Cerclage In Women Research Articles

Cervical cerclage vs cervical pessary in women with cervical insufficiency: A multicentric, open-label, randomised, controlled pilot trial [the CEPEIC trial]

ObjectiveCervical insufficiency accounts for 8 % of preterm births. Pessary and cerclage are considered preventive approaches for preterm birth. These interventions were compared in terms of reducing the prematurity rate in women with previous preterm birth, due to cervical insufficiency or due to having a short cervix in their current pregnancy. MethodsThis was a prospective, multicentric, open-label, randomised, pilot, controlled trial. Participants were women with singleton pregnancies who had previous preterm birth caused by cervical insufficiency or previous preterm birth and a short cervix [≤ 25 mm] in their current pregnancy. Women were randomised [1:1] to either cerclage or pessary. The primary outcome was to assess the feasibility of a trial on cervical pessary vs. cerclage to prevent preterm birth before 34 weeks in women with cervical insufficiency. As a secondary outcome, we studied the morbidity rate of the pessary versus the cerclage in women with cervical insufficiency and assessed the financial impact of using both devices in these women. The sample size was calculated based on the estimated population that we could potentially recruit: 60 women, 30 for each group, to ascertain whether the rate of preterm birth < 34 weeks of gestation may be reduced from 34 % to at least 27 % in the pessary group, as in the results obtained with the cerclage. ResultsNo significant differences in preterm birth < 34 weeks of gestation were observed in our study, although it was underpowered to detect these differences [the relative risk [RR] of PB < 34 weeks of gestation was 0.8 [95 % CI: 0.31–2.09, p = 0.888]. The rates of obstetric and perinatal complications were similar for both devices [15 cases in both groups, 50 % of cases [RR; 0.6–1.68; p = 1]. Cervical pessary had fewer secondary effects than the cerclage [less bleeding at insertion in the pessary group compared with cerclage, 1 case vs 14 cases, p < 0.001; less pain at removal in the pessary group compared with cerclage, 14 vs 22 cases. p = 0.042 and less bleeding, 2 cases vs. 10 cases, p = 0.027]. ConclusionsPessary does not seem less effective than cerclage, although these findings need to be confirmed in a larger randomised controlled trial. Pessary had fewer secondary effects than cerclage both at insertion and removal. SinopsisCervical pessary does not seem to be less effective than cerclage. Cervical pessary had fewer secondary effects than cerclage.

Effectiveness of Double Cervical Cerclage in Women with at Least One Previous Pregnancy Loss in the Second Trimester

Effectiveness of Double Cervical Cerclage in Women with at Least One Previous Pregnancy Loss in the Second Trimester

Pregnancy outcomes of cerclage in twin gestations: a multicenter retrospective cohort study

Objectives To determine the effects of cerclage on twin pregnancies. Methods A multicenter, retrospective, cohort study was conducted at 10 tertiary centers using a web-based data collection platform. The study population included twin pregnancies delivered after 20 weeks of gestation. Patients with one or two fetal deaths before 20 weeks of gestation were excluded. Maternal characteristics, including prenatal cervical length (CL) and obstetric outcomes, were retrieved from the electronic medical records. Results A total of 1,473 patients had available data regarding the CL measured before 24 weeks of gestation. Seven patients without CL data obtained prior to cerclage were excluded from the analysis. The study population was divided into two groups according to the CL measured during the mid-trimester: the CL ≤2.5 cm group (n = 127) and the CL >2.5 cm group (n = 1,339). A total of 127 patients (8.7%) were included in the CL ≤2.5 cm group, including 41.7% (53/127) who received cerclage. Patients in the CL >2.5 cm group who received cerclage had significantly lower gestational age at delivery than the control group (hazard ratio (HR): 1.8; 95% confidence interval (CI): 1.11–2.87; p = .016). Patients in the CL ≤2.5 cm group who received cerclage had a significantly higher gestational age at delivery than the control group (HR: 0.5; 95% CI: 0.30–0.82; p value = .006). Conclusions In twin pregnancies with a CL ≤2.5 cm, cerclage significantly prolongs gestation. However, unnecessary cerclage in women with a CL >2.5 cm may result in a higher risk of preterm labor and histologic chorioamnionitis although this study has a limitation originated from retrospective design.

