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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (2): 262-267    DOI: 10.31083/j.ceog.2020.02.5200
Original Research Previous articles | Next articles
Outcomes of prophylactic and emergency cerclage versus expectant management for cervical insufficiency: a single-center retrospective, comparative study
E. J. Shim1, H. J. Kim1, I. Y. Kim1, K. Y. Oh1, Y. S. Yang1, C. H. Jin1, *()
1Department of Obstetrics and Gynecology, School of Medicine, Eulji University, Daejeon, Republic of Korea
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Abstract  Aim: To compare the outcomes after prophylactic cerclage, emergency cerclage, and expectant management in women with cervical insufficiency. Materials and Methods: From 2011 to 2015, Eulji University Hospital’s database was retrospectively analyzed to identify women with cervical insufficiency without premature rupture of membranes (PROM), clinical chorioamnionitis, or labor pain from 12 to 26 weeks of gestation. Gestational age at delivery, term delivery rate, after-34-weeks-of-gestation delivery rate, intensive-careunit admission rate, neonatal sepsis, and neonatal mortality rate were compared between each group. Results: Forty-eight women underwent prophylactic cerclage: 56 emergency cerclage and 21, expectant management. Prolongation of pregnancy was longer in the prophylactic cerclage group than in the emergency group (22.8 ± 2.7 weeks vs. 13.3 ± 6.1 weeks, p < 0.001). Preterm delivery rate < 34 gestational weeks was significantly higher in the emergency cerclage group than the prophylactic group (37.5% vs. 14.6%, p = 0.009). Elevated pre-cerclage C-reactive protein (CRP) was associated with delivery before 34 weeks in the emergency cerclage group [odds ratio (OR): 15.849; 95% confidence interval (CI): 1.289-194.898, p = 0.031]. Comparing the emergency cerclage and expectant groups, prolongation of pregnancy was higher in the emergency group than the expectant group (13 ± 6.1 weeks vs. 8 ± 5.7 weeks, p = 0.002). However, there were no significant differences between the two groups regarding preterm delivery < 34 weeks and perinatal outcomes. Conclusions: Preterm delivery rate < 34 gestational weeks was higher in the emergency cerclage group than the prophylactic group. There were no significant differences between the emergency cerclage and the expectant groups in pregnancy and perinatal outcomes.
Key words:  Cervical insufficiency      Emergency cerclage      Expectant management     
Published:  15 April 2020     
Fund: 2016-EMBRI-DJ0005/Eulji University
*Corresponding Author(s):  C. H. Jin     E-mail:  bangle99@hanmail.net

Cite this article: 

E. J. Shim, H. J. Kim, I. Y. Kim, K. Y. Oh, Y. S. Yang, C. H. Jin. Outcomes of prophylactic and emergency cerclage versus expectant management for cervical insufficiency: a single-center retrospective, comparative study. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(2): 262-267.

URL: 

https://ceog.imrpress.com/EN/10.31083/j.ceog.2020.02.5200     OR     https://ceog.imrpress.com/EN/Y2020/V47/I2/262

Table 1  — Characteristics and pregnancy outcomes between prophylactic cerclage and emergency cerclage groups.
Prophylactic cerclage, n=48Emergency cerclage, n=56p-value
MeanSDMeanSD
Maternal age (years)33.14.232.94.40.958
Parity1.181.040.690.650.016
Cervical length (cm)3.10.631.360.97<0.001
Pre-cerclage CRP (mg/dL)0.580.70.671.030.924
Post-cerclage CRP (mg/dL)0.810.970.831.010.904
Gestational age at cerclage (weeks)14.3121.24<0.001
Gestational age at delivery (weeks)36.73.434.34.60.005
Prolongation of pregnancy (weeks)22.82.713.36.1<0.001
Term delivery (n, %)2756.32544.60.238
Preterm delivery (n, %)
< 37 weeks2143.83155.40.238
< 34 weeks714.62137.50.009
Birth weight (kg)2.80.582.320.90.007
Apgar score 1 min6.91.75.62.40.003
Apgar score 5 min8.21.57.51.90.093
Table 2  — Odds ratios (using a logistic regression model) for potential associations for outcomes of pregnancy after emergency cerclage.
Delivery <34 weeks
OR95% CIp-value
Cervical length1.3290.343-5.1480.681
Funneling2.0930.278-15.7680.473
Membrane bulging9.2250.536-158.6490.126
Pre-cerclage CRP15.8491.289-194.8980.031
Post-cerclage CRP1.3650.402-4.6320.618
Table 3  — Perinatal outcomes between prophylactic cerclage and emergency cerclage groups.
Prophylactic cerclage, n=48Emergency cerclage, n=56p-value
Number%Number%
Intensive care unit admission1122.92748.20.008
Neonatal sepsis510.4814.30.552
Neonatal mortality0023.60.498
Take home baby2143.814250.044
Table 4  — Comparison of characteristics, pregnancy outcomes, and perinatal outcomes between women with amniotic membrane bulging group and those without.
Membrane bulging(-), n=90Membrane bulging (+), n=13p-value
MeanSDMeanSD
Maternal age (years)33.14.3832.74.00.804
Parity0.970.90.690.750.30
Pre-cerclage CRP (mg/dL)0.610.950.780.920.282
Post-cerclage CRP (mg/dL)0.690.851.561.420.005
Gestational age at cerclage (weeks)174.123.83.3<0.001
Gestational age at delivery (weeks)363.730.64.80.001
Prolongation of pregnancy (weeks)19.15.675.1<0.001
Birth weight (kg)2.60.721.760.940.002
Apgar score 1 min6.51.83.62.6<0.001
Apgar score 5 min8.11.55.92.20.005
Intensive care unit admission (n, %)2831.11076.90.004
Neonatal sepsis (n, %)88.9538.50.011
Neonatal mortality (n, %)22.2001.0
Take home baby (n, %)3538.9000.004
Table 5  — Comparison of characteristics, pregnancy outcomes, and perinatal outcomes between emergency cerclage group and expectant groups.
<break/>Emergency cerclage, n=56Expectant group, n=21p-value
MeanSDMeanSD
Maternal age (years)32.94.4131.95.180.421
Parity0.690.650.420.50.096
Cervical length (cm)1.360.970.810.820.024
CRP (mg/dL)0.671.030.440.520.331
Gestational age at diagnosis (weeks)213.724.22.9<0.001
Gestational age at delivery (weeks)344.6325.80.183
Prolongation of pregnancy (weeks)136.185.70.002
Amniotic membrane bulging (n, %)1323.6838.10.207
Term delivery (n, %)2544.6628.60.2
Preterm delivery (n, %)
<37 weeks3155.41571.40.2
<34 weeks2137.51152.40.238
Birth weight (kg)2.320.92.291.050.901
Apgar score 1 min5.62.375.452.540.782
Apgar score 5 min7.51.97.252.020.568
Intensive care unit admission (n, %)2748.213540.197
Neonatal sepsis (n, %)814.32101.0
Neonatal mortality (n, %)23.529.50.298
Take home baby (n, %)14254200.766
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