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- W4313643727 abstract "To identify socio-demographic, clinical and sonographic predictors of pregnancy prolongation up to 32 weeks among women undergoing an exam-indicated cerclage. We conducted a retrospective cohort study of women undergoing a cervical cerclage at a single tertiary academic center between 2008 to 2020. Data pertaining to maternal demographics, obstetric course, sonographic cervical length and cerclage operative technique were abstracted for women undergoing exam-indicated cerclage with a singleton gestation. Co-variates with P≤0.2 in the unadjusted survival analyses were considered for incorporation into an adjusted Cox proportional-hazards model evaluating factors associated with pregnancy prolongation up to 32 weeks. Out of 1086 transvaginal cervical cerclages performed over the study period, 285 cases of exam–indicated cerclage were included in analyses. In the unadjusted survival analyses 5 factors were associated with longer pregnancy duration: multiparity with recent birth ≥32 weeks (P < .001), use of Mersilene suture (P .03), evidence of prior cervical trauma (P .03), gestational age at cerclage placement (P .04), and concomitant progesterone use (P < .01) while 4 were associated with shorter pregnancy duration: preoperative cervical dilation (P < .0001), post-operative cervical length (P < .0001), and administration of a penicillin antibiotic (P .03) and/or multiple doses of indomethacin (P < .01). An adjusted Cox proportional-hazards model incorporated 5 of these covariates and 3 with an unadjusted P value ranging from .05 to .2 that were independently predictive of pregnancy prolongation up to 32 weeks. Delivery < 32 weeks gestation occurred in 99 (35%) of cases. The bias-corrected bootstrapped (1000 repetitions) AUROC for a logistic regression model predictive of delivery < 32 weeks containing these 8 covariates was 0.84 (95% CI 0.77-0.87). A survival analyses approach using 8 covariates as shown in our model offers valuable clinical insight into predictors of pregnancy prolongation up to 32 weeks among women undergoing an exam-indicated cerclage.View Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
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- W4313643727 date "2023-01-01" @default.
- W4313643727 modified "2023-09-26" @default.
- W4313643727 title "Predictors of pregnancy duration among women undergoing exam-indicated cerclage: a survival analysis approach" @default.
- W4313643727 doi "https://doi.org/10.1016/j.ajog.2022.11.616" @default.
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