Abstract

Background/Objectives: Amnioreduction prior to emergency cervical cerclage (ECC) has been proposed as a method to relieve the tension of the protruding amniotic membrane, thereby facilitating its intact retraction back into the uterine cavity. However, the effect of this procedure on pregnancy outcomes remains unclear. This study aims to evaluate the effect of amnioreduction on pregnancy outcomes in patients who received ECC during the second trimester. Methods: We conducted a retrospective analysis of the characteristics and pregnancy outcomes of patients who underwent ECC across four institutions between 1 July 2021 and 31 December 2024. Pregnancies were classified into the amnioreduction group and the non-amnioreduction group based on whether amnioreduction was performed prior to the ECC. The gestational age (GA) at delivery was the primary outcome measure. A multivariate linear regression model was employed to identify factors associated with GA at delivery. Additionally, a propensity score matching model was constructed for sensitivity analysis. A subgroup analysis was also conducted for pregnancies with cervical dilation ≥ 4 cm to evaluate the effect of amnioreduction in this specific subpopulation. Results: A total of 406 pregnancies were analyzed, and the results indicated no significant differences between the amnioreduction group and the non-amnioreduction group regarding GA at delivery (30.4 (25.7, 35.9) vs. 31.2 (26.0, 37.0) weeks, p = 0.655) or pregnancy latency (days from cerclage to delivery: 49.0 (15.0, 87.5) vs. 57.0 (18.0, 92.3) days, p = 0.397). The rates of preterm birth at <28 weeks (37.0% vs. 37.2%, p = 0.969), <32 weeks (54.6% vs. 52.3%, p = 0.684), <34 weeks (64.8% vs. 60.7%, p = 0.455), and <37 weeks (77.8% vs. 73.8%, p = 0.417) of gestation, as well as the rate of preterm premature rupture of membranes (26.9% vs. 22.5%, p = 0.360), were comparable between the two groups. No differences were observed in the neonatal birth weight or 5 min Apgar score between the groups. After balancing baseline characteristics using propensity score matching, all outcome measures remained similar between the two groups. Subgroup analysis of pregnancies with painless cervical dilation ≥ 4 cm also revealed no significant differences in any outcome measures between those who received amnioreduction and those who did not prior to ECC. Conclusions: Amnioreduction performed prior to ECC was not associated with adverse pregnancy outcomes based on the endpoints assessed in this cohort. Because procedure-specific complications were not systematically recorded, prospective studies collecting procedure-related safety data are required before amnioreduction can be definitively recommended.

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