Evaluation of a new technique of prophylactic cervical cerclage simplified from the Shirodkar cerclage: A pilot study

Abstract

IntroductionIn terms of prophylactic cerclage, the simplest and most commonly used technique is the McDonald cervical cerclage. Cervico-isthmic cerclage techniques may have better results, but are more difficult to achieve. A simplified Shirodkar technique would have the advantage of being “cervical high” while remaining easy to achieve. ObjectiveTo compare the results of high cervical cerclage, according to a simplified Shirodkar technique, with those of a classic McDonald cerclage, in the case of women at high risk of prematurity in an exploratory study. MethodsA comparative, retrospective study of prophylactic cerclage was conducted according to one or the other technique performed in a university hospital from 2006 to 2013. Women were included only if they had a history of at least two late miscarriages and/or premature delivery before 33 weeks. The primary outcome was the rate of delivery before 35 weeks. ResultsOur study involved 38 women: 24 in the McDonald cerclage group and 14 in the simplified Shirodkar cerclage group. The two groups were comparable for their obstetric and general characteristics. The percentage of preterm deliveries before 35 weeks was similar in both groups (7.1% and 25.0% in the Shirodkar and McDonald groups respectively; P=0.17). No significant difference was observed in the rate of surgical complications or hospitalizations during the pregnancies. ConclusionIn this study, we were unable to demonstrate an advantage to using the simplified Shirodkar technique – high cervical cerclage – compared with use of the McDonald technique – classical cerclage.