with cervical insufficiency. However, these patients still remain at a higher risk for preterm delivery. Several studies have attempted to ascertain predictors for preterm delivery among patients with cervical cerclage with mixed findings. We aimed to study the impact of obstetric risk factors for preterm delivery among women with cervical cerclage.
Study Design:
A population-based cohort study was performed including all patients with cervical cerclage. Deliveries occurred between the years 1991-2023 in a tertiary medical center. Multiple gestations and pregnancies with chromosomal abnormalities were excluded from the study. Diagnoses were pre-defined based on ICD-9 codes, as recorded in the hospital medical files. A multiple linear regression model was used to assess the impact of maternal characteristics as well as pregnancy complications on the length of pregnancy.
Results:
A total of 1416 deliveries following a pregnancy with cervical cerclage were included in the study. After univariate analysis, the following factors were found to be associated with preterm delivery in our study group: fetal growth restriction, placental abruption, nulliparity and advanced maternal age. Using a multiple linear regression model, with backward elimination, the impact of these variables on the length of pregnancy was assessed (R² = 0.18, p < 0.001). The mean gestational age at birth among patients without risk factors was 38.4 weeks. Placental abruption reduced gestational age by 7 weeks, chorioamnionitis reduced gestational age by 6.27 weeks, fetal growth restriction reduced gestational age by 1.2 weeks, nulliiparity reduced gestational age by 0.89 weeks, and maternal age over 35 years reduced gestational age by 0.21 weeks (Table).
Conclusion: Placental abruption, chorioamnionitis, fetal growth restriction, nulliiparity and maternal age over 35 years are independent risk factors for preterm delivery among patients with cervical cerclage.