Clinical and cervical factors associated with obstetric outcomes following cervical cerclage: a ten-year retrospective cohort study

Objective This study aimed to evaluate obstetric and neonatal outcomes following cervical cerclage and to identify maternal and cervical characteristics associated with gestational age at delivery in a ten-year retrospective cohort. Methods We retrospectively reviewed the records of 66 women who underwent cervical cerclage for cervical insufficiency between 1 January 2013 and 1 January 2023 (cerclage at 12 to 25 weeks; four multiple pregnancies, 6.1%). Cerclage was classified as emergency (examination-indicated; n = 23, 34.8%) or elective (history- or ultrasound-indicated; n = 43, 65.2%). Associations with gestational age at delivery were evaluated using correlation analysis, stratification by indication, multivariable regression, and a sensitivity analysis excluding multiple pregnancies. Results Sixty-six women were included. In unadjusted analyses, later gestational age at cerclage (r = −0.349, p = 0.004), shorter cervical length (r = 0.562, p < 0.01), and greater cervical dilation (r = −0.540, p < 0.01) were associated with earlier delivery, whereas maternal age, parity, and previous cerclage were not. Emergency cerclage was associated with earlier delivery than elective cerclage (median 31 vs. 37 weeks, p = 0.007), and the association of cervical length with delivery timing differed between strata (interaction p = 0.016). In the primary adjusted model no variable was significant; cervical length ( β = 0.21 weeks per mm, p = 0.055) and cervical dilation ( β = −1.36 weeks per cm, p = 0.088) were borderline, and cervical length became significant when an emergency indicator replaced dilation ( β = 0.31, p = 0.005). For delivery before 34 weeks, neither cervical dilation (OR 1.83 per cm, p = 0.062) nor cervical length (OR 0.90 per mm, p = 0.064) was significant. Excluding multiple pregnancies gave similar results. Apgar scores were delivery-related outcomes. Conclusions In this retrospective cohort, earlier cerclage, longer cervical length, and less advanced cervical changes were associated with later delivery in unadjusted analyses; in the primary adjusted model no variable was independently significant, although cervical length and dilation were borderline and findings were sensitive to model specification. These findings do not establish causal effectiveness, as no untreated control group was available. Prospective controlled studies are needed.