Rescue Cerclage in Women With Acute Cervical Insufficiency and Intra-Amniotic Inflammation: A Retrospective Cohort Study.

To assess the effectiveness of rescue cerclage concerning pregnancy and neonatal outcomes in women with acute cervical insufficiency (CI) complicated with intra-amniotic inflammation (IAI) compared with those managed expectantly. This retrospective cohort study included 87 consecutive singleton pregnant women (17-25 weeks) with acute CI who underwent amniocentesis to assess IAI. Amniotic fluid (AF) samples were assayed for interleukin-6 to define IAI (≥ 2.6 ng/mL). Primary and secondary outcomes were assessed in a subset of CI patients with IAI. The primary outcome measures were spontaneous preterm birth (SPTB) at < 28 and < 34 weeks, and the secondary outcomes were interval from sampling to delivery, neonatal survival, neonatal birth weight, and histologic and clinical chorioamnionitis. Macrolide antibiotics were prescribed depending on the type of microorganism isolated from the AF, clinically suspected IAI, and the discretion of the attending clinician. IAI was identified in 65.5% (57/87) of patients with CI, of whom 73.6% (42/57) were treated with macrolide antibiotics. Among the CI patients with IAI (n = 57), 40 underwent rescue cerclage and 17 were expectantly managed. The rates of SPTBs at < 28 and < 34 weeks were significantly lower and the latency period was significantly longer in the cerclage group than in the group that was managed expectantly. The median birth weight and neonatal survival rate were significantly higher in the cerclage group than in the group that was managed expectantly. However, the rates of histologic and clinical chorioamnionitis did not differ between the groups. Multivariable analyses revealed that rescue cerclage placement and administration of macrolide antibiotics were significantly associated with a decrease in SPTBs at < 28 and < 34 weeks, prolonged gestational latency, and increased likelihood of neonatal survival, after adjusting for possible confounding parameters; however, macrolide antibiotic administration did not reach statistical significance with respect to SPTB at < 34 weeks and neonatal survival (P = 0.076 and 0.063, respectively). Rescue cerclage along with macrolide antibiotic treatment may positively impact pregnancy and neonatal outcomes in women with CI complicated by IAI, compared with expectant management. These findings suggest the benefit of cerclage placement even in patients with CI complicated by IAI.

EP14.23: Cervical cerclage in women with short or dilated cervix before fetoscopic laser surgery for twin–twin transfusion syndrome

EP14.23: Cervical cerclage in women with short or dilated cervix before fetoscopic laser surgery for twin–twin transfusion syndrome

Screening and Prevention of Preterm Birth in Twin Pregnancies.

Twins represent 3.2% of all live births. However, they account for 20% of all preterm deliveries, 60% delivering <37 weeks, 10.7% <32 weeks, and 5 times higher risk of infant death. Risk factors for preterm birth (PTB) include the history of preterm delivery, monochorionic twins, short cervical length, and cervical surgery. Transvaginal cervical length <24 weeks is the best tool to predict PTB. Only vaginal progesterone in women with transvaginal cervical length <25mm and physical exam indicated cerclage in women with cervical dilation >1cm have shown a significant decrease in PTB and improvement in neonatal outcomes.

O-055 Efficacy of Laparoscopic Abdominal Cerclage in Women With Prior 2nd Trimester Losses/Preterm Birth: Perinatal Outcomes of Case Series

