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Poster Session 4

(988) Safety of cervical cerclage between 24 and 27 weeks: Analysis from the IC-CLEAR Cohort Study

Friday, January 31, 2025
4:00 PM – 6:00 PM  

    Submitting Author and Presenting Author(s)

  • Catalina M. Valencia, MD (she/her/hers)

    Head of Maternal Fetal Medicine Unit
    Clinica del Prado, Unidad de Medicina Materno Fetal, Medellín, Colombia
    Medellin, Antioquia, Colombia

    • Coauthor(s)

  • AC

    Arturo Cardona, MD

    Clinica del Prado, Unidad de Medicina Materno Fetal, Medellín, Colombia
    Medellin, Antioquia, Colombia

  • JB

    Jose Bareño Silva, MD, MSc

    Universidad CES, Medellin, Colombia
    Medellín, Antioquia, Colombia

  • LH

    Lina Herrera- Agudelo

    Resident
    Departamento de Obstetricia y Ginecologia, Corporación Universitaria Remington, Medellín, Colombia
    Medellin, Antioquia, Colombia

  • SV

    Susana Villegas-Sanchez

    Facultad de Medicina
    Department of Obstetrics & Gynecology, Universidad CES, Medellín, Colombia
    Medellin, Antioquia, Colombia

  • SG

    Santiago Galeano-Herrera, MD

    Resident in Obstetrics & Gynecology, Corporacion Universitaria Remington
    Departamento de Obstetricia y Ginecologia, Corporación Universitaria Remington, Medellín, Colombia
    Medellin, Antioquia, Colombia

  • SV

    Silvia M. Villegas

    Clinica del Prado, Departamento de Obstetricia y Ginecología, Medellín, Colombia
    Medellin, Antioquia, Colombia

  • NR

    Nicole D. Rojas

    Resident
    Departamento de Obstetricia y Ginecología, Corporación Universitaria Remington, Medellín, Colombia
    Medellin, Antioquia, Colombia

  • Rupsa C. Boelig, MD, MS

    Assistant Professor
    Sidney Kimmel Medical College, Thomas Jefferson University
    Philadelphia, Pennsylvania, United States

  • Vincenzo Berghella, MD (he/him/his)

    Professor, Director
    Sidney Kimmel Medical College of Thomas Jefferson University
    Philadelphia, Pennsylvania, United States

  • JB

    Joseph Bell, MD

    Associate Professor
    St. Luke’s University Health Network, Department of Obstetrics & Gynecology, Maternal Fetal Medicine, Bethlehem, PA, 18015
    Bethlehem, Pennsylvania, United States

  • Leonardo Pereira, MD

    Professor, Division Director Maternal Fetal Medicine
    Oregon Health & Science University
    Portland, Oregon, United States

  • LL

    Luisa López-Torres, MD

    Fellow Medicina Materno Fetal
    Universidad Pontificia Bolivariana, Medicina Materno Fetal, Medellín, Colombia
    Medellin, Antioquia, Colombia

  • Richard M. Burwick, MD, MPH

    Clinical Associate Professor, Western University of Health Sciences
    San Gabriel Valley Perinatal Medical Group; Pomona Valley Hospital Medical Center
    Pomona, California, United States

  • JM

    Julio Mateus Nino, MD, PhD

    Atrium Health, Wake Forest University School of Medicine
    Charlotte, North Carolina, United States

  • Joanne N. Quiñones, MD, MSCE (she/her/hers)

    Program Director, Maternal Fetal Medicine Fellowship; VC Research, Dept OBGYN
    Lehigh Valley Health Network
    Allentown, Pennsylvania, United States

  • JT

    Jorge E. Tolosa, MD, MSCE

    Professor of Obstetrics & Gynecology
    St. Luke’s University Health Network
    Bethlehem, Pennsylvania, United States

Objective: Cervical cerclage before 24 weeks gestation prolongs pregnancy in patients at risk for preterm birth. Its benefits after 24 weeks are unclear due to limited safety data. We sought to describe maternal and perinatal outcomes with cerclage placement at 24-27 weeks.

Study Design: This is a secondary analysis from the International Collaborative for Cerclage Longitudinal Evaluation and Research (IC-CLEAR), a cohort study of women with singleton pregnancies and cerclage placement. Participants were enrolled at 6 institutions in the U.S. and 2 in Colombia from June 2016 to June 2020. For this study, the primary exposure was cerclage placement between 24 0/7 and 27 5/7 weeks; the comparator group was cerclage between 20 0/7 and 23 6/7 weeks. Maternal and neonatal outcomes were evaluated using a test of medians and chi-squared test.

Results: 35 out of 839 pregnancies underwent cerclage placement between 24 0/7 and 27 5/7 weeks; 88% (n=31) were from the centers in Colombia and 12% (4) in the U.S. Cerclage was performed at a median gestational age of 25.4 weeks (IQR 24.8-26.3) and the median latency from placement to delivery was 10.7 weeks (IQR 7.4-11.35). Premature rupture of membranes occurred in 18% (n=6), and clinical chorioamnionitis in 3% (n=1). Three patients required ICU admission, two due to preeclampsia with severe features. NICU admission was required for 10 neonates (32%), with two cases of sepsis and two neonatal deaths. When comparing maternal and perinatal safety outcomes in those with cerclage at 24-27 weeks to those with cerclage at 20-24 weeks (n=328), there was a higher rate of maternal ICU admission, not associated with cerclage use; no significant differences were observed in maternal or neonatal infectious morbidity, or in other neonatal morbidity or mortality (Table 1).

Conclusion: Cervical cerclage performed between 24 and 27 weeks is not associated with a significant increase in maternal morbidity or adverse neonatal outcomes. Randomized controlled studies to evaluate the effectiveness and safety of cerclage in patients at 24 or more weeks of gestation are needed.