Maternal and obstetric factors associated with successful vaginal cerclage treatment: a prospective cohort study
In brief
Low-risk women after ultrasound-guided cerclage face just 7% preterm birth <32 weeks
In a cohort of 222 women with prior preterm birth, a prediction model using maternal age, smoking status, gestational age at cerclage placement, and cervical length stratified ultrasound-indicated cases into high, medium and low risk groups with 80%, 22% and 7% rates of delivery before 32 weeks, respectively. The tool may aid counseling, but requires external validation.
- Journal
- European journal of obstetrics, gynecology, and reproductive biology (Q2)
- Published
- 23 July 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Jasper T Lamens, Annabelle L van Gils, Flip W van der Made, Sanne J Gordijn, Marjon A de Boer, Brenda B J Hermsen, et al.
- PMID
- 42503276
- DOI
- 10.1016/j.ejogrb.2026.115329
Why clinicians should know about it
- Picked for Obstetrics and Gynecology (paper of the day, 27 July 2026).
- Picked for Reproductive Medicine (paper of the day, 27 July 2026).
Abstract
OBJECTIVE: To identify maternal and obstetric factors associated with cerclage effectiveness in preventing preterm birth (PTB) < 32 weeks, in order to subsequently develop a prediction model. METHODS: Patients with prior spontaneous PTB < 34 weeks and a singleton pregnancy who received a history-based or ultrasound-indicated cerclage were included. Main outcome was PTB < 32 weeks. Maternal and obstetric factors were included in multivariate logistic regression to compose weighted prediction models for PTB < 32 weeks, separately for both indications. Individual risk scores were calculated using the composed prediction models using the regression coefficients. Optimal cut-off values between high-, medium- and low-risk were determined using receiver operating characteristic curves. RESULTS: 222 patients received cerclage treatment. PTB < 32 weeks occurred in 43/222 (19.4%), of which in 13/85 (15.3%) in the history-based and 30/137 (21.9%) in the ultrasound-indicated group. Multivariate logistic regression was deemed unreliable in the history-based group. Following multivariate logistic regression in the ultrasound-indicated group, the prediction model included maternal age (p = 0.009), smoking (p = 0.004), gestational age at placement (p = 0.001) and cervical length (p = 0.004). We divided patients in high-, medium- and low-risk groups. PTB < 32 occurred in 12/15 (80.0%) in the high-risk, 11/50 (22.0%) in the medium-risk and 5/68 (7.4%) in the low-risk group. CONCLUSIONS: Longer cervical length, higher maternal age, higher gestational age at placement and smoking status are associated with increased cerclage effectiveness. The prediction model effectively stratified included patients and can be a valuable tool in patient counselling. Future investigations should aim to include more variables and to externally validate the prediction model.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.