Abstract
INTRODUCTION:Cervical incompetence is associated with preterm delivery and poor obstetric outcomes. Placement of cervical cerclage may mitigate these risks but standard of care choice of suture material is not well established in the literature.
METHODS:This retrospective cohort study at a single tertiary care center between 2001-2016 evaluated singleton pregnancies with cerclage placement. Women included had placement prior to 24 weeks, met appropriate indication for cerclage placement and delivered at our institution. Patients were excluded if pregnancy terminated or induced preterm for medical indication. Patients were grouped by cerclage indication and suture type (thick-braided suture, monofilament or tape). Primary outcome was gestational age at delivery time analyzed by type of suture material and cerclage indication. Secondary outcomes include vaginal delivery, 5 minute Apgar <7, birthweight, chorioamnionitis, preterm rupture of membranes and adverse neonatal outcomes.
RESULTS:218 singleton pregnancies underwent transvaginal cerclage placement prior to 24 weeks. 117 were history-indicated, 64 were ultrasound-indicated. 37 received physical-exam indicated cerclage. There were no demographic differences between suture types used. No tape suture was used for physical exam indicated cerclage. There was no difference in gestational age at delivery for any suture types regardless of indication of cerclage. There were no differences in the secondary outcomes reported.
CONCLUSION:Gestational age at delivery does not appear to be associated with choice of thick braided suture or monofilament at time of cerclage. Due to small number of tape used, limited conclusions can be drawn for that suture. Suture type may be left to surgeon discretion during cerclage placement.