Cervical Cerclage Placement Research Articles

Racial and Ethnic Disparities in Cervical Insufficiency, Cervical Cerclage, and Preterm Birth.

Background: The frequency of cervical insufficiency differs among the major racial and ethnic groups, with limited data specific to Asian American and Native Hawaiian/Pacific Islander (AANHPI) subpopulations. We assessed cervical insufficiency diagnoses and related outcomes across 10 racial and ethnic groups, including disaggregated AANHPI subgroups, in a large population-based cohort. Study Design: We performed a retrospective cohort study of all singleton births between 20-42 weeks' gestation in California from 2007 to 2018. Logistic regression models were performed to estimate the odds of cervical insufficiency and, among people with cervical insufficiency, the odds of cerclage and preterm birth according to self-reported race and ethnicity. Results: Among 5,114,470 births, 38,605 (0.8%) had a diagnosis code for cervical insufficiency. Compared with non-Hispanic White people, non-Hispanic Black people had the highest odds of cervical insufficiency (adjusted odds ratio [aOR] 3.07; 95% confidence interval [CI], 2.97, 3.18), for cerclage placement and higher odds for preterm birth. Disaggregating AANHPI subgroups showed that Indian people had the highest odds (aOR 1.94; 95% CI, 1.82, 2.07) of cervical insufficiency and had significantly higher odds of cerclage without increased odds of preterm birth; Southeast Asian people had the highest odds of preterm birth. Conclusion: Within a large, diverse population-based cohort, non-Hispanic Black people experienced the highest rates of cervical insufficiency, and among those with cervical insufficiency, had among the highest rates of cerclage and preterm birth. Among AANHPI subgroups specifically, Indian people had the highest rates of cervical insufficiency and cerclage placement, without increased rates of preterm birth; Southeast Asian people had the highest rates of preterm birth, without increased rates of cerclage. Disaggregating AANHPI subgroups identifies important differences in obstetric risk factors and outcomes.

A comparison of Mersilene tape versus braided suture in transvaginal cervical cerclage: A retrospective case-control study.

Previous studies have indicated that there is an association between cervical cerclage and type of suture material. However, it is still unclear which suture material can provide the greatest benefit to patients who have undergone cerclage. This study investigated the effect of two different suture materials (Mersilene tape vs braided suture) used for transvaginal cervical cerclage placement on maternal outcomes of women with cervical insufficiency. In this retrospective case-control study, 170 women who underwent history-, ultrasound-, or physical examination-indicated transvaginal cervical cerclage were categorized according to suture materials used for cerclage: a total of 96 received Mersilene tape and 74 received braided suture. Study participants received a transvaginal cervical cerclage before 28 weeks and were followed up until delivery to assess pregnancy and neonatal outcomes. The primary outcome was gestational age at delivery. Secondary outcomes included preterm premature rupture of membranes (PPROM), premature rupture of membranes (PROM), chorioamnionitis, neonatal survival rate, and neonatal morbidity. Out of 170 eligible women, 74 (43.5%) received braided suture while 96 (56.5%) received Mersilene tape. Baseline characteristics were similar between the two groups. The group that received braided suture had a lower incidence of gestational age at delivery <37 weeks (29.2% vs 54.2%, P = 0.046), PPROM (9.5% vs 21.9%, P = 0.029) and PROM (17.6% vs 32.3%, P = 0.028) compared to the group that received Mersilene tape. However, there were no significant differences between the two groups in average gestational age at delivery, the rate of gestational age at delivery <24, <28, <32, and < 34 weeks, chorioamnionitis, and neonatal survival rate, as well as neonatal morbidity. Compared to Mersilene tape, the utilization of braided suture has been significantly associated with a reduction in the incidence of gestational age at delivery <37 weeks, as well as a decreased risk of PPROM and PROM. However, the use of braided sutures did not result in discernible differences in the rates of chorioamnionitis or adverse neonatal outcomes.

Perinatal Outcomes Associated With the Modified Shirodkar Cervical Cerclage Technique.

