Effectiveness of cervical cerclage in preventing preterm birth

Background: The delivery of newborn babies before term is one of the main causes of the high rates of death and illness in newborn babies, particularly those of women who have had a spontaneous preterm delivery or those with cervical insufficiency. The use of cervical cerclage as a surgical procedure for the prevention of preterm birth in high-risk pregnancies is well described, but the extent of its benefit in improving pregnancy outcomes is a topic of much research. Objective: This study aimed to assess the effectiveness of cervical cerclage on prevention of preterm birth, maternal, fetal and neonatal outcomes such as gestational age at delivery, birth weight, and neonatal morbidity in the high-risk pregnant women. Methodology: A prospective interventional controlled trial was conducted at Tikrit Teaching Hospital from March 2024 to March 2025. In total, 300 pregnant women with high risk of preterm delivery were included in the study. Patients were divided into two groups: the intervention group received cervical cerclage (n = 150) and the control group (n = 150). The primary outcome of interest was gestational age at birth, with secondary outcomes being preterm birth, birth weight, NICU admission, and neonatal death. Data were collected using SPSS, with statistical methods including Chi-square, independent t-tests, and multivariate logistic regression. Results: The mean gestational age at delivery in the cerclage group was significantly higher (37.9 ± 1.8 weeks) than in the control group (34.2 ± 2.6 weeks, p< 0.001). The preterm birth rate in the cerclage group was 17.3%, which was significantly lower compared to the control group (46.0%, p< 0.001). The birth weight in the cerclage group was significantly higher (2850 ± 420 grams vs. 2360 ± 510 grams, p< 0.001), and neonatal mortality was lower (1.3% vs. 5.3%, p = 0.048). The most common procedure-related complication was mild vaginal bleeding (4.0%). Conclusion: Cervical cerclage improves pregnancy outcomes in high risk women, the increase in gestational age at delivery, decrease in preterm birth, increase in birth weight and decrease in neonatal mortality. Despite the low rate of complications, cervical cerclage can be considered as an effective measure for the management of high-risk pregnancies and preterm birth prevention.