Abstract Study question What is the efficacy of laparoscopic abdominal cerclage (LAC) that placed during periconceptional period in singletons with prior 2nd trimester pregnancy losses/preterm deliveries (PTDs)? Summary answer LAC seems to prolong pregnancy duration and enhance perinatal outcomes in singletons prior 2nd trimester losses/PTDs. What is known already Cervical insufficiency (CI) is defined as the inability of the uterine cervix to retain a pregnancy till term without the signs and symptoms of clinical contractions ,with an incidence up to 1% (Berghella, 2011). Cervical cerclage (CC) has been proposed as an effective treatment for CI in terms of successfully prolonging the pregnancy period and improving the perinatal prognosis. The common clinical approach is transvaginal cervical cerclage (TVC), which is a feasible and relatively easy technique. However, some group of women may experience late abortions and/or PTD and LAC has been proposed to enhance pregnancy outcomes. Study design, size, duration Case series consisting of singletons with at least 2 prior PTDs and managed with LAC was reviewed between January 2019-November 2022. After placement of LAC, reproductive and perinatal outcomes of women were reviewed for 2 years. Participants/materials, setting, methods All women with at least 2 prior 2nd trimester losses and/or PTDs were offered to LAC procedure during the period. After having informed consents, total of 28 LAC procedures were performed. All surgeries were performed by a single experienced laparoscopist in the same center. Non-absorbable mersilene tape was placed during preconceptional period. Reproductive outcomes including spontaneous and assisted conception cycles and perinatal outcomes were reported. Main results and the role of chance A total of 28 LAC proceudres were performed during the period. Mean age of women was 34±2 and mean numbers of previous 2nd trimester losses/PTDs was 2.8±0.8, of which all of them were &amp;lt;24 weeks. Total of 8 women have had gynecologic surgery in their history. Less than 12 months interval, 19 out of 28 women got pregnent; 13/28 conceived spontaneously and 6/28 conceived with after IVF treatment. For the perinatal outcomes; there were no single case of 2nd trimester losses/PTDs &amp;lt;24 weeks in the entire cohort. 15 women delivered &amp;gt;34 weeks and remaining 4 delivered at term (&amp;gt;37 weeks). During the gestation, no additional medication was provided to pregnants such as progesterone treatment. The mean gestational age was 35 4/7 weeks. There were no remarkable adverse events during the pregnancy. All newborns were healthy without remarkable issues, only 2 infants required intensive care for less than 2 weeks. Limitations, reasons for caution Small sample size, lack of a control group and randomization and heterogenious patient population. Wider implications of the findings LAC appears to have favorable pregnancy outcomes in singletons with prior pregnacy losses and/or PTDs. To precisely conclude, randomized controlled trials are needed with different intervention arms in the same population. Trial registration number non applicable

The Mersilene Tape Passing Through the Cervical Canal During Preconceptional Laparoscopic Abdominal Cerclage

Cervical insufficiency is defined as painless cervical dilation leading to second-trimester pregnancy losses. [1]. There is good scientific evidence for improved neonatal outcomes to place a vaginal cerclage in women with a history of preterm delivery and whose cervical length is <25 mm between 16-23th gestatonal weeks [2].

Longitudinal change in cervical length following vaginal or abdominal cervical cerclage: a randomized comparison

Cervical cerclage has been shown to reduce the risk of recurrent spontaneous preterm birth in a high-risk patient population; however, the mechanism is not well understood. Transabdominal cerclage is superior to low and high vaginal cerclage in reducing early spontaneous preterm birth and fetal loss in women with previous failed vaginal cerclage. Cervical length measurements are commonly used to monitor high-risk women and may explain the mechanism of success. This study aimed to evaluate the rate of change in longitudinal cervical length after randomized placement of low transvaginal, high transvaginal, or transabdominal cerclage in women with a previous failed vaginal cerclage. This was a planned analysis of longitudinal transvaginal ultrasound cervical length measurements from patients enrolled in the Vaginal Randomised Intervention of Cerclage trial, a randomized controlled trial comparing transabdominal cerclage or high transvaginal cerclage with low transvaginal cerclage. Cervical length measurements at specific gestational ages were compared over time and between groups, using generalized estimating equations fitted using the maximum-likelihood random-effects estimator. In addition, cervical length measurements were compared in women with transabdominal cerclage placed before and during pregnancy. The diagnostic accuracy of cervical length as a predictor of spontaneous preterm birth at <32 weeks of gestation was explored. This study included 78 women who underwent longitudinal cervical length assessment (70% of the analyzed cohort) with a history of failed cerclage, of whom 25 (32%) were randomized to low transvaginal cerclage, 26 (33%) to high transvaginal cerclage, and 27 (35%) to transabdominal cerclage. Abdominal cerclage was superior to low (P=.008) and high (P=.001) vaginal cerclage at maintaining cervical length over the surveillance period (14 to 26 weeks of gestation) (+0.08 mm/week, 95% confidence interval, -0.40 to 0.22; P=.580). On average, the cervical length was 1.8 mm longer by the end of the 12-week surveillance period in women with transabdominal cerclage (+1.8 mm; 95% confidence interval, -7.89 to 4.30; P=.564). High vaginal cerclage was no better than low cervical cerclage in the prevention of cervical shortening; the cervix shortened by 13.2 mm over 12 weeks in those with low vaginal cerclage (95% confidence interval, -21.7 to -4.7; P=.002) and by 20 mm over 12 weeks in those with high vaginal cerclage (95% confidence interval, -33.1 to -7.4; P=.002). Preconception transabdominal cerclage resulted in a longer cervix than those performed during pregnancy; this difference was significant after 22 weeks of gestation (48.5 mm vs 39.6 mm; P=.039). Overall, cervical length was an excellent predictor of spontaneous preterm birth at <32 weeks of gestation (receiver operating characteristic curve, 0.92; 95% confidence interval, 0.82-1.00). In women with a previous failed cervical cerclage, in the next pregnancy, the cervical length in women treated with vaginal cerclage funneled and shortened over time, whereas there was preservation of cervical length in women who receive transabdominal cerclage. Cervical length remained longer in transabdominal procedures performed before pregnancy than in transabdominal procedures performed during pregnancy. Overall, cervical length was an excellent predictor of spontaneous preterm birth in our cohort. Our findings may explain the mechanism of benefit for transabdominal cerclage, with its high placement better maintaining the structural integrity of the cervix at the level of the internal os.