The objective of this study was to describe demographic and clinical characteristics and surgical and neonatal results related to the modified Shirodkar cervical cerclage technique. This was an observational descriptive and retrospective study. Data was called from anonymized medical records of women who were pregnant and diagnosed with cervical incompetenceand who had also undergone cervical cerclage procedures using the modified Shirodkar technique. The variables recorded included demographics such as the maternal age of patients, clinical features like obstetric history, physical examination, and ultrasound findings, and surgical and neonatal outcomes. The qualitative variables were processed using frequencies and percentages, and the quantitative variables were obtained through median, interquartile range, mean, and standard deviation. Our study included 39 anonymized medical records. The main indication for cervical cerclage placement was prophylactic (56%). The median gestational age at cerclage placement was 16 weeks, with a median gestational age at birth of 38 weeks; only 13% had complications related to prematurity, and 5% were admitted to the neonatal intensive care unit. The modified Shirodkar technique is associated with favorable surgical, maternal, and neonatal outcomes.

Late emergency cervical cerclage placement in a patient with early recurrent pregnancy loss and bicorporeal uterus: A case report

Introduction: Uterine Müllerian anomalies are relatively common among the population, affecting approximately 4% of women, and can lead to various pregnancy-related pathologies. Cervical cerclage, a surgical procedure involving the placement of a stitch around the cervix, has been recognized as an optional treatment to mitigate the risk factors associated with these anomalies. Case Report: A 33-year-old woman with a bicorporeal uterus and a history of early recurrent pregnancy loss, who was diagnosed with a cervical os shortening during her second anatomy screening at 22+3 weeks gestation. A cervical cerclage was performed to prevent preterm delivery, and subsequently. An elective cesarean section was conducted at 37+0 weeks of gestation, resulting in the birth of a healthy baby boy. Conclusion: Although the literature about the effectiveness of cervical cerclage in pregnant women with Müllerian anomalies is limited, this case highlights its potential as an effective treatment option.

The outcome of cervical stitch in the prevention of pre-viable and preterm deliveries in Nigerian Tertiary Hospital

Background: Cervical incompetence, defined as the inability to sustain a pregnancy to term due to functional and anatomical defects of the cervix is a distressing cause of childlessness in Nigeria. Cervical cerclage, introduced into clinical practice by Shirodkar and McDonald in the 1950s still a time-tested intervention in the prevention of pregnancy wastages from cervical incompetence. Aim: The purpose of this study was to audit the outcome of the applications of cervical cerclages in the prevention of pregnancy wastages at the Maternity Complex of the Ekiti State University Teaching Hospital and Maternal and Child Specialists’ Clinic in Ekiti State, Southwest Nigeria. Methods: In this prospective observational cohort study, we included all pregnant women who had cervical stitches applied over ten years, (2010-2019). Information on sociodemographic biodata, risk factors, indications, and outcomes were collated. Statistical analysis was performed using the SPSS package, version 22 (SPSS Inc, Chicago, IL). Statistical significance of the categorical variables was tested using the chi-square or Fisher’s exact test, confidence level of 95%and P-value of 0.05. Results: The 134 pregnant women diagnosed with cervical incompetence had cervical stitches applied over the ten years. 15,037 deliveries giving a prevalence rate of 0.89% of cervical incompetence. 75% were multigravida, while 92.5% were of low parity. Risk factors found included recurrent mid-trimester abortions (55%), and prior cervical dilatation (20%). The cervical cerclages were history and physical examination indicated in 22.5% and 75% had ultrasound scanning confirmation. In the majority (82.5%), cervical cerclage was placed at 14-16 weeks using Mersilene tape in 92.5%. Spinal anesthesia and conscious sedation were administered in equal proportion. Majority had McDonald’s procedure (96.27%) whereas only 3.73% had Shirodkar’s. Placement to removal interval ranged from 10-20 weeks in 53%, while in 12.5% it lasted 4 weeks. The indications for removal included pregnancy carried to term at 72.5%, preterm labor at 7.5%, and vagina bleeding occurred in 7.5% of cases. Vaginal deliveries were achieved in 62.5% while 25% had cesarean delivery. 7.5% expelled pre-viable fetuses. Cervical cerclage placement was successful in 75%, while 25% had failed cerclage. 10% of those who had failed cerclage had live births. We achieved 85% of babies take home. There was no significant association between the overall outcomes of cervical cerclage (inevitable abortion, preterm delivery, term delivery) and certain defined co-variables (age, gravidity, and parity). On multivariate linear regression. Conclusion: We recommend that timely application of cervical stitches will rescue women from pregnancy wastages associated with cervical incompetence in Ekiti State.

