Comparative analysis of pregnancy outcomes after emergency and elective cerclage: A systematic review and meta-analysis

Abstract

Cervical insufficiency poses significant risks to ongoing pregnancies, often necessitating interventions such as cervical cerclage. This review compares pregnancy outcomes in women who underwent emergency or elective cerclage. A comprehensive literature search of PubMed, Scopus, Embase, Cochrane library and Web of Science databases was conducted from the inception of these databases up to 30 April 2024. The risk of bias was assessed using the Newcastle Ottawa scale (NOS). Odds ratios (OR) and weighted mean differences (WMD) were calculated depending on the type of outcome using random-effects model. Overall, 27 studies were included. Gestational age of women who underwent emergency cerclage was significantly higher at cerclage (WMD of 6.500 and 5.698 weeks for physical examination-guided and ultrasound-guided cerclage, respectively, compared to elective cerclage). Emergency cerclage placement was associated with lower neonatal birth weights, particularly in the physical examination-guided group (WMD = -780.52 grams). The risk of PROM was higher in the physical examination-guided emergency cerclage group (OR = 2.197). However, the incidence of PROM was comparable in the elective and ultrasound-guided groups. Physical examination-guided cerclage was associated with significantly higher vaginal delivery rates compared to the emergency cerclage (OR = 1.750). Emergency cerclage, especially when guided by physical examination, is associated with later gestation at application and higher risks of adverse neonatal outcomes compared to elective cerclage.