Comparison of pregnancy outcomes of triangular 3-bites and mcdonald techniques of cervical cerclage in women with cervical insufficiency: A pilot study.

Cervical cerclage is the procedure of choice for preventing preterm birth due to cervical insufficiency. Despite the simplicity of the McDonald's method of cerclage application, it is still technically difficult to take four bites around the cervix before knotting. There is a need to develop a simpler method of cervical cerclage application with similar or improved pregnancy outcomes. This is to compare the ease/duration of application and pregnancy outcomes of the new triangular three-bite cervical cerclage technique and McDonald's technique in women with cervical insufficiency. This is a pilot study with 20 participants that met the inclusion criteria. They were randomly grouped into triangular three-bite method (n = 10) and McDonald's method (n = 10). The pregnancy outcomes were compared between the groups with the Chi-square test and student's t-test. A P value of <.05 was set as level of significance. The sociodemographic characteristics of the two groups were similar. There was no statistically significant difference between the two groups regarding the pregnancy outcome (spontaneous miscarriage P = 1.00, preterm delivery P = 0.61, and neonatal birthweight P = 0.96). However, the duration of cerclage application (5.98 ± 1.79 minutes vs. 14.25 ± 7.5 minutes; P <.002) and estimated blood loss (29 ± 9.94 mls vs. 48.5 ± 25.82 mls; P = .04) were significantly lower in the triangular three-bite arm than in the McDonald's arm. The new triangular three-bite technique has similar pregnancy outcomes with the conventional McDonald's technique and has shown a lower duration of procedure and blood loss. Since this is a pilot study, a well-structured randomized control trial to compare the two methods is recommended.

Comparison between vaginal and laparoscopic cerclage in women with mid-trimester pregnancy loss or history of spontaneous preterm delivery.

Women with unfavorable obstetric history can benefit from prophylactic cerclage ("history indicated") which can be performed vaginally or transabdominally with laparoscopic techniques. The aim of our study is to evaluate the effectiveness in the prevention of preterm birth of the vaginal technique and of the minimally invasive laparoscopic technique in women with an unfavorable obstetric history. This was a retrospective cohort study examining elective cerclages performed in women with adverse obstetrics history. The primary outcome was rate of early preterm and second trimester deliveries while other outcomes analyzed were surgical complications, the time needed for cerclage procedures, live birth rate, gestational age at delivery, birth weight, Apgar score. Data from 64 women were analyzed; among them, 14 underwent a laparoscopic procedure (22%) while 50 a vaginal cerclage (78%). The two groups were homogeneous in terms of demographic characteristics, but of course differed significantly in terms of obstetrics history, as well as for the surgical indications of cerclage procedures. The rate of early preterm deliveries and second trimester miscarriage were the same in the vaginal and laparoscopic group (8%), comparable to what was reported in literature. The operative time was longer in the laparoscopic group, but with similar duration of the hospital stay. We reported no intraoperative complications in both groups. As the laparoscopic procedure, usually reserved for women with a previous failed vaginal cerclage, has been proved to be equally safe and effective, it may could be proposed to a wider group of women. Prospective randomized studies are needed to provide new and conclusive data about this topic.

