Preterm deliveries among women with MacDonald cerclage performed due to cervical incompetence

Abstract

Objective: The study was aimed to assess the impact of obstetric risk factors for preterm delivery among women with MacDonald cerclage performed due to cervical incompetence.

Study design: A cohort study was conducted including all patients with MacDonald cerclage performed at 12-14 weeks gestation due to cervical incompetence (n = 793). Deliveries occurred between the years 1988 and 2002 in a University Medical Center. A multiple linear regression model was used to assess the impact of maternal characteristics as well as pregnancy complications on the length of pregnancy.

Results: The following factors were found to be associated with preterm delivery among these patients, in the univariate analysis: nulliparity, fertility treatments, severe preeclampsia, second-trimester bleeding, premature rupture of membranes (PROM), chorioamnionitis and placental abruption. Using a multiple linear regression model, with backward elimination, the impact of these variables on the length of pregnancy was assessed (R(2) = 0.33, p < 0.001). The mean gestational age at birth among patients without risk factors was 38.1. Second-trimester bleeding reduced gestational age by 6.4 weeks, chorioamnionitis by 5.6 weeks, placental abruption by 5.1 weeks, PROM by 3.2 weeks and severe preeclampsia by 2.4 weeks.

Conclusions: Second-trimester bleeding, chorioamnionitis, placental abruption, PROM and severe preeclampsia are ominous signs for preterm delivery among patients with MacDonald cerclage performed due to cervical incompetence.