# Comparison of pregnancy outcomes after history-indicated and ultrasound-indicated cervical cerclage: A systematic review and meta-analysis

## TL;DR

This study compares pregnancy outcomes for women who received cervical cerclage based on ultrasound versus medical history, finding worse outcomes with ultrasound-indicated cerclage.

## Contribution

The study provides a meta-analysis comparing outcomes of ultrasound-indicated versus history-indicated cervical cerclage in high-risk pregnancies.

## Key findings

- Ultrasound-indicated cerclage was linked to higher preterm birth and low birth weight risks.
- Women with ultrasound-indicated cerclage had increased risk of chorioamnionitis.
- Findings were based on observational studies and may be biased due to unadjusted confounders.

## Abstract

To compare maternal and neonatal outcomes in women with a previous history of pregnancy loss and/or preterm delivery who underwent ultrasound-indicated cerclage (UIC) or history-indicated cerclage (HIC).

PubMed, Web of Science, Scopus, and Embase databases were searched for observational studies and randomized controlled trials (RCT) from inception to 30 April 2024. Eligible studies should have compared the outcomes of women with singleton pregnancies who underwent UIC or HIC. STATA version 15.0 was employed, and the analysis was done using a random effects model and unadjusted effect sizes from the included studies.

Of 25 included studies (n = 3909), most (n = 18) were retrospective cohort studies. Compared to women who underwent HIC, UIC was associated with higher risk of having a preterm birth (<37 weeks of gestation) (OR 1.48, 95% CI: 1.17, 1.88; N = 15), low birth weight (<2500g) (OR 1.78, 95% CI: 1.32, 2.41; N = 6) and admission to neonatal intensive care unit (OR 1.70, 95% CI: 1.27, 2.27; N = 6,). Women with UIC also had a higher risk of chorioamnionitis (OR 2.34, 95% CI: 1.36, 4.04; N = 4). The risk of having a low APGAR score (5-minute score of less than 7), fetal death and preterm premature rupture of membrane (PPROM) was comparable among the two groups.

Our results demonstrate that UIC is associated with higher risks of adverse pregnancy outcomes compared to HIC. However, our evidence emanates from observational studies and is prone to biases, particularly because the findings were unadjusted for potential confounders. More clinical trials are needed to confirm our observations.

PROSPERO CRD42024544181