Revision of Failed Cerclage Is Associated With Higher Risk of Premature Birth Compared to Primary Cerclage [24N]

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Abstract

INTRODUCTION:

Little is known about the outcome of revising failed cerclage, previously placed for sonographically short mid-trimester cervix. Our previous data reported higher risk of premature delivery in patients (pts) with revision compared to single cerclage. We aim to find if addition of 23 pts to previously reported 54 changes the results.

METHODS:

This is a cohort of 77 pts with ultrasound cervical length (CL) of <25 mm at 16–24 6/7 weeks (wks) who underwent high MacDonald cerclage. Nine pts required revision to correct a failed cerclage (performed by other operators). Failed cerclage was defined as presence of prolapsed membrane beyond cerclage or CL distal to cerclage of <1 cm. All surgeries were performed or supervised by one operator (FB). Gestational age (GA) at delivery, and other obstetrical outcomes, were compared between 2 groups.

RESULTS:

68/77 pts had primary cerclages, 9/77 pts had revision cerclages. 4 pregnancy losses noted (2 in primary, 2 in revision). Pts with revision had shorter delivery GA; mean of 27 3/7 (±6.7) vs 36 2/7 (±4.1) wks (P=.003). Birth weight was lower in revision group; mean 1345 (±1056) vs 2830 grams (±816) (P=.005). More babies in revision group had NICU admissions 5/7 (71.4%) vs 14/64 (22%) pts (P=.008).

CONCLUSION:

Patients with revision cerclages have higher premature delivery compared to successful primary cerclages. Revised cerclages were associated with a high take-home baby (7/9 or 78%) but also with high preterm delivery rate (8/9 or 89%), which should be considered when counseling pts with failed cerclages and candidates for revision cerclage.

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