Longitudinal change in cervical length following vaginal or abdominal cervical cerclage: a randomized comparison

• Published in: American journal of obstetrics & gynecology MFM 2023-07, Vol.5 (7), p.100987-100987, Article 100987
• Main Authors: Ridout, Alexandra E., Carter, Jenny, Seed, Paul T., Chandiramani, Manju, David, Anna L., Tribe, Rachel M., Shennan, Andrew H.
• Format: Article
• Language: English
• Subjects: cervical cerclage; cervical length; preterm birth prediction; spontaneous preterm birth; transabdominal cerclage
• ISSN: 2589-9333; 2589-9333
• DOI: 10.1016/j.ajogmf.2023.100987

Cervical cerclage has been shown to reduce the risk of recurrent spontaneous preterm birth in a high-risk patient population; however, the mechanism is not well understood. Transabdominal cerclage is superior to low and high vaginal cerclage in reducing early spontaneous preterm birth and fetal loss in women with previous failed vaginal cerclage. Cervical length measurements are commonly used to monitor high-risk women and may explain the mechanism of success. This study aimed to evaluate the rate of change in longitudinal cervical length after randomized placement of low transvaginal, high transvaginal, or transabdominal cerclage in women with a previous failed vaginal cerclage. This was a planned analysis of longitudinal transvaginal ultrasound cervical length measurements from patients enrolled in the Vaginal Randomised Intervention of Cerclage trial, a randomized controlled trial comparing transabdominal cerclage or high transvaginal cerclage with low transvaginal cerclage. Cervical length measurements at specific gestational ages were compared over time and between groups, using generalized estimating equations fitted using the maximum-likelihood random-effects estimator. In addition, cervical length measurements were compared in women with transabdominal cerclage placed before and during pregnancy. The diagnostic accuracy of cervical length as a predictor of spontaneous preterm birth at