Outcomes of prophylactic and emergency cerclage versus expectant management for cervical insufficiency: a single-center retrospective, comparative study

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.