Comparison of maternal-fetal outcomes between laparoscopic cervicoisthmic cerclage and McDonald cerclage in women with cervical insufficiency

Objective: To compare the maternal and fetal outcomes of women with cervical insufficiency (CI) undergoing McDonald cerclage (MC) and laparoscopic cervicoisthmic cerclage (LCC), so as to provide evidence for the selection of cerclage methods. Methods: A retrospective trial was carried out in the First Affiliated Hospital of Sun Yat-sen University from January 2010 to December 2020. A total of 221 women who underwent the prophylactic cerclage were divided into MC group (n=54), LCC with MC history group (n=28) and LCC without MC history group (n=129) by the mode of operation and whether the pregnant women who underwent LCC had MC history. General clinical data, pregnancy complications and pregnancy outcomes were compared between the three groups. Results: (1) General clinical data: the proportion of women accepted cervical cerclage during pregnancy in MC group, LCC with MC history group and LCC without MC history group were 100.0% (54/54), 7.1% (2/28) and 27.1% (35/129), respectively (P<0.001). The indications of the three groups showed statistical significance (P=0.003), and the main indication was the history of abortion in the second and third trimester [75.9% (41/54) vs 89.3% (25/28) vs 84.5% (109/129)]. (2) Pregnancy complications: the incidence of abnormal fetal position [7.8% (4/51) vs 17.4% (4/23) vs 19.8% (24/121)], placenta accrete [5.9% (3/51) vs 13.0% (3/23) vs 11.6% (14/121)], uterine rupture [0 vs 4.3% (1/23) vs 5.8% (7/121)] in the MC group were all lower than those in LCC with MC history and LCC without MC history groups. However, there were no statistical significances (all P>0.05). Intrauterine inflammation or chorioamnionitis [15.7% (8/51) vs 0 vs 0.8% (1/121)] and premature rupture of membrane [23.5% (12/51) vs 4.3% (1/23) vs 0] were both significantly higher in MC group than those in LCC with MC history and LCC without MC history groups (all P<0.001). (3) Pregnancy outcomes: the cesarean section rate was significantly lower in MC group (41.2%, 21/51) than that in LCC with MC history group (100.0%, 23/23) and LCC without MC history group (100.0%, 121/121; P<0.001). MC group was associated with lower expenditure than LCC with MC history and LCC without MC history groups (12 169 vs 26 438 vs 27 783 yuan, P<0.001). The success rates of live birth cerclage did not differ significantly in MC (94.4%, 51/54), LCC with MC history (82.1%, 23/28) and LCC without MC history (93.8%, 121/129) groups (χ2=5.649, P=0.059). There was no significant difference in neonatal intensive care unit occupancy, neonatal birth weight and neonatal asphyxia between the three groups (all P>0.05). Conclusions: Both LCC and MC are the treatment choice for women with CI, which may get similar liver birth. However, MC has the advantages of low cesarean section rate, economical and easy operation. Therefore, MC is recommended as the first choice for CI patients, and LCC is for women with failed MC.

Pre-Cerclage cervical length predicts long-term pregnancy sustenance: A case-control study

BackgroundThis study aimed to assess a predictor of long-term pregnancy sustenance post cervical cerclage in women with or without a medical history of cervical insufficiency. Materials and methodsWe included pregnant women who underwent cerclage at 12–25 weeks gestation in four perinatal medical centers between January 2009 and December 2010. We classified the cerclage modality as ultrasound-indicated cervical cerclage if the pre-cerclage CL was <25 mm because the prophylactic and therapeutic cerclage definitions varied among institutions. The procedure was deemed successful if the pregnancy continued for more than 13 weeks post cerclage. We compared the outcomes of women who underwent successful and unsuccessful cerclage and investigated whether the pre-cerclage CL could predict pregnancy outcomes in women who underwent successful cerclage using receiver-operating characteristic curves. ResultsWe screened 114 pregnant women; 91 met the inclusion criteria. Pre-cerclage CL was a moderately accurate predictor of long-term pregnancy sustenance in the successful group (optimal cut-off value: 17 mm; area under the curve: 0.76; P = 0.0016). Approximately 87% of patients with a pre-cerclage CL ≥ 17 mm sustained their pregnancies for more than 13 weeks post cerclage; however, 64% of patients with a pre-cerclage CL < 17 mm did not. ConclusionWe speculate that the use of other treatment options in addition to cerclage in women with a pre-cerclage CL < 17 mm may result in a successful pregnancy.

