{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T05:47:50Z","timestamp":1770443270539,"version":"3.49.0"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T00:00:00Z","timestamp":1755129600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Objective<\/jats:title>\n To compare maternal and neonatal outcomes in women with a previous history of pregnancy loss and\/or preterm delivery who underwent ultrasound-indicated cerclage (UIC) or history-indicated cerclage (HIC).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n PubMed, Web of Science, Scopus, and Embase databases were searched for observational studies and randomized controlled trials (RCT) from inception to 30 April 2024. Eligible studies should have compared the outcomes of women with singleton pregnancies who underwent UIC or HIC. STATA version 15.0 was employed, and the analysis was done using a random effects model and unadjusted effect sizes from the included studies.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of 25 included studies (n\u2009=\u20093909), most (n\u2009=\u200918) were retrospective cohort studies. Compared to women who underwent HIC, UIC was associated with higher risk of having a preterm birth (<37 weeks of gestation) (OR 1.48, 95% CI: 1.17, 1.88; N\u2009=\u200915), low birth weight (<2500g) (OR 1.78, 95% CI: 1.32, 2.41; N\u2009=\u20096) and admission to neonatal intensive care unit (OR 1.70, 95% CI: 1.27, 2.27; N\u2009=\u20096,). Women with UIC also had a higher risk of chorioamnionitis (OR 2.34, 95% CI: 1.36, 4.04; N\u2009=\u20094). The risk of having a low APGAR score (5-minute score of less than 7), fetal death and preterm premature rupture of membrane (PPROM) was comparable among the two groups.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Our results demonstrate that UIC is associated with higher risks of adverse pregnancy outcomes compared to HIC. However, our evidence emanates from observational studies and is prone to biases, particularly because the findings were unadjusted for potential confounders. More clinical trials are needed to confirm our observations.<\/jats:p>\n <\/jats:sec>\n \n Systematic review protocol registration<\/jats:title>\n \n PROSPERO\n CRD42024544181<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0328564","type":"journal-article","created":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T17:35:51Z","timestamp":1755192951000},"page":"e0328564","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of pregnancy outcomes after history-indicated and ultrasound-indicated cervical cerclage: A systematic review and meta-analysis"],"prefix":"10.1371","volume":"20","author":[{"given":"Jiamei","family":"Wang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ling","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunyan","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenjun","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8966-0314","authenticated-orcid":true,"given":"Xuya","family":"Shen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,8,14]]},"reference":[{"issue":"3","key":"pone.0328564.ref001","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/j.ijsu.2006.02.006","article-title":"Cervical cerclage: a review","volume":"5","author":"R Simcox","year":"2007","journal-title":"Int J Surg"},{"issue":"9","key":"pone.0328564.ref002","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1097\/OGX.0000000000001182","article-title":"Cervical cerclage: a comprehensive review of major guidelines","volume":"78","author":"S Giouleka","year":"2023","journal-title":"Obstet Gynecol Surv"},{"issue":"6","key":"pone.0328564.ref003","article-title":"Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy","volume":"6","author":"Z Alfirevic","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"issue":"4","key":"pone.0328564.ref004","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1080\/00016340701239651","article-title":"Cerclage in cervical insufficiency: when and to whom?","volume":"86","author":"E RUTANEN","year":"2007","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"1","key":"pone.0328564.ref005","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1002\/ijgo.13835","article-title":"FIGO good practice recommendations on cervical cerclage for prevention of preterm birth","volume":"155","author":"FIGO Working Group for Preterm Birth","year":"2021","journal-title":"Int J Gynaecol Obstet"},{"issue":"1","key":"pone.0328564.ref006","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1097\/AOG.0b013e31821fd5b0","article-title":"Cervical length screening with ultrasound-indicated cerclage compared with history-indicated cerclage for prevention of preterm birth: a meta-analysis","volume":"118","author":"V Berghella","year":"2011","journal-title":"Obstet Gynecol"},{"issue":"12","key":"pone.0328564.ref007","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1097\/OGX.0b013e318189634e","article-title":"Ultrasound-Predicated Versus History-Predicated Cerclage in Women at Risk of Cervical Insufficiency","volume":"63","author":"MJC Blikman","year":"2008","journal-title":"Obstetrical & Gynecological Survey"},{"key":"pone.0328564.ref008","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"MJ Page","year":"2021","journal-title":"BMJ"},{"key":"pone.0328564.ref009","unstructured":"Wells G, Shea B, O\u2019Connell D, Peterson J, Welch V, Losos M, et al. 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