Median Effective Dose of Ropivacaine for Prophylactic Cervical Cerclage in Chinese Women: A Dose-Finding Study

(Reg Anesth Pain Med. 2023;48:168–172. doi: 10.1136/rapm-2022-104242) Complications in pregnancy leading to preterm labor or miscarriage can occur for a variety of reasons. One reason that represents a significant public health burden is cervical incompetence or insufficiency. Current treatment guidelines focus on cervical cerclage as an effective treatment to prevent or arrest the effects of cervical insufficiency. Performing this procedure requires surgery, and therefore different anesthetic methods can be used to minimize pain and adverse outcomes for the patients, namely general or neuraxial anesthesia. One local anesthetic used for spinal neuraxial blocks in obstetrics is ropivacaine, but research has not explored its effect when used for cervical cerclage. This study from China was designed to find the median effective dose of intrathecal ropivacaine for cervical cerclage placement in 50% of patients (ED50). Secondary to this, the effective dose of intrathecal ropivacaine in 95% of patients (ED95) was also calculated. Other outcome measures included the duration of the sensory and motor blocks.

Cervical Cerclage: Prolonging Gestational Period for Successful Pregnancy Outcome

Background: Cervical Cerclage may be an effective treatment option in true cervical insufficiency. Cervical function plays a crucial role to protect growing fetus in utero in maintaining successful pregnancy. As the gestational weeks progress, the cervix undergoes dynamic changes, including softening and shortening, to accommodate fetal growth. Objective: The objective of this study is to evaluate the effectiveness and outcome of cervical cerclage placement as a preventive measure against recurrent pregnancy loss and preterm delivery and its complications, to analyze pregnancy outcomes among participants who received cervical cerclage and to investigate the relationship between cervical cerclage and pregnancy outcome based on gestational age. Method and Materials: The study was conducted over three years at CMH, Jashore and Ibn Sina Hospital Jashore, utilizing a retrospective and longitudinal interventional approach. Ethical approval was obtained before commencing the study, which involved 92 cases undergoing mid-trimester cervical cerclage. Cervical length measurements, cervical cerclage using the McDonald technique, and subsequent medical management were performed with outcome analyzed using descriptive statistics and odds ratio. Data were analyzed retrospectively through SPSS data analysis tool. Result: 45.65% of patients experienced term deliveries, while 33.70% had preterm deliveries, with 20.65% facing abortions. Distinct inclusion criteria unveiled diverse outcomes, such as recurrent pregnancy loss cases showing 40.82% preterm and 38.78% term deliveries. Odds ratios highlighted cervical length's significance, with a 0.25 ratio indicating reduced preterm risk. Interestingly, 61.69% of preterm births occurred between 34 and 36 weeks. Maternal outcomes indicated low incidence rates of hemorrhage (4.8%), infections (1.1%) and cervix laceration (2.4%). Conclusion: The study underscores cervical cerclage's potential in enhancing full-term pregnancies, particularly for patients with cervical incompetence. While highlighting its success, the study also acknowledges associated risks and complications. J Bangladesh Coll Phys Surg 2024; 42: 57-62

Eradication of cervical canal colonization associated with prophylactic cervical cerclage: the look further study.

The perioperative management of the cervical cerclage procedure is not unified. In general population controlling microbiome cervical status does not affect obstetric outcomes, but it might be beneficial in patients with cervical insufficiency. The aim of our study was to present the obstetric, neonatal and pediatric outcomes of patients undergoing the cervical cerclage placement procedure in our obstetric department using a regimen of care that includes control of the microbiological status of the cervix and elimination of the pathogens detected. Thirty-five patients undergoing cervical cerclage in the 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, were included in the study. The procedure was performed only after receiving a negative culture from the cervical canal. Thirty-one (88.6%) patients delivered after the 34th and twenty-eight (80.0%) after the 37th week of gestation. The colonization of the genital tract was present in 31% of patients prior to the procedure, in 42% of patients - during the subsequent pregnancy course and in 48% of patients - before delivery. A total of 85% of patients who had miscarriage or delivered prematurely had abnormal cervical cultures. In patients with normal cervical cultures, and 91.7% of women delivered at term. No abnormalities in children's development were found. Controlling microbiological status of the cervical canal results in better or similar outcomes to those reported by other authors in terms of obstetric and neonatal outcomes. Active eradication of the reproductive tract colonization potentially increases the effectiveness of the cervical cerclage placement.

Cervical cerclage for prevention of preterm birth and adverse perinatal outcome in twin pregnancies with short cervical length or cervical dilatation: A systematic review and meta-analysis.

