Name: Paul A.

Date: September 19, 2023

Section : BSN 3-A Area of Exposure: DR BQMH

Role of body mass index in pregnancy outcomes after emergency cerclage for cervical
insufficiency in singleton pregnant patients
As one of the causes of premature birth, cervical insufficiency is responsible for about 8% of
recurrent pregnancy losses in the second or third trimester , and for 0.2 – 7% of all complications
encountered during pregnancy. Therefore, more efforts are being made to diagnose and treat cervical
insufficiency at an early stage.
Cervical cerclage is the most commonly used surgical approach to manage cervical insufficiency
and has been included as the rescue operation in the American College of Obstetricians and
Gynecologists (ACOG) guidelines with various indications. Emergency cerclage is usually performed in
the second trimester on pregnant patients who present with a shortened and dilated cervix, sometimes
even accompanied by amniocele. Its clinical significance, however, in salvaging pregnancy has not been
unequivocally proven, especially when severe cervical insufficiency occurs. In addition, its related
complications and adverse events have not been fully reported in the published literature. Therefore, it
is not known whether the effects of emergency cerclage due to shortening or dilation of the cervix in the
second trimester may potentiate the development of related complications.
Among all the possible contributory factors to premature birth due to cervical insufficiency,
overweight and obesity became a clinical cynosure on their roles in devastating pregnant outcomes. A
meta-analysis of more than one million pregnancies found that being both overweight and obese
increased the risk of preterm birth before 32 gestational weeks. Presumptively, being both overweight
and obese may ill-prime pregnant women for various obesity-related gestational disorders. Although
emergency cerclage has been used in clinical practice for dealing with cervical insufficiency -induced
preterm births, few studies have looked into the possible link between the BMI status and the outcome
of cerclage. However, whether being overweight or obese is associated with increased, decreased or
neutral cerclage efficacy has largely remained unaddressed.
Thus, the present study aimed to evaluate the effectiveness of emergency cerclage in patients
with different BMIs, explore the clinical value of emergency cerclage in improving pregnancy outcomes,
and to analyze if a high BMI value was a significant risk factors.
Pregnant cervical insufficiency patients with BMIs > 28 kg/m2 may ill-serve the gestational
outcomes and suture-to-delivery interval after their emergent cerclage. Additionally, BMI, frequency of
cerclage and vaginal microecology accounted for higher fetal loss in patients who underwent emergency
cerclage.

Reference:
Liu, W., Lu, Y., Fan, Y. et al. Role of body mass index in pregnancy outcomes after emergency cerclage for
cervical insufficiency in singleton pregnant patients. BMC Pregnancy Childbirth 23, 645 (2023).
https://doi.org/10.1186/s12884-023-05974-y