Clinical Obstetrics
Poster Session 3
Lola Loussert, MD, MPH (she/her/hers)
Toulouse University Hospital, France
Toulouse, Midi-Pyrenees, France
Mathilde Terral, MD
Toulouse University Hospital, France
Toulouse, Midi-Pyrenees, France
François Goffinet, MD, PhD
Maternité Port Royal, Groupe hospitalier Paris Centre, APHP
Paris, Ile-de-France, France
Paul Guerby, MD, PhD (he/him/his)
Head of Obstetrics Department
Hopital Paule de Viguier, CHU Toulouse, Toulouse III University
Toulouse, Midi-Pyrenees, France
Chloe Lieng, MD
Maternité Port-Royal, Groupe hospitalier Paris Centre, AP–HP
Paris, Ile-de-France, France
Yoann Athiel, MD
Maternité Port-Royal, Groupe hospitalier Paris Centre, AP–HP
Paris, Ile-de-France, France
International guidelines regarding the management of women with one unique previous preterm delivery (PTD) or second-trimester loss are inconsistent.
Our objective was to compare history-indicated cerclage to ultrasound cervical length screening in women with one previous severe PTD or second-trimester loss.
Study Design:
We conducted a retrospective bicentric cohort study from 01/2015 to 12/2022. We compared two French tertiary care maternity units with different standards of care for women with one previous severe PTD or second-trimester loss: history-indicated cerclage in the 1st trimester in center 1, and ultrasound cervical length screening, with cerclage placement reserved for women whose cervical length shortens in center 2. We included women with one unique previous spontaneous PTD before 28 weeks or second-trimester loss. We excluded women whose previous PTD was not evocative of cervical insufficiency: bleeding from placenta previa or placental abruption, intrauterine fetal death, delivery following invasive prenatal testing. We also excluded women with more than one previous PTD or second-trimester loss and women with multiple pregnancies. Our primary outcome was delivery before 34 weeks, including second-trimester loss. We performed a sensitivity analysis after excluding the women who were not treated according to the protocol of their center.
Results:
The study included 314 women: 165 in center 1 and 149 in center 2. Twenty-six (15.8%) women delivered before 34 weeks in center 1 versus 38 (25.5%) in center 2 (p=0.032). In the multivariable analysis, the risk of delivery before 34 weeks was significantly lower for women with history-indicated cerclage compared to ultrasound screening (adjusted OR 0.47[0.23–0.97]). The results were unchanged in the sensitivity analysis. In center 2, 73 (49%) women underwent cerclage due to cervical shortening.
Conclusion: In women with one previous PTD or second-trimester loss, history-indicated cerclage is associated with a lower risk of delivery before 34 weeks compared to ultrasound screening of cervical length.