The optimal approach to prevent preterm birth (PTB) in twins has not been fully established yet. Recent evidence suggests that placement of cervical cerclage in twin pregnancies with short cervical length at ultrasound or cervical dilatation at physical examination might be associated with a reduced risk of PTB. However, such evidence is based mainly on small studies thus questioning the robustness of these findings. The aim of this systematic review was to determine the role of cervical cerclage in preventing PTB and adverse maternal or perinatal outcomes in twin pregnancies. Key databases searched and date of last search: MEDLINE, Embase, and CINAHL were searched electronically on 20 April 2023. Eligibility criteria: Inclusion criteria were observational studies assessing the risk of PTB among twin pregnancies undergoing cerclage versus no cerclage and randomized trials in which twin pregnancies were allocated to cerclage for the prevention of PTB or to a control group (e.g., placebo or treatment as usual). The primary outcome was PTB <34 weeks of gestation. The secondary outcomes were PTB <37, 32, 28, 24 weeks of gestation, gestational age at birth, the interval between diagnosis and birth, preterm prelabor rupture of the membranes (pPROM), chorioamnionitis, perinatal loss, and perinatal morbidity. Subgroup analyses according to the indication for cerclage (short cervical length or cervical dilatation) were also performed. Risk of bias assessment: The risk of bias of the included randomized controlled trials (RCTs) was assessed using the Revised Cochrane risk-of-bias tool for randomized trials, while that of the observational studies using the Newcastle-Ottawa scale (NOS). Statistical analysis: Summary risk ratios (RRs) of the likelihood of detecting each categorical outcome in exposed versus unexposed women, and (b) summary mean differences (MDs) between exposed and unexposed women (for each continuous outcome), with their 95% confidence intervals (CIs) were computed using head-to-head meta-analyses. Synthesis of the results: Eighteen studies (1,465 twin pregnancies) were included. Placement of cervical cerclage in women with a twin pregnancy with a short cervix at ultrasound or cervical dilatation at physical examination was associated with a reduced risk of PTB <34 weeks of gestation (RR: 0.73, 95% CI [0.59, 0.91], p = 0.005 corresponding to a 16% difference in the absolute risk, AR), <32 (RR: 0.69, 95% CI [0.57, 0.84], p < 0.001; AR: 16.92%), <28 (RR: 0.54, 95% [CI 0.43, 0.67], 0.001; AR: 18.29%), and <24 (RR: 0.48, 95% CI [0.23, 0.97], p = 0.04; AR: 15.57%) weeks of gestation and a prolonged gestational age at birth (MD: 2.32 weeks, 95% [CI 0.99, 3.66], p < 0.001). Cerclage in twin pregnancy with short cervical length or cervical dilatation was also associated with a reduced risk of perinatal loss (RR: 0.38, 95% CI [0.25, 0.60], p < 0.001; AR: 19.62%) and composite adverse outcome (RR: 0.69, 95% CI [0.53, 0.90], p = 0.007; AR: 11.75%). Cervical cerclage was associated with a reduced risk of PTB <34 weeks both in women with cervical length <15 mm (RR: 0.74, 95% CI [0.58, 0.95], p = 0.02; AR: 29.17%) and in those with cervical dilatation (RR: 0.68, 95% CI [0.57, 0.80], p < 0.001; AR: 35.02%). The association between cerclage and prevention of PTB and adverse perinatal outcomes was exclusively due to the inclusion of observational studies. The quality of retrieved evidence at GRADE assessment was low. Emergency cerclage for cervical dilation or short cervical length <15 mm may be potentially associated with a reduction in PTB and improved perinatal outcomes. However, these findings are mainly based upon observational studies and require confirmation in large and adequately powered RCTs.

Analysis of Characteristics Associated With Pregnancy Duration After Cervical Cerclage Placement in Singleton Gestations [ID: 1378088

