ELECTIVE VERSUS ULTRASOUND -INDICATED CERVICAL CERCLAGE IN WOMEN AT RISK FOR CERVICAL INCOMPETENCE

Background: To compare pregnancy outcomes in women at risk for cervical incompetence after elective versus ultrasound - indicated cerclage.
Methods: In a prospective randomized trial, singleton pregnancies with at least one previous spontaneous midtrimester loss or early preterm delivery (between 15 and 32 weeks' gestation) who met clinical criteria for the diagnosis of cervical incompetence were allocated to receive either an elective cerclage (elective cerclage group) or serial transvaginal cervical sonography at rest and after transfundal pressure every 2 weeks between 14 and 24 weeks'gestation, with cerclage only if indicated by cervical shortening (transvaginal sonography group). The Mann-Whitney U test, Chi- square and Fisher exact test were used for analysis of the data.
Results: A total of 97 patients were identified. Forty-five received elective cerclage and 52 were followed up with transvaginal sonography, of which 53.8% (28/52) required a cervical cerclage because of cervical changes. There were no significant differences in demographic characteristics and risk factors for cervical incompetence. The median gestational age at delivery [38 (range 17- 40) vs. 38 (range 19-40)weeks; p= 0.90], the early losses before 25 weeks'gestation (8.8% vs. 9.6%; p= 0.70) and preterm deliveries before 37 weeks'(20% vs. 25%; p= 0.50) were similar in the elective cerclage group and transvaginal sonography group respectively.
Conclusion: In women at risk for cervical incompetence, serial transvaginal cervical sonography, with cerclage only if indicated by cervical shortening, appears to be a safe alternative to traditional elective cerclage.

Keywords
Cervical incompetence, Cerclage, Transvaginal Sonography, Preterm birth.