Maternal and neonatal outcomes after prophylactic and ultrasound-indicated emergency cervical cerclage

OBJECTIVES: To evaluate maternal and neonatal outcomes after prophylactic and ultrasound-indicated emergency cervical cerclage. METHODS: This retrospective cohort study included all the women who underwent McDonald cervical cerclage at a tertiary medical center during 2010-2024 and delivered at ≥23 weeks. Women were categorized according to the clinical timing and urgency of cerclage placement: prophylactic cerclage, placed electively based on obstetric history before cervical change was detected; and ultrasound-indicated emergency cerclage, performed for ultrasound-detected cervical shortening in the absence of contractions, bleeding, ruptured membranes, or physical examination-detected cervical dilation. RESULTS: Cerclage was performed earlier in the prophylactic (n=127) than the emergency (n=52) group (14.1 ± 1.2 vs. 18.4 ± 3.2 weeks, p<0.001). Significant differences were not observed between the groups in the mean gestational age at cerclage removal (37.1 ± 3.4 vs. 37.2 ± 3.4 weeks, p=0.614) or the mean gestational age at delivery (38.0 ± 3.2 vs. 37.0 ± 3.6 weeks, p=0.885). Nor did the proportions differ significantly of spontaneous preterm birth <37 weeks (18.1 vs. 19.2 %, p=1.00) or <32 weeks (7.1 vs. 5.8 %, p=1.000). Neonatal outcomes, including birthweight, admission to the neonatal intensive care unit, respiratory complications, and neonatal mortality, were comparable. Multivariable analysis confirmed that cerclage, whether prophylactic or emergency, was not independently associated with spontaneous preterm birth <37 weeks. CONCLUSIONS: Emergency cerclage was not associated with worse maternal and neonatal outcomes compared with prophylactic cerclage in this cohort, suggesting that, in selected patients, it may be a reasonable management approach.