INTRODUCTION: Cervical cerclage technique and perioperative interventions vary widely among providers because of lack of evidence to inform management. Our aim was to identify factors independently associated with pregnancy duration in singleton gestations after cerclage placement. METHODS: This was a retrospective cohort analysis from 2008 to 2020 at an academic tertiary care center. Because of the inclusion of one or more pregnancies for ∼37% of the cohort, a linear mixed-effects model was utilized to evaluate the association between various factors and pregnancy duration. Variables with P&lt;.2 on unadjusted analysis were considered for incorporation into a multivariable model. Model fit was assessed using Akaike’s information criterion (AIC). RESULTS: Out of 762 pregnancies, 42% underwent history-indicated, 22% ultrasound-indicated, and 36% physical exam-indicated cerclage placement. Mean gestational age (GA) at delivery was 35.0±5.8 weeks. 22% occurred less than 32 weeks and 7% resulted in previable delivery. Mean duration of pregnancy after cerclage placement was 17.1±7.0 weeks. An 8-covariate multivariable analysis revealed adjusted differences (β) in weeks of GA at delivery (95% CI): nulliparity +1.61 (0.57, 2.64), multiparity with most recent delivery 34 weeks or greater +1.31 (0.53, 2.10), married +0.94 (0.18, 1.70), concomitant progesterone use +1.06 (0.35, 1.76), preoperative cervical dilation 0.5 cm or higher −1.26 (−2.10, −0.41), utilization of Foley balloon for membrane elevation −2.27 (−3.53, −1.01), postoperative cervical length less than 20 mm −6.34, (−7.37, −5.32), and requiring cerclage revision −3.79 (−5.40, −2.18). CONCLUSION: Apart from use of a Foley balloon for membrane elevation and concomitant progesterone, we did not find any modifiable factors associated with pregnancy duration after cervical cerclage placement. However, this information may inform counseling as well as management for those with a postoperative cervical length less than 20 mm.

Factors Associated With Pregnancy Duration up to 32 Weeks in Patients With Twin Gestations Who Underwent Cerclage Placement [ID: 1378167

INTRODUCTION: Historically, cerclages were not recommended in multiple-gestation pregnancies because of uncertain efficacy and concern for harm. However, a meta-analysis of twin pregnancies found cerclage was associated with reduction in preterm birth (PTB) less than 32 weeks with cervical length (CL) of 15 mm or lower. METHODS: We conducted a retrospective analysis of women who underwent cervical cerclage placement at a single tertiary academic center from 2008 to 2020. Data pertaining to maternal demographics, obstetric course, sonographic CL, and cerclage operative technique were abstracted for women with twin gestations. Factors with P value of .2 or lower on univariate analysis of spontaneous PTB (sPTB) less than 32 weeks were considered for incorporation along with history of sPTB into a Cox proportional-hazards model to assess factors associated with pregnancy duration up to 32 weeks. RESULTS: Seventy-five twin gestations were analyzed. On univariate analysis, neuraxial anesthesia during cerclage placement, preoperative cervical dilation, use of Foley catheter for membrane elevation, shorter postoperative CL, and twin B male sex were found to be significantly associated with sPTB less than 32 weeks. Cox proportional-hazards analysis demonstrated that use of Foley catheter for membrane elevation, neuraxial anesthesia, postoperative CL less than 25 mm recorded 24 weeks or earlier, and history of sPTB greater than 16 weeks had significantly higher adjusted hazard ratios. The bias-corrected bootstrapped (1,000 repetitions) AUROC for a logistic regression model with these four covariates predictive of sPTB less than 32 weeks was 0.83 (95% CI 0.69–0.89). CONCLUSION: A survival analysis approach offers valuable clinical insight into predictors of shorter pregnancy duration up to 32 weeks in twin gestations undergoing cervical cerclage placement.

Monofilament Suture Versus Braided Suture Thread to Improve Pregnancy Outcomes After Vaginal Cervical Cerclage (C-STICH): A Pragmatic Randomized, Controlled, Phase 3, Superiority Trial

