Original title: Pregnancy outcomes and prognostic factors after history- and ultrasound-indicated cerclage in women with cervical insufficiency and/or short cervix: A retrospective cohort study
Cecile C Hulshoff, Maria G Plasman, Kanthi de Groot, Jacklijn A A Pijls +4 · September 2026
During pregnancy, the cervix acts like a doorway that must stay firmly closed until delivery. If it is too weak or shortens too early, a baby can be born dangerously early. To prevent this, doctors place a cerclage, which is a stitch sewn around the cervix to keep it shut. Researchers studied women who got this stitch either because of their past pregnancy history or because an ultrasound spotted early cervical shortening. Both methods helped women deliver around a median of 37.9 to 38.4 weeks. However, women with a past history of weakness who waited for an ultrasound sign had double the rate of early births under 34 weeks compared to those stitched based on history alone. Placing the stitch higher up on the cervix was strongly linked to longer pregnancies, showing that where the stitch sits matters more than measurements taken before the surgery.
Imagine you are trying to keep a tent from collapsing by tying a rope around its base. You can either tie the rope before you set up the tent because you know the ground is soft, or you can tie it after you see the tent starting to sag. The study found that how high up you tie the rope matters more than whether you tied it preemptively or reactively. Here, the tent is the part of the body that holds the pregnancy, the rope is the medical stitch, and the height of the rope corresponds to how close the stitch is to the opening.
For pregnant women with a short or weak cervix, a stitch called a cerclage can help prevent preterm birth. This study shows that how high the stitch is placed matters more than the reason it was placed. That means doctors may be able to improve outcomes by focusing on placement technique, and it also identifies which women are at highest risk after the stitch.
This is a retrospective study from a single center, so results may not generalize. The ultrasound-indicated group was small, especially when subdivided. Because women were not randomly assigned to cerclage type, differences in outcomes may reflect underlying risk factors rather than the procedure itself. The study cannot establish causation.
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Pregnancy outcomes and prognostic factors after history- and ultrasound-indicated cerclage in women with cervical insufficiency and/or short cervix: A retrospective cohort study — Cecile C Hulshoff, Maria G Plasman, Kanthi de Groot et al. — European journal of obstetrics & gynecology and reproductive biology: X — doi:10.1016/j.eurox.2026.100489
Abstract licence: CC BY
Explanation generated by Synthesis from the abstract — it is not the original paper.