Cerclage Reinforcement Following Primary Cerclage Procedure for Prevention of Preterm Birth: A Systematic Review and Meta-Analysis.

Publication/Presentation Date

8-1-2025

Abstract

BACKGROUND: Transvaginal cerclage is an important intervention used to decrease the risk of preterm delivery.

OBJECTIVE: We performed a systematic review and meta-analysis to evaluate the efficacy of a reinforcing cerclage (RC) should the initial cerclage fail.

SEARCH STRATEGY: Scopus, PubMed, Cochrane Central Register of Controlled Trials, Ovid Medline, CINAHL and clinicaltrials.gov were searched from database inception through December 2023.

SELECTION CRITERIA: All studies compare the use of RC to expectant management after initial cerclage placement to prevent preterm birth.

DATA COLLECTION AND ANALYSIS: Two authors extracted data following PRISMA guidelines. Primary outcomes were gestational age at delivery and preterm delivery rate before 37 weeks. Subgroup analyses examined outcomes by initial cerclage indication (history-indicated, ultrasound-indicated, and physical exam-indicated). Results were summarised as weighted mean difference (MD) or risk ratio (RR) with associated 95% confidence intervals. Heterogeneity was measured using Higgins I

MAIN RESULTS: Eight studies (n = 440), comparing RC to no RC after initial cerclage failure, met inclusion criteria. Primary analysis showed delivery occurred 3.98 weeks earlier with RC (95% CI [-5.29, -2.67], p <  0.0001). The RC group had a higher preterm delivery rate before 37 weeks (RR 1.46, 95% CI [1.03, 2.06], p = 0.03). High heterogeneity (I

CONCLUSION: Placement of a RC following failure of an initial cerclage was associated with a reduced pregnancy latency and an increased risk for preterm delivery. Given the non-randomised nature of the available evidence and significant heterogeneity, these findings should be interpreted with caution. Reinforcing cerclage should only be considered within research settings.

Volume

132

Issue

9

First Page

1202

Last Page

1211

ISSN

1471-0528

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

40297973

Department(s)

Administration and Leadership

Document Type

Article

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