ABSTRACT Preterm birth complicates approximately 10% of pregnancies worldwide. It can lead to neonatal mortality or lifelong complications for those babies who survive. One cause of preterm birth is cervical insufficiency, which affects up to 1% of pregnant women and can be treated with the placement of vaginal cervical cerclage. There are 2 techniques for cervical cerclage: the modified Shirodkar cerclage, which involves dissecting the bladder and placing a suture around the supravaginal cervix with the suture thread buried, and the McDonald cerclage, which involves inserting the suture thread as high as possible around the upper section of the cervix. The effectiveness of either technique is dependent on perioperative decisions, such as suture thread choice. One UK survey found that 87% of clinicians prefer to use braided thread, with 13% preferring monofilament thread. The preference for braided thread was due to its easy handling and concerns that monofilament thread is difficult to remove if it becomes embedded in the cervix. However, an observational, nonrandomized systemic review suggested that monofilament thread was better than braided thread to prevent pregnancy loss (7% vs 18.9%; risk ratio [RR], 0.34; 95% confidence interval [CI], 0.18–0.63). Additional evidence suggests that monofilament thread is superior because braided thread could serve as a reservoir for bacteria, causing vaginal dysbiosis and increasing the risk of pregnancy loss. There are no randomized clinical trials to inform the choice of suture thread to prevent pregnancy loss. The aim of this study was to compare the effectiveness of monofilament suture thread to braided suture thread on pregnancy loss in women undergoing cervical cerclage. This was a superiority randomized clinical trial, conducted at 75 obstetric units in the United Kingdom between August 21, 2015, and January 28, 2021. Included were women aged 18 years and older with singleton pregnancies, who required vaginal cervical cerclage. Excluded were women who required emergency or rescue cerclage, needed immediate suture insertion, or had ruptured or visible membranes, as well as those who did not have a cerclage placed vaginally. Eligible women were randomized to receive either monofilament thread or braided thread. Women were followed up until 28 days postdelivery or hospital discharge, whichever came first. Preterm neonates were followed up until delivery or discharge, and babies born at term were followed up 28 days postdelivery or hospital discharge, whichever came first. A total of 2049 women were randomized to the monofilament suture thread group (n = 1025) or the braided suture thread group (1024). The intention-to-treat analysis included 1003 women in the monofilament group and 993 women in the braided group. No significant differences were observed in the rate of pregnancy loss between the monofilament group and braided group (8% vs 7.6%, respectively; RR, 1.05; 95% CI, 0.79–1.40; adjusted risk difference, 0.002; 95% CI, −0.02 to 0.03; P = 0.73). Insertion complications occurred in 4% of women in the monofilament group and 3% in the braided suture group. Women in the monofilament group experienced more removal complications than the braided group (RR, 1.25; 95% CI, 1.15–1.36). No significant differences were observed in maternal secondary outcomes or neonatal outcomes. In conclusion, there was no difference in the rate of pregnancy loss when using monofilament suture thread or braided suture thread in women undergoing cervical cerclage.

FIGO Good Practice Recommendations on Cervical Cerclage for Prevention of Preterm Birth

(Int J Gynaecol Obstet. 2021;155:19–22) Cervical cerclage, a suture preventing dilation, is an intervention commonly used on women at increased risk of preterm birth and second-trimester fetal loss. Evidence-based recommendations derived from randomized controlled trials (RCTs) and meta-analyses help determine which patients would benefit from cervical cerclage. Pregnant women with obstetric or gynecologic history of increasing preterm birth risk; ultrasound suggesting cervical shortening; and presence of an already open cervix with fetal membrane exposure have the recommendation to undergo cervical cerclage. History-indicated cerclage indications are mid-trimester loss and/or 3 or more preterm deliveries. Ultrasound-indicated cerclage indications are cervical length &lt;25 mm with a history of mid-trimester loss or at least one spontaneous preterm birth. Parturient women with exposed, prolapsed membranes should be offered cervical cerclage on a case-by-case basis. Vaginal cerclage does not increase the risk of preterm labor, rupture of membranes, cesarean section, or chorioamnionitis. Cervical cerclage placement technique and timing of removal should be under the discretion of a trained surgeon, though removal at 36 to 37 weeks is typical. Stitches should be placed as high as realistically possible, and anesthesia use is needed for insertion but may not be necessary for removal.

Rapid Amniotic Fluid Assessment for Cervical Cerclage Placement

A 22-year-old female whose first pregnancy resulted in the delivery of a full-term healthy newborn presented at 20 weeks gestation in her second pregnancy for urgent maternal fetal consultation. A recent ultrasound diagnosed a short cervix of 20 mm. A pelvic exam revealed 1 to 2 cm of cervical dilation and the urgent need for cervical cerclage placement to reduce the risk of preterm delivery and fetal demise. Amniocentesis was carried out, and cultures, glucose, and lactate dehydrogenase testing were performed on the amniotic fluid to quickly exclude chorioamnionitis prior to the operation (Table 1). ... ... Amniotic fluid glucose and lactate dehydrogenase test results can aid physicians when assessing the risk of ascending infection before cerclage placement and are available within hours compared to cultures (2–3 days). Median glucose and lactate dehydrogenase concentrations in intraamniotic infections are 4.5 mg/dL and 1084 IU/L, respectively (1, 2). Glucose <15 mg/dL and lactate dehydrogenase > 250 U/L demonstrate 73.3%/57% sensitivity and 88.1%/87% specificity, respectively for chorioamnionitis (3, 4). Our patient did not have an infection. Common culture isolates include Ureaplasma urealyticum and Mycoplasma hominis (5).

