Trends and Predictors of Cerclage Use in the United States From 2005 to 2012

OBJECTIVE: To characterize the use of cervical cerclage on a population basis. METHODS: This population-based study of U.S. natality records from 2005 to 2012 evaluated use of cerclage in singleton and multiple gestation live births. Obstetric, medical, and demographic characteristics were evaluated. A multivariable logistic regression model was developed to determine factors associated with cerclage. Sensitivity analyses were performed to evaluate cerclage placement in multiple gestations. RESULTS: A total of 21,312,920 pregnancies including 71,582 women who underwent cerclage were included in the analysis. The overall rate of cerclage ranged between 0.3% and 0.4% during the study period. Multiple gestation was a leading characteristic associated with cerclage with 0.3% of singleton pregnancies, 1.3% of twins, 7.9% of triplets, and 18.0% of higher-order pregnancies undergoing the procedure. Another leading characteristic associated with cerclage included prior preterm birth (2.4%). In multivariate regression analyses, these factors retained significance. Cerclage use based on specific risk factors did not change appreciably during the study period. CONCLUSION: Cerclage is a commonly performed obstetric procedure that was used in similar clinical scenarios over the course of the study period. Although research evidence is less supportive of cerclage use in particular high-risk groups such as multiple gestations, these findings have not been translated into clinical practice. These findings underscore the importance of society guidelines and other tools to encourage best clinical practices.