(1000) Emergency Cervical Cerclage Versus Expectant Management in Women with Cervical Insufficiency Beyond 24 weeks.

Objective: To determine whether cervical cerclage (CC) reduced the rate of preterm birth (sPTB), prolonged pregnancy (PP) latency and improved perinatal outcomes (PO) in women with cervical insufficiency (CI) > 24 weeks compared to expectant management (EM).

Study Design: This was a prospective quasi-experimental study that compared CC vs EM in patients with CI > 24 weeks (cervical dilatation + exposed fetal membranes). Prospective data of the CC group was compared with historic data of similar characteristics of EM between 2022 to 2024 at an urban hospital in a 3:1 ratio. Both groups received Vaginal Progesterone, Betamethasone, Antibiotics and Indomethacin. Patient in the CC group were discharged home within 24 hours of surgery while EM group remained on admission until delivery. The outcomes were overall sPTB < 37 weeks, early and late sPTB (< 34 and 34 - 37 weeks), PO, NICU admission and duration. Baseline characteristic and PO were stratified and reported by intervention groups using Chi square and Kruskal Wallis. Multivariable and adjusted binomial and multinomial logistic regression models were used to assess rate of PTB between the two study groups. (Table 2).

Results: Of the 91 patients recruited, 67 had CC while 24 had EM. Baseline characteristics were similar. Neonates of women with CC were delivered at a later gestational age [ 38.2 wks vs 29.9 wks, p < 0.00 1], had higher birth weight [ 3170 g vs 2295 g, p < 0.001 ], lower NICU admission rate [ 18 (27.3%) vs 16 (66.7%), p=0.001 ] and lower rate of severe neonatal complications [ 1 (6%) vs 6 (46.2%), p < 0.010 ] Table 1. Compared to women with EM, those with CC had 95% lower odds of PTB < 37 weeks [ aOR; 0.05, (0. 0.14 - 0.19) , p < 0.001 ] and 97% lower risk of early PTB < 34 weeks [ aRR; 0.03, (0.01 - 0.15), p < 0.001]. There was no difference in late PTB (34 - 37 weeks) between the groups [ aRRR; 0.18, (0.25 - 1.25), p=0.08] Table 2.

Conclusion: This study showed that compared to EM, CC in women with CI > 24 weeks reduced the risks of sPTB, prolonged pregnancy latency and reduced NICU admission and severe neonatal complications rates.