The prevalence and timing of cervical cerclage placement in multiple gestations

Objectives: To investigate the prevalence and timing of cervical cerclage placement in multiple gestations. Methods: Our perinatal database was queried for all multiple gestations delivered at Evanston Hospital from 12/95 through 12/00. This list was then cross-matched with billing and medical records for 'incompetent cervix' and 'cerclage.' The medical records of all deliveries ≤26 weeks were reviewed in order to ascertain if cervical incompetence was responsible for the preterm delivery. Results: There were 802 deliveries of multiple gestations ≥14 weeks over a 5-year period. The number of patients that underwent cerclage placement was 29 or 3.6%. The mean gestational age at cerclage placement was 18.6±4.5 weeks (range 11-24.6). Twelve were elective or prophylactic while 17 were 'urgent' or 'emergent.' The mean gestational age for the 17 emergent cerclages was 21.4±2.2 weeks (range 16.6-24.6). When compared with those patients who did not undergo cerclage placement, there was no difference in maternal demographics including age, parity, or previous full-term delivery. There was a significant difference in the gestational age at delivery for the cerclage vs. no cerclage group; 29.3±5.6 vs. 34.4±4.6 weeks, respectively, and in the frequency of losses at ≤26 weeks; 8/23 (38%) vs. 48/707 (6.8%), P<0.001. Ten of the losses in the no cerclage group appeared consistent with incompetent cervix for a total of 39/802 or 4.9% rate of cervical incompetence in our multiple gestation population. Conclusions: The relatively low prevalence of cervical incompetence in our multiple gestations does not justify prophylactic cervical cerclage placement. Expectant management with serial cervical examinations starting at 16-18 weeks appears more prudent.