Premium
Cervical cerclage placed before 14 weeks gestation in women with one previous midtrimester loss: A population‐based cohort study
Author(s) -
Harpham Margaret E.,
Algert Charles S.,
Roberts Christine L.,
Ford Jane B.,
Shand Antonia W.
Publication year - 2017
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/ajo.12635
Subject(s) - medicine , cervical cerclage , miscarriage , obstetrics , pregnancy , relative risk , gestation , population , gestational age , premature birth , cohort study , confidence interval , gynecology , genetics , environmental health , biology
Background Cervical cerclage is used in an attempt to reduce recurrence risk of preterm birth, but evidence for use is limited. Aims To compare pregnancy outcomes among women with a single previous midtrimester delivery when managed with or without a cervical cerclage. Materials and methods Population‐based cohort study of all women in New South Wales, Australia with a singleton pregnancy ending in birth/miscarriage ≥14 and <28 weeks, between 2003 and 2011. Modified Poisson regression was used to compare outcomes in the next subsequent pregnancy, for women with a cerclage inserted <14 weeks, and those without cerclage. The primary outcome was gestational age <37 weeks at birth/miscarriage in the next pregnancy. Secondary outcomes included: maternal morbidity, preterm prelabour rupture of membranes ( PPROM ), stillbirth/neonatal death and composite neonatal morbidity for liveborn infants ≥28 weeks. Adjusted risk ratios ( ARR ) and 95% confidence intervals ( CI ) were determined. Results Five thousand, six hundred and ninety‐eight births/miscarriages were potential index deliveries. Of these, 2175 women had an eligible subsequent pregnancy: 108 received cerclage at <14 weeks gestation, 2067 did not. Women with cerclage were significantly more likely to deliver <37 weeks than those without (39.8% vs 19.3%, ARR 1.92, 95% CI 1.48–2.48), and had increased risks of PPROM ( ARR 4.38, 95% CI 2.62–7.32) and stillbirth/neonatal death ( ARR 2.20, 95% CI 1.02–4.73). Following cerclage, liveborn infants ≥28 weeks had double the risk of severe morbidity ( ARR 2.54, 95% CI 1.55–4.16). Conclusions In women with a single previous midtrimester delivery, cervical cerclage <14 weeks gestation in subsequent pregnancy was associated with worse pregnancy outcomes.