Implementation of a Three-Step Cervical Cerclage Technique in Prophylactic and Emergency Settings: Maternal and Perinatal Outcomes in Clinical Practice

Background: Cervical insufficiency is associated with second-trimester pregnancy loss and spontaneous preterm birth. A three-step cervical cerclage approach has been implemented at our center for prophylactic and emergency indications. This study describes maternal, obstetric, and neonatal outcomes following this institutional approach and compares outcomes between indications. Methods: We conducted a retrospective, single-center observational study including 142 pregnancies managed between January 2015 and March 2026. Cerclage indications were prophylactic (n = 80) or emergency (n = 62). The groups represented clinically distinct populations; comparisons were descriptive and exploratory. Outcomes were analyzed at pregnancy and individual newborn levels. Exploratory neonatal regression models included gestational age at delivery to estimate conditional associations rather than causal treatment effects. Results: Prophylactic cerclage was placed earlier (15.28 ± 2.64 vs. 20.14 ± 3.33 weeks; p < 0.001), with greater preprocedure cervical length (31.33 vs. 14.58 mm; p < 0.001) and more frequent previous adverse obstetric outcomes. Gestational latency was longer in the prophylactic group (20.48 vs. 14.34 weeks; p < 0.001), but no statistically significant difference in gestational age at delivery was detected (median, 263.5 vs. 263.0 days; p = 0.306). Preterm birth before 37 weeks occurred in 33.8% and 43.5%, respectively (p = 0.296). Cervical cleisis was more frequent in emergency cases (25.8% vs. 3.8%; p < 0.001). Six pregnancies ended in gestational loss before 22 weeks. Among 140 newborns with available birth-weight data, emergency cases had lower mean birth weight (2485.8 vs. 2786.1 g; p = 0.049) and higher low birth weight rates (45.0% vs. 26.3%; p = 0.021). After adjustment for gestational age at delivery, no statistically significant association with cerclage indication was detected for birth weight (p = 0.825) or low birth weight (p = 0.824). Conclusions: This cohort describes outcomes following an institutional cerclage approach in clinically non-interchangeable groups. Between-group comparisons and gestational-age-adjusted neonatal associations do not establish causal effects or equivalence. Procedural feasibility was not formally assessed, and efficacy, comparative safety, and superiority over standard cerclage or expectant management cannot be established.