Comparison of Outcomes Following General Anesthesia and Spinal Anesthesia During Emergency Cervical Cerclage in Singleton Pregnant Women in the Second Trimester at a Single Center

BackgroundLittle information exists regarding the best anesthesia method for emergency cerclage.This single-center study aimed to compare the outcomes following general anesthesia and spinal anesthesia during emergency cervical cerclage in women in the second trimester of a singleton pregnancy.Material/MethodsA total of 297 pregnant patients were recruited: 141 patients were assigned to the general anesthesia group and 156 patients were assigned to the spinal anesthesia group. Periprocedural data and obstetric outcomes were recorded and statistically analyzed.ResultsAverage duration of the cerclage procedure was shorter in the general anesthesia group than in the spinal anesthesia group (25.78±9.4 min versus 30.88±10.5 min; P<0.05). No severe maternal complications, such as hematosepsis or maternal death, occurred after the procedure for either group. The neutrophil-lymphocyte ratio and C-reactive protein (CRP) increased after emergency cerclage in both groups, but at no time did the 2 groups differ significantly (P>0.05). There was also no significant difference in the incidence of miscarriage or preterm delivery (delivery <34 gestational weeks) or in neonatal outcome between the 2 groups (P>0.05).ConclusionsThe results of this study showed that there were no significant differences in maternal and neonatal outcomes, rates of miscarriage, or preterm delivery between general anesthesia and spinal anesthesia during emergency cervical cerclage in women in the second trimester of a singleton pregnancy.

Ultrasound indicated cerclage in women with previous late preterm birth

It is unclear whether women with a history of late preterm birth (34 to 36+6 weeks’ gestation) should undergo serial transvaginal cervical length screening. We sought to compare the rates of ultrasound indicated cerclage between women with a history of preterm birth prior to 34 weeks and those with previous late preterm birth.

Pregnancy outcomes and factors affecting the clinical effects of emergency cerclage in twin pregnancies with cervical dilation and prolapsed membranes.

To determine the effect of mid-trimester emergency cerclage in women with twin pregnancies with cervical dilation and prolapsed membranes, and to identify risk factors predicting spontaneous preterm birth (sPTB) before 28weeks, after cerclage. Retrospective analysis of twin gestations with cervical dilation and prolapsed membranes treated with emergency cerclage or expectant management (2015-2020). The primary outcomes were the rate of sPTB before 28weeks and the gestational latency. Multiple logistic regression analysis was used to determine the factors associated with sPTB before 28weeks, after cerclage. Ninety-seven women were included, cerclage (n=58) or no cerclage (n=39). Cerclage placement was associated with significantly lower incidence of sPTB before 28weeks of pregnancy (34.5% vs 82.1%) and prolongation of the gestational latency (46.71±27.52 vs 10.95±11.71days). Positive cervical culture (odds ratio [OR] 10.69, 95% confidence interval [CI] 1.82-62.95), pregnancy duration at diagnosis less than 22weeks (OR 9.42; 95% CI 1.69-52.69) and cervical dilation at least 4cm (OR 7.92; 95% CI 1.40-44.71) were found to be independent risk factors for sPTB before 28weeks, after cerclage. Emergency cerclage in women with twin pregnancies with cervical dilation and prolapsed membranes was associated with an overall 40% decrease in sPTB before 28weeks and a prolongation of latency by 5weeks. The strongest predictor of sPTB before 28weeks after cerclage was a positive cervical culture.

