(861) Timing of history-indicated cerclage placement and pregnancy outcomes

Objective: Patients with history of cervical insufficiency are offered a history (Hx)-indicated cerclage in a future pregnancy; however, data on timing of placement is limited. We compared the relationship between gestational age (GA) at cerclage placement to selected perinatal outcomes in patients undergoing a Hx-indicated vaginal cerclage.

Study Design: Retrospective cohort study of patients with non-anomalous singleton gestations who underwent Hx-indicated vaginal cerclage (between 11-20 wks GA) and delivery at a single tertiary center 1/2013-4/2021. At our institution, Hx-indicated cerclages are typically placed at 12-14 wks, but can vary upon GA at entry to prenatal care. The primary exposure was GA at cerclage placement. Primary outcome was birth GA. Secondary outcomes included preterm birth (PTB), operative morbidities, and select pregnancy outcomes. Linear and logistic regression modeled the relationship between GA at cerclage placement and primary and secondary outcomes, and OR and β with 95% CI were calculated.

Results: Of 542 cerclages performed in our study period, 175 cases were analyzed. The mean GA of Hx-indicated cerclage placement was 13 ± 1.4 wks. Our cohort were largely obese, publicly insured, non-married, non-Hispanic Black, and had high rates of intramuscular progesterone use. There was no significant association between GA at cerclage placement and birth GA (p=0.72, b 0.13 [-0.57, 0.82], Table). While there was a significant association between GA at placement and readmission within 7 days (p=0.048, OR 1.7 [1.01, 3.1]), there was no significant relationship between GA at placement and PTB (at any GA cut-off), intraoperative complications, or other studied maternal or neonatal outcomes (Table).

Conclusion: GA at time of Hx-indicated cerclage placement up to 20 wks was not associated with birth GA, PTB, or intraoperative complications. However, for each additional wk of GA at cerclage placement, there were increased odds of post-operative readmission. Future studies should evaluate if there an optimal GA for Hx-indicated cerclage placement.