Poster Session III ajog.

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previous LLETZ procedures. All but one woman had a laparoscopic

abdominal cerclage performed prior to pregnancy. There was one
laparotomy with abdominal cerclage at 9 weeks gestation. Of the 12
pregnancies, there were 11 liveborn infants. One woman had a first
trimester miscarriage, which was managed with misoprostol. The
median age of delivery was 38+3 weeks and the mean birthweight
was 3188 grams. Most (9/11) were delivered by elective cesarean
section; however two (18%) were delivered preterm by emergency
cesarean section at 34 and 36 weeks for preterm prelabour rupture of
membranes and contractions.
CONCLUSION: In carefully selected population, there is a high success
rate of transabdominal cerclage.

536 Cerclage suture type: provider preference or

does it matter?
Ashley N. Battarbee, Josh Ellis, Tracy A. Manuck
University of North Carolina School of Medicine, Chapel Hill, NC
OBJECTIVE: Prior studies have evaluated whether braided or non-
braided suture material influences outcomes post-cerclage, with
mixed results. We sought to evaluate whether pregnancy outcomes
vary by the thickness of suture material.
STUDY DESIGN: Retrospective cohort study at a single tertiary care
center, 2013-2016. Women with a singleton, non-anomalous
gestation who underwent cervical cerclage placement during
pregnancy were included. We evaluated those with history-indi-
cated cerclages (prophylactic, after
1 prior mid-trimester preg-
nancy losses suggestive of cervical insufficiency), transvaginal
ultrasound (TVUS)-indicated cerclages (unplanned, for cervical
length <25mm and history of prior PTB), and exam-indicated
cerclages (unplanned, due to mid-trimester cervical dilation).
Outcomes were analyzed by type of suture material, comparing
thinner polyester braided thread (EthibondÒ) and polypropylene
non-braided monofilament (ProleneÒ) to thicker 5mm braided
polyester fiber suture (MersileneÒ tape). The primary outcome was
PTB<37 weeks.
RESULTS: 214 women met inclusion criteria; 128 (60%) with
thicker Mersilene tape and 86 (40%) with thinner EthibondÒ or
ProleneÒ suture. Overall, 141 had history-indicated, 35 TVUS-
indicated, and 38 exam-indicated cerclages. The majority (69%)
were McDonald cerclages. 100 (47%) delivered <37 weeks. De-
mographics and baseline characteristics are shown in the Table.
Women with unplanned cerclage (TVUS-indicated, exam-indi-
cated) were less likely to have Mersilene suture (Table). However,
among women with unplanned cerclage, those with Mersilene had
lower rates of PTB <37 weeks (Figure). Improvements in median
delivery GA were also seen for those with Mersilene (37.7 weeks,
IQR 34.7-39) vs. Ethibond/Prolene (32.5 weeks, IQR 27.9-36.3),
p<0.001. Rates of composite neonatal morbidity (NEC, grade 3/4
IVH, BPD, death) were also lower in the Mersilene group (9% vs.
21%, p¼0.017). In regression models, Mersilene tape (aOR 0.51,
95% CI 0.27-0.96, p¼0.037) and unplanned cerclage timing (aOR
1.87, 95% CI 1.02-3.43, p¼0.044) were associated with PTB <37
weeks.
CONCLUSION: Rates of PTB are high in women with cervical cerclage
placed in pregnancy. Though placement of the thicker Mersilene
tape is less common for unplanned cerclages, its use in this high risk
subset is associated with later delivery gestational ages and lower
rates of PTB.

S320 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2018