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Recording available 2/16-5/2
Recording available 2/16-5/2
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Abstract Award
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Poster Session 4

Category: Prematurity

Poster Session 4

(1167) Risk Factors of Extreme Preterm Birth after Physical Exam Indicated Cerclage

Thursday, February 12, 2026
3:30 PM - 5:00 PM  

    Submitting Author and Presenting Author(s)

  • MM

    Mackenzi R. McHugh, MD

    Resident OB/GYN Physician
    EVMS Department of Obstetrics and Gynecology, Macon & Joan Brock Virginia Health Sciences at Old Dominion University
    Eastern Virginia Medical School/Norfolk, Virginia, United States

    • Coauthor(s)

  • GS

    Grace Spencer, BS, MS

    Eastern Virginia Medical School at Old Dominion University
    EVMS OBGYN, Virginia Health Sciences at Old Dominion University, Virginia, United States

  • Tetsuya Kawakita, MD, MS (he/him/his)

    Associate Professor
    Eastern Virginia Medical School Department of Obstetrics and Gynecology, Macon & Joan Brock Virginia Health Sciences at Old Dominion University
    Norfolk, Virginia, United States

Objective:
To identify risk factors associated with extreme preterm birth (< 28 weeks) in patients undergoing physical exam-indicated cerclage.

Study Design:
This was a retrospective cohort study conducted among patients who underwent physical exam-indicated cerclage at an academic institution from 2014 to 2022. The primary outcome was delivery timing (< 28 weeks’ gestation or ≥28 weeks’ gestation). We examined risk factors including maternal demographics, gestational age at cerclage, and the degree of cervical dilation before cerclage. Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). We also examined the association between the time from cerclage placement to delivery and the degree of cervical dilation using the Kaplan-Meier curve.

Results:
A total of 117 patients were included, with 31.6% (n=37) delivering < 28 weeks and 68.4% (n=80) delivering ≥28 weeks. There were no statistically significant differences between groups in maternal demographics, genitourinary infection, and gestational age at cerclage placement (Table 1). Cervical dilation at the time of cerclage was significantly greater among those who delivered before 28 weeks (median 2.0 cm vs. 1.0 cm, p=0.006). Compared to cervical dilation 1 cm, cervical dilation 2, 3, and 4-5 cm were associated with increased odds of delivery < 28 weeks (aOR 1.51 [95% CI 0.50–4.60] for 2 cm; aOR 8.82 [1.91–40.79] for 3 cm; and aOR 12.17 [2.21–67.01] for 4–5 cm). In time-to-delivery analyses, more than half of patients with 4–5 cm dilation delivered within 2 weeks of cerclage placement (Figure 1).

Conclusion:
Greater cervical dilation at physical exam–indicated cerclage is independently associated with markedly increased odds of delivery before 28 weeks. Patients presenting with 4–5 cm dilation have the shortest latency, with most delivering within 2 weeks despite cerclage. Cervical dilation should be emphasized in prognostication, risk stratification, and counseling at the time of cerclage placement.