Provider willingness towards periviable cervical cerclage placement in singleton gestations: a survey of providers nationwide

Cervical cerclage placement up to 24 weeks may prolong pregnancy and reduce preterm birth rates and associated neonatal morbidity. In certain settings, neonatal viability now extends as early as 22 weeks’ gestational age (GA). This periviability overlap leads to great variability among providers’ willingness to perform an ultrasound-indicated (UC) or physical exam-indicated (PEC) cerclage at 22- and 23-weeks GA. We aimed to elucidate current periviable cerclage placement practices among Maternal-Fetal Medicine (MFM) physicians. A survey was available to all MFM members of the Society for Maternal-Fetal Medicine from February-May 2022. Participants were asked about their practice for UC and PEC between 22 0/7 – 22 6/7 weeks (22 weeks) and between 23 0/7 – 23 6/7 weeks (23 weeks). UC and PEC were defined in the instructions. This abstract specifically addresses provider willingness to provide UC and PEC at each GA in singletons. Rates of cerclage placement were calculated. Chi-square analysis and Fisher’s exact test assessed response differences according to physician characteristics (number of years in practice, practice model, and region of practice in the country). Separate logistic regression models were used on adjusted analysis to estimate the association between the odds of offering cerclage and each characteristic above. 406 responses (response rate 18.1%) revealed that at 22 weeks, 92.1% would offer UC and 95.8% would offer PEC. At 23 weeks, 62.6% would offer UC and 66.3% would offer PEC, with differences noted according to the number of years in practice and the region of the country of practice (Table 1). On adjusted analysis these differences remained, with the odds of UC and PEC being significantly lower at 23 weeks for those in practice > 10 years and providers in the South (Table 2). Periviable cerclage management varies greatly, with willingness to perform UC and PEC being significantly different according to region of the country and the number of years in practice. These differences reflect the need for evidence-based guidelines in these scenarios.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Utility of cervical length measurement within 24 hours post transvaginal cervical cerclage placement

Utility of cervical length measurement within 24 hours post transvaginal cervical cerclage placement

Provider willingness towards periviable cervical cerclage placement in multifetal gestations: a survey of practitioners nationwide

Provider willingness towards periviable cervical cerclage placement in multifetal gestations: a survey of practitioners nationwide

Characteristics associated with previable delivery and/or delivery

To identify socio-demographic, clinical and sonographic predictors of cerclage failure, defined as previable delivery or delivery < 21 days after transvaginal cervical cerclage placement, among women with singleton gestations.

Complications Associated with Cervical Cerclage: A Systematic Review.

Cervical cerclages are associated with improved live birth rates and have low short- and long-term risks. However, there have been reports of fistula formation or erosion of cerclage into the surrounding tissue. Those complications are uncommon and yet are serious. The risk factors associated with its development are still unclear. The purpose of our study was to evaluate the incidence of fistula formation or erosion following transvaginal cervical cerclage and the associated clinical and sociodemographic factors. We conducted a systematic search of PubMed, Medline, and Embase databases to retrieve articles related to transvaginal or transabdominal cervical cerclage. Databases were searched up to July 2021. The study protocol was registered (PROSPERO ID 243542). A total of 82 articles were identified describing cervical cerclage and erosion or fistula formation. A total of 9 full-text articles were included. There were seven case reports and series that described 11 patients who experienced late complications following cervical cerclage. Many of the cerclage procedures were done electively (66.7%). The most common type of cerclage was McDonald (80%). While all cases reported fistula formation, the main location was vesicovaginal fistulas (63.6%). One patient (9.1%) had erosion of their cerclage and another (9.1%) had bladder calculi. Of 75 patients who underwent cerclage in two retrospective case reviews, the overall incidence of fistula was 1.3% and abscess was also 1.3%. Although rare, the most common long-term complication of cervical cerclage placement is fistula formation, particularly vesicovaginal fistulas.

Use of perioperative neonatology consultation with periviable cervical cerclage placement: a survey of providers nationwide

Use of perioperative neonatology consultation with periviable cervical cerclage placement: a survey of providers nationwide