The Impact of the Indications for Emergency Cervical Cerclage on Pregnancy Outcomes

Background: Emergency cervical cerclage is performed when indicated to mitigate the risk of preterm birth based on ultrasound or physical examination findings. Although success rates for emergency cervical cerclage range from 60% to 80%, with an average pregnancy extension of 4 weeks, the impact of the specific indication on pregnancy outcomes remains unclear. Objective: To clarify differences between the impact of emergency cervical cerclage for cases diagnosed by ultrasound vs. physical examination to mitigate the risk of preterm birth. Study Design: This retrospective cohort study examined singleton pregnancies that underwent emergency cerclage using McDonald’s technique, at 18–23.6 weeks of gestation, at a single tertiary healthcare center, from 2017 to 2023. The cohort was grouped according to whether the need for cerclage was based on ultrasound or physical examination. The primary study outcome was early preterm birth, defined as delivery <34 weeks of gestation. Secondary outcomes included pregnancy prolongation following cerclage, and other obstetric sequelae. Results: : total of 52 cases of emergency cervical cerclage were included in this analysis. Among these, 39 patients were categorized in the ultrasound group, while 13 patients comprised the physical examination group. Maternal characteristics, including age, gravidity, and parity, did not differ significantly between groups. The gestational age at the time of the procedure was similar between the ultrasound (20.2 ± 1.9 weeks) and physical examination groups (21.1 ± 1.7 weeks, respectively; p=0.131). The ultrasound group had longer pre-cerclage cervical length compared to the physical exam group (13.7 ± 7.3 mm vs. 6.2 ± 5.0 mm, respectively (p=0.008)). History of hysteroscopy was more common in the physical examination group (p=0.035). Most patients (84.6%) who underwent emergency cerclage delivered after 34 weeks of gestation, with no significant difference in gestational age at delivery observed between groups (p = 0.886). Pregnancy prolongation was comparable between the ultrasound and physical examination groups (15.5 ± 4.2 weeks vs. 13.3 ± 6.2 weeks, respectively; p=0.168). Conclusion: Emergency cervical cerclage effectively extends pregnancy duration and reduces the risk of early preterm birth. The specific indication for cerclage does not influence pregnancy outcomes significantly.