Patients with prior second-trimester loss: prophylactic cerclage or serial transvaginal sonograms?

OBJECTIVE: To compare management with prophylactic cerclage versus serial transvaginal sonograms of the cervix in patients with prior second-trimester loss.

STUDY DESIGN: Singleton pregnancies with prior second-trimester spontaneous loss between 14 and 24 weeks' gestation were retrospectively reviewed. At the obstetricians' discretion, some were managed with prophylactic cerclage and some with serial transvaginal sonograms of the cervix, starting at 14 weeks, and cerclage only if cervical length was <25 mm or funneling was >25% before 24 weeks. All cerclages were McDonald. Primary outcome was preterm delivery at <35 weeks.

RESULTS: Of 177 patients with singleton pregnancies who had prior second-trimester loss identified, 66 received prophylactic cerclage and 111 were followed up with transvaginal sonography, of which 36% (40/111) had therapeutic cerclage because of cervical changes. The two management groups of prophylactic cerclage versus transvaginal sonography of the cervix did not differ in any measure of obstetric outcome, including preterm delivery at <35 weeks (23% vs 30%; P =.3), preterm delivery at <33 weeks (21% vs 26%; P =.5), or gestational age at delivery (34.6 +/- 6.8 weeks vs 34.4 +/- 6.8 weeks; P =.8).

CONCLUSION: In patients with prior second-trimester loss, serial transvaginal sonography of the cervix, with cerclage only if indicated by cervical changes, is a valuable alternative to a policy of uniform prophylactic cerclage.