Call to action: long‐term neurodevelopment in monochorionic twins

Call to action: long‐term neurodevelopment in monochorionic twins

Obstetric outcome after emergency cervical cerclage: A prospective observational study performed in CSI Kalyani hospital, Chennai

Cervical insufficiency is a well documented etiological factor in preterm delivery. This study was conducted to evaluate the efficacy and safety of Emergency cervical cerclage in women who presented with advanced cervical changes such as cervical dilatation and bulging fetal membranes. The study was prospective observational study performed in the department of obstetrics and gynaecology CSI Kalyani General Hospital, Chennai, Tamil Nadu over a duration of 18 months. This study included all women who presented in late second trimester with advanced cervical dilatation (2 to 4cms) for whom emergency cervical cerclage was done by McDonald technique. Out of the 15 patients for whom emergency cerclage was performed, 3 had spontanous abortion after cerclage, 6 had PROM and 5 of these patients had term delivery. The time interval between emergency cervical cerclage and delivery was 11 weeks. No surgical complications were reported. The mean gestational age at delivery was 32 weeks. 11 fetuses were live born after the period of viability. 3 of these babies were admitted to NICU. Post emergency cervical cerclage, the outcomes in terms of prolongation of pregnancy, live births and neonatal survival are better.

The efficacy of therapeutic cervical cerclage in singleton pregnancies: a retrospective study

Objectives We compared the pregnancy prolongation effect attributable to cervical cerclage to that achieved by conservative management, and determined the cervical length for which cervical cerclage is effective. Methods We retrospectively examined medical records of 281 women admitted to our hospital between January 2013 and December 2017 for management of threatened preterm birth at 22−28 weeks of gestation. Obstetricians determined suitability for cervical cerclage, which was performed using the McDonald procedure in all cases. Of the 281 subjects, 71 underwent cervical cerclage (cerclage group); the other 210 received conservative therapy (non-cerclage group). We recorded maternal and neonatal characteristics of all patients. The two groups were compared in terms of length of extension of pregnancy and weeks of gestation at delivery. Multivariate analysis was performed to identify factors associated with extension of time to delivery. Results Our analyses revealed that the cerclage group was hospitalized earlier in pregnancy than the non-cerclage group (23.7 ± 1.5 weeks vs. 26.4 ± 1.9 weeks, p < .001) and had shorter cervixes (6.0 ± 9.4 mm vs. 16.9 ± 13.0 mm, p < .001). The two groups did not differ significantly in terms of gestational weeks at delivery. Multivariate analysis regarding extension of pregnancy revealed significant differences in extension of pregnancy related with cervical cerclage (26.65 days, 95% CI 17.0 − 36.3, p < .001) and cervical length <10 mm (−27.4 days, 95% CI −36.0–−18.8, p < .001). While the time to delivery was extended by cervical cerclage in women with short cervixes (<25 mm), the two groups did not differ when cervical length was ≥15 mm. Conclusions Cervical cerclage was a significant positive factor and short cervix was a significant negative factor for elongating pregnancy. In primigravida and multigravida women with no history of preterm birth, when the cervix is short (<10 mm), cervical cerclage should be recommended.

Predictors of cerclage failure in singleton pregnancies with a history of preterm birth and a sonographic short cervix

To identify predictors of ultrasound-indicated cerclage failure in singleton pregnancies for preventing extremely preterm birth. A retrospective cohort study included 96 singleton pregnancies with ultrasound-indicated McDonald cerclage in women with prior preterm birth (PTB) and cervical shortening. Descriptive statistics were calculated at baseline and logistic regression analyses were performed to identify the factors associated with cerclage failure. In all, 28 (29%) of them suffered preterm delivery at <28 weeks. Multivariate analysis identified cervical dilation, noncephalic presentation, and platelet-lymphocyte ratio (PLR) as independent predictors of cerclage failure (OR, 3.12, 95%CI, 1.01-9.66; OR, 5.81, 95%CI, 1.04-32.53; OR, 1.02, 95%CI, 1.01-1.03, respectively). The efficacy of these predictors was evaluated using a receiver operating characteristics. The area under the curve was 0.87 (95%CI: 0.78-0.96, P<0.001) with a sensitivity of 78.6% and specificity of 88.2%. Our findings indicated that cervical dilation, fetal presentation, and PLR were valuable predictors of cerclage failure in singleton pregnancies with a history of PTB and a sonographic short cervix. Theresultscan be potentially usedto assess the prognosis of patients after cerclage and alert clinicians to considerenhanced surveillance and administration of individuals at an increased risk.