Cerclage for Prevention on Preterm Birth in Women With Placenta Previa

The purpose of this study is to perform a large multi-center randomized trial comparing the role of cervical cerclage versus expectant management in women with placenta previa presenting with shortened cervical length ( ≥ 10mm and ≤ 30mm) between 18w0d and 26w0d of gestation. In addition, the role of fetal fibronectin (fFN) for the prediction of preterm birth and hemorrhage will be elucidated. The hypothesis is that placement of a cervical cerclage between 18w0d to 26w0d in patients with a short cervix and complete placenta previa will decrease preterm birth as compared to expectantly managing these patients.

• Placement of a Cervical Cerclage (Procedure), also known as cerclage: Surgical placement of a cervical cerclage
• Standard Expectant Management (Procedure), also known as Expectant Management: Participants assigned to the expectant management group will be followed by their doctor and managed per standard management which includes: * Standard management for placenta previa. * Hospital admission for vaginal bleeding/hemorrhage * Antenatal corticosteroids > 24w0d of gestation * Tocolytic therapy per physician's discretion * Magnesium sulfate for neuroprotection * Fetal Heart Rate Monitoring * Avoidance of digital examinations of the cervix * Elective delivery no earlier than 36w0d gestation unless indicated (uncontrolled hemorrhage, imminent delivery, PROM > 34 wks, worsening maternal or fetal condition ) * Fetal Fibronectin (fFN) test collected at the time of transvaginal Ultrasound.

Primary outcomes

• Gestational age (GA) at birth [measure taken in the first 23 hours after birth.]: The gestational age (GA) of the baby noted at birth

Secondary outcomes

• Newborn Birth weight [measured within 1-2 days after birth]: Newborn Birth weight measure within 1-2 days after birth.
• Need for Maternal Blood Product replacement [measured from the time participant is enrolled in the study until 30 days after delivery.(approximately 40 weeks)]: Maternal need for blood product replacement such as Fresh Frozen Plasma.
• Number of participants delivering prematurely following hemorrhage who have a positive fFN test. [measured at delivery]: Measure the total number of patients (participants) who delivered prematurely as a result of hemorrhage who also had a positive fFN test.

Sex: Female, ages: 18 Years to any, accepts healthy volunteers

Inclusion Criteria:

* Singleton pregnancy, ≥ 18yrs old
* GA 18w0d to 26w0d inclusive @ time of enrollment
* Documentation of complete placenta previa (≥ 10mm over internal os)
* Agrees to participate in trial and signs/date an informed consent form.

Exclusion Criteria:

* Contraindication to expectant management (i.e. active labor, Non-reassuring fetal heart rate (NRFHR), Intrauterine fetal demise (IUFD), uncontrolled hemorrhage)
* Fetal condition likely to cause serious neonatal morbidity independent of GA (e.g. hydrops, fetal viral infections, fetal malformations likely to need surgery like hydrocephalus, neural tube defects, cardiac defects, abdominal wall defects)
* Known uterine anomaly at time of enrollment
* History of two or more prior cesarean deliveries
* Suspected placenta accrete, increta or percreta on US at enrollment
* Cervical cerclage present at time of enrollment

• Irene Stafford, MD, Principal investigator, Obstetrix Medical Group of Tucson.