791 Timing of Exam-Indicated Cerclage and Pregnancy Outcomes: to Emergently or Urgently Schedule?

Exam-indicated cerclage (EC) is an important treatment for cervical insufficiency with the goal of preventing preterm birth (PTB). How the interval from diagnosis of cervical dilation to EC affects pregnancy outcomes is not known. A retrospective cohort study was conducted at a single academic center from 2015-2023. Patients with a dilated cervix < 24 weeks gestation (GA) recommended for EC were included. Multiples and patients with incomplete delivery data were excluded. The time interval (hours) from ultrasound with dilated cervix to operating room anesthesia was calculated and analyzed categorically (< 12, 12-24, > 24). Age, parity, GA at EC, cervical length, dilation, and prior PTB were collected. The primary outcome was GA at delivery. Secondary outcomes included latency from EC to delivery, PTB, PPROM, and NICU admission. Categorical variables were analyzed by Fisher's exact test. Continuous variables were assessed by ANOVA or Kruskal-Wallis test. Time-to-event curves were created to display time-to-delivery by group. Linear regression was used to assess the association between interval to EC and the primary outcome after adjusting for potential confounders. 155 patients with EC were identified. The median GA at diagnosis was 21.0 weeks (IQR 19.7-21.9) and cervical dilation 1.0cm (IQR 0.5-1.0). The median GA at delivery was 37.1 weeks (IQR 30.0-39.1). As a continuous variable, there was no correlation between interval to EC and GA at delivery (ρ=-0.02, p=0.83). Comparing groups, baseline characteristics were not significantly different aside from parity (p=0.048) and pre-EC amniocentesis (p=0.001). Linear regression showed no significant difference in GA at delivery between those receiving EC < 12 (β [95% CI]: 0.36 [-1.87,2.59]) or 12-24 hours (β [95% CI]: 0.83 [-1.75,3.41]) from diagnosis, compared to those at > 24 hours. There was no difference in secondary outcomes. We observed no significant correlation between interval to EC placement and GA at delivery. These results suggest that EC can be scheduled urgently rather than emergently with similar outcomes.