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Recurrence rates after abdominal and vaginal cerclages in women with cervical insufficiency: a validated cohort study

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To estimate the incidence of cervical insufficiency and compare recurrence rates of second trimester miscarriage/delivery in second and third pregnancies after prophylactic vaginal cerclage, abdominal cerclage, or no cerclage.

Methods

Retrospective chart review of a representative register-based sample of 621 women with a spontaneous second trimester miscarriage/delivery in the first pregnancy in Denmark (1997–2012). We used strict criteria for the diagnosis of cervical insufficiency. The outcome of subsequent pregnancies was described by treatment with prophylactic vaginal cerclage, abdominal cerclage, or no prophylactic cerclage. Women were followed until June 2015.

Results

Of 621 women, 149 (24%) fulfilled the strict criteria of cervical insufficiency. Prophylactic treatment with abdominal cerclage (n = 20), vaginal cerclage (n = 59), and no prophylactic cerclage (n = 61) resulted in a second pregnancy ending before 28 weeks in 5, 30, and 72% (p < 0.001) and before 34 weeks in 10, 46, and 84% (p < 0.001), respectively. Take-home baby rate was 95% after abdominal cerclage, 73% after vaginal cerclage, and 33% after no cerclage. In a third pregnancy, abdominal cerclage (n = 47), vaginal cerclage (n = 38), and no cerclage (n = 8) resulted in pregnancy ending before 34 weeks of gestation in 2, 21, and 25%, respectively (p = 0.01).

Conclusions

Cervical insufficiency was diagnosed in 24% of women with an initial second trimester spontaneous miscarriage/delivery. In second and third pregnancies, recurrence rates were significantly lower after prophylactic vaginal or abdominal cerclage compared with no cerclage.

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Acknowledgements

We gratefully acknowledge the Center of Clinical Research, North Region Hospital for their support of this study.

Authors contribution statement

KS: Project development, Data collection and management, Data analysis, Manuscript writing. OB Christiansen: Project development, Manuscript editing. IB Sundtoft: Project development, Manuscript editing. J Langhoff-Roos: Project development, Data analysis, Manuscript writing and editing

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Authors and Affiliations

  1. Department of Clinical Research, North Region Hospital, Hjørring, Denmark

    Kirstine Sneider

  2. Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark

    Ole Bjarne Christiansen

  3. The Fertility Clinic, University Hospital Copenhagen, Copenhagen, Denmark

    Ole Bjarne Christiansen

  4. Department of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, Aarhus, Denmark

    Iben Blaabjerg Sundtoft

  5. Department of Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

    Jens Langhoff-Roos

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  1. Kirstine Sneider
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  2. Ole Bjarne Christiansen
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  3. Iben Blaabjerg Sundtoft
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  4. Jens Langhoff-Roos
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Corresponding author

Correspondence to Kirstine Sneider.

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Funding

This study was funded by: King Christian X Foundation, Spar Nord Foundation, Director Madsen and his wife Olga Madsen’s Foundation, Torben and Alice Frimodt’s Foundation, Johannes M. Klein’s Foundation, and Alfred Helsted’s og Eli Møller’s Grant.

Conflict of interest

Author KS declares that he/she has no conflict of interest. Author OBC declares that he has no conflict of interest. Author IBS declares that she has no conflict of interest. Author JLR declares that he has no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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Sneider, K., Christiansen, O.B., Sundtoft, I.B. et al. Recurrence rates after abdominal and vaginal cerclages in women with cervical insufficiency: a validated cohort study. Arch Gynecol Obstet 295, 859–866 (2017). https://doi.org/10.1007/s00404-017-4315-y

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  • DOI: https://doi.org/10.1007/s00404-017-4315-y

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