Funneling, dynamic change, and change with transfundal pressure do not predict preterm birth in patients receiving cerclage

Abstract

ObjectiveThe purpose of this study was to investigate if the variables of dynamic change, funneling, or change with transfundal pressure are associated with increased rates of preterm birth or tocolytic usage.Study designA retrospective cohort of patients who underwent prophylactic or emergent McDonald cerclage from 1997-2004 were included. All patients were assessed with transvaginal sonography before cerclage and after cerclage up to 28 weeks of gestation. Dynamic change (DC) was the qualitative assessment of shortening from spontaneous uterine contractions noted during sonography. Change with transfundal pressure (CTFP) was defined as a greater than 3 mm change during the application of manual pressure to the uterine fundus. Funneling (F) was qualitatively noted during sonography as present or absent. Data was analyzed utilizing the Mann-Whitney U or Fisher's exact test as appropriate.ResultsA total of 236 eligible patients were included. There were 198 singleton and 38 twin gestations. DC and F were analyzed for their presence before cerclage, after cerclage, or at any exam up to 28 weeks of gestation. CTFP was evaluated only prior to cerclage and was not performed after cerclage placement. There was no statistically significant difference in gestational age at delivery, tocolytic usage, or in separate analysis of delivery at ≤34 weeks or ≤36 weeks. When singleton and twin gestations were evaluated separately for CTFP, DC, or F, statistically significant differences were not seen for all of the above endpoints.ConclusionIn patients who receive a McDonald cerclage, CTFP, DC, or F do not predict premature delivery and are not associated with increased tocolytic usage. ObjectiveThe purpose of this study was to investigate if the variables of dynamic change, funneling, or change with transfundal pressure are associated with increased rates of preterm birth or tocolytic usage. The purpose of this study was to investigate if the variables of dynamic change, funneling, or change with transfundal pressure are associated with increased rates of preterm birth or tocolytic usage. Study designA retrospective cohort of patients who underwent prophylactic or emergent McDonald cerclage from 1997-2004 were included. All patients were assessed with transvaginal sonography before cerclage and after cerclage up to 28 weeks of gestation. Dynamic change (DC) was the qualitative assessment of shortening from spontaneous uterine contractions noted during sonography. Change with transfundal pressure (CTFP) was defined as a greater than 3 mm change during the application of manual pressure to the uterine fundus. Funneling (F) was qualitatively noted during sonography as present or absent. Data was analyzed utilizing the Mann-Whitney U or Fisher's exact test as appropriate. A retrospective cohort of patients who underwent prophylactic or emergent McDonald cerclage from 1997-2004 were included. All patients were assessed with transvaginal sonography before cerclage and after cerclage up to 28 weeks of gestation. Dynamic change (DC) was the qualitative assessment of shortening from spontaneous uterine contractions noted during sonography. Change with transfundal pressure (CTFP) was defined as a greater than 3 mm change during the application of manual pressure to the uterine fundus. Funneling (F) was qualitatively noted during sonography as present or absent. Data was analyzed utilizing the Mann-Whitney U or Fisher's exact test as appropriate. ResultsA total of 236 eligible patients were included. There were 198 singleton and 38 twin gestations. DC and F were analyzed for their presence before cerclage, after cerclage, or at any exam up to 28 weeks of gestation. CTFP was evaluated only prior to cerclage and was not performed after cerclage placement. There was no statistically significant difference in gestational age at delivery, tocolytic usage, or in separate analysis of delivery at ≤34 weeks or ≤36 weeks. When singleton and twin gestations were evaluated separately for CTFP, DC, or F, statistically significant differences were not seen for all of the above endpoints. A total of 236 eligible patients were included. There were 198 singleton and 38 twin gestations. DC and F were analyzed for their presence before cerclage, after cerclage, or at any exam up to 28 weeks of gestation. CTFP was evaluated only prior to cerclage and was not performed after cerclage placement. There was no statistically significant difference in gestational age at delivery, tocolytic usage, or in separate analysis of delivery at ≤34 weeks or ≤36 weeks. When singleton and twin gestations were evaluated separately for CTFP, DC, or F, statistically significant differences were not seen for all of the above endpoints. ConclusionIn patients who receive a McDonald cerclage, CTFP, DC, or F do not predict premature delivery and are not associated with increased tocolytic usage. In patients who receive a McDonald cerclage, CTFP, DC, or F do not predict premature delivery and are not associated with increased tocolytic usage.