Efficacy of transvaginal cervical cerclage in women at risk of preterm birth following previous emergency cesarean section

Abstract

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Previous term emergency caesarean section is a risk factor for recurrent spontaneous preterm birth; a retrospective cohort study

“…It would be expected that this intervention would prolong the gestational age at delivery, however, we show that over 70% of these women still deliver preterm despite this intervention, compared with only a quarter in our control group. This is consistent with previous published data from our group showing that transvaginal cerclage is less effective at preventing preterm birth in women who have a sPTB after previous EmCS compared with other high risk women [7].…”

“…after 37 week's gestation) SS-EmCS was 3 times the risk of that following an initial term vaginal delivery [3]. We have also recently demonstrated that women receiving cervical cerclage have a 10-fold increased risk of recurrent, early preterm birth < 30 weeks' gestation, even if the emergency caesarean is performed earlier in labour [7]. It has been postulated that unintentional cervical trauma; either by an inadvertently low uterine incision that includes the cervix or caudal extensions into the cervix during the caesarean section, contributes to a compromise in cervical integrity which predisposes to subsequent preterm birth [8,9].…”

Prior term delivery increases risk of subsequent recurrent preterm birth: An unexpected finding

“…This study has also shown that approximately half of women in the prior term birth group still deliver preterm despite a cervical cerclage, compared with only 20% in our sPTB only group although these numbers are small. This is consistent with previous published data showing that transvaginal cerclage is less effective at preventing PTB in women who have a sPTB after previous term EmCS compared with other high‐risk women 12 …”

“…This is consistent with previous published data showing that transvaginal cerclage is less effective at preventing PTB in women who have a sPTB after previous term EmCS compared with other high-risk women. 12 Although our data suggest a causative link between a prior term birth and subsequent recurrent sPTB, prospective confirmation would be important and is the subject of ongoing investigation. 21 It is also possible that some women may have acquired new risk F I G U R E 1 Gestational age at birth among the three groups (term CS + sPTB, term VB + sPTB and sPTB only groups) (A).…”

“…More worrying is the high risk of a recurrent sPTB in this group of women 11 . Recent evidence suggests that the risk of a recurrent sPTB following an initial term full dilatation EmCS could be up to three times the risk of that following an initial term vaginal birth (VD) 11,12 . Therefore, the objective of this study was to evaluate the risk of sPTB recurrence following an initial term birth.…”