Abstract
BackgroundPreterm birth (PTB) is the leading cause of death in children under five years. Spontaneous preterm birth (SPTB) is the major cause of preterm delivery. The key risk factors for SPTB are women who have a short cervix and women who have had previous preterm birth. Cervical cerclage has been used for several decades and has shown to decrease rates of preterm birth. The most commonly used cerclage techniques were described by Shirodkar and McDonald, with no current consensus on the preferred technique. The objective of this review is to determine and compare the effectiveness of both techniques.MethodsStudies will be sourced from six electronic databases, as well as from experts in the field, reference lists, and grey literature. Eligible studies will include pregnant women, with a singleton or twin pregnancy, requiring a cervical cerclage, using either the Shirodkar or McDonald technique and run comparative analyses between the two techniques. Randomized control trials (RCT)s, non-randomized control trials, and cohort studies will be eligible. Two independent reviewers will conduct study screening at abstract and full-text level, data extraction and risk of bias assessment. Discrepancies will be resolved by a consensus third reviewer if required. Fixed-effects or random-effects models will be used where appropriate to synthesize results. Alternative synthesis methods will be investigated in instances where a meta-analysis is not appropriate, such as summarizing effect estimates, combining P values, vote counting based on direction of effect, or synthesis in narrative form.DiscussionThis review will synthesize the evidence on both the Shirodkar and McDonald cerclage method, and will help clinicians and health services to determine and deliver best practice antenatal care that has the potential to make an impact on preterm birth.Systematic review registrationPROSPERO on 25 of May, 2020 with registration number CRD42020177386
Highlights
Description of the condition Preterm birth (PTB), defined as birth prior to < 37 weeks gestation [1], remains a common complication of pregnancy (5–13%) [2] despite an increasing body of evidence surrounding its prevention
Compared to planned preterm birth, Spontaneous preterm birth (SPTB) is regarded as a complex syndrome with multiple causes and includes deliveries after both preterm premature rupture of membranes (PPROM) and spontaneous preterm labor
The key risk factors of SPTB are a short cervix found on vaginal ultrasonography during pregnancy and a history of previous PTB [5,6,7]
Summary
Description of the condition Preterm birth (PTB), defined as birth prior to < 37 weeks gestation [1], remains a common complication of pregnancy (5–13%) [2] despite an increasing body of evidence surrounding its prevention. It is the leading cause of death in children under 5 years [3]. Spontaneous preterm birth (SPTB) is the major cause of premature delivery(5). Compared to planned preterm birth, SPTB is regarded as a complex syndrome with multiple causes and includes deliveries after both preterm premature rupture of membranes (PPROM) and spontaneous preterm labor. The objective of this review is to determine and compare the effectiveness of both techniques
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