Predictors of cerclage failure in singleton pregnancies with a history of preterm birth and a sonographic short cervix.

OBJECTIVE To identify predictors of ultrasound-indicated cerclage failure in singleton pregnancies for preventing extremely preterm birth. METHODS A retrospective cohort study included 96 singleton pregnancies with ultrasound-indicated McDonald cerclage in women with prior preterm birth (PTB) and cervical shortening. Descriptive statistics were calculated at baseline and logistic regression analyses were performed to identify the factors associated with cerclage failure. RESULTS In all, 28 (29%) of them suffered preterm delivery at <28 weeks. Multivariate analysis identified cervical dilation, noncephalic presentation, and platelet-lymphocyte ratio (PLR) as independent predictors of cerclage failure (OR, 3.12, 95%CI, 1.01-9.66; OR, 5.81, 95%CI, 1.04-32.53; OR, 1.02, 95%CI, 1.01-1.03, respectively). The efficacy of these predictors was evaluated using a receiver operating characteristics. The area under the curve was 0.87 (95%CI: 0.78-0.96, P<0.001) with a sensitivity of 78.6% and specificity of 88.2%. CONCLUSION Our findings indicated that cervical dilation, fetal presentation, and PLR were valuable predictors of cerclage failure in singleton pregnancies with a history of PTB and a sonographic short cervix. The results can be potentially used to assess the prognosis of patients after cerclage and alert clinicians to consider enhanced surveillance and administration of individuals at an increased risk.