P15Cervical cerclage: comparison of two techniques by transvaginal ultrasound

Abstract

BackgroundCervical cerclage can be performed using either the MacDonald technique or following an anterior colpotomy (Shirodkar technique). A randomized study comparing the two techniques would be impossible to run since 1900 patients would have to be included in each arm.ObjectiveTo evaluate the benefit of performing a colpotomy prior to putting a cervical suture, by measuring the distance between the stitch and the external os.Design and methodsRetrospective case‐control study (January 1997–January 1999). All patients having had cervical cerclage after anterior colpotomy and giving birth in our Institution were the study group. Each case was matched with the next patient giving birth in our Institution after having had a MacDonald cerclage. The indication was left to the surgeon's decision and each surgeon used only one technique. Obstetrical characteristics were recorded and ultrasound measurement of the cervix was performed within 8 days following the procedure.ResultsDuring the study period, there were 15 cases in each group. There was no significant difference between the two groups in the obstetrical outcome. Cervical length was 36.6 mm and 35.4 mm, and the distance between the stitch and the external os was 16.1 mm and 13.5 mm in the Shirodkar and the MacDonald groups, respectively.ConclusionAnterior colpotomy did increase the distance between the stitch and the external os by only 2.6 mm and does not seem to offer any clinical benefit.