Role Of Cervical Cerclage Research Articles

Role of Cervical Cerclage and Vaginal Progesterone in the Treatment of Cervical Incompetence with/without Preterm Birth History.

Background:Preterm birth (PTB) is the leading cause of perinatal morbidity and mortality worldwide, and its prevention is an important health-care priority. The cervical incompetence is a well-known risk factor for PTB and its incidence is about 0.1–2.0%, while there is no ideal optimum treatment recommended currently. The cervical incompetence causes about 15% of habitual abortion in 16–28 weeks. This study aimed to evaluate the effectiveness and safety of cervical cerclage and vaginal progesterone in the treatment of cervical incompetence with/without PTB history.Methods:We retrospectively observed the pregnancy outcome of 198 patients diagnosed with cervical incompetence from January 2010 to October 2015 in Beijing Hospital. Among the 198 women involved, women who had at least one PTB before 32 weeks (including abortion in the second trimester attributed to the cervical competence) were assigned to the PTB history cohort, and others were assigned to the non-PTB history cohort. All women underwent cerclage placement (cervical cerclage group) or administrated with vaginal progesterone (vaginal progesterone group) until delivery. The outcomes of interest were the differences in gestational age at delivery, the rate of premature delivery, neonatal outcome, complications, and route of delivery between the two treatment groups.Results:Among the 198 patients with cervical incompetence, 116 patients in PTB history cohort and 80 patients in non-PTB history cohort were included in the final analysis. In the PTB history cohort, cervical cerclage group had significantly longer cervical length at 2 weeks after the start of treatment (23.1 ± 4.6 mm vs. 12.4 ± 9.1 mm, P = 0.002), higher proportion of delivery ≥37 weeks’ gestation (63.4% vs. 33.3%, P = 0.008), bigger median birth weight (2860 g vs. 2250 g, P = 0.031), and lower proportion of neonates whose 1-min Apgar score <7 (5.9% vs. 33.3%, P = 0.005), compared with vaginal progesterone group. No significant differences were found in other outcome measures between the two treatment groups. In the non-PTB history cohort, there were no significant differences in the maternal outcomes between cervical cerclage and vaginal progesterone groups, such as median gestational age at delivery (37.4 weeks vs. 37.3 weeks, P = 0.346) and proportion of delivery ≥37 weeks’ gestation (55.9% vs. 60.9%, P = 0.569). There were also no significant differences in the neonatal outcomes between the cervical cerclage and vaginal progesterone groups including the median birth weight (2750 g vs. 2810 g, P = 0.145), perinatal mortality (5.9% vs. 6.5%, P = 0.908), and 1-min Apgar scores (8.8% vs. 8.7%, P = 0.984).Conclusions:Cervical cerclage showed more benefits in the maternal and neonatal outcomes than vaginal progesterone therapy for women with an asymptomatic short cervix and prior PTB history, while cervical cerclage and vaginal progesterone therapies showed similar effectiveness for women with an asymptomatic short cervix but without a history of PTB.

Role of cervical cerclage and prolonged antibiotic therapy with azithromycin in patients with previous perinatal loss amnionitis

In the group of 35 patients with cerclage, intermediate fetal mortality was reduced from 37.1% to 0 (p < 0.001); late fetal mortality rate from 8.5% to 2.8% (p = 0.606); prematurity from 65.7% to 5.7% (p < 0.001); newborn underweight from 11.4% to 5.7% (p = 0.671); newborns with very low weight from 34.2% to 0 (p < 0.001) and the abortion rate from 8.5% to 0 ( p < 0.001). In the group of 19 patients without buckling, intermediate fetal mortality was reduced from 26.3% to 10.5% (p = 402); late fetal mortality from 63.1% to 0 (p < 0.001); prematurity 78.9% to 31.5% (p < 0.009); the newborn of low weight from 31.5% to 10.5% (p = 0.234); newborns with very low weight from 68.4% to 15.7% (p < 0.003) and the abortion rate from 36.8 to 0 (p < 0.001). In conclusion, we believe the results of this study demonstrate the effectiveness of therapeutic and prophylactic cervical cerclage associated with prolonged antibiotic therapy

A clinico-epidemiological review of cervical cerclage from the Assir region of Saudi Arabia

A retrospective review was conducted on patients who had cervical cerclage performed because of suspected cervical incompetence over a 7-year period to assess the outcome of pregnancy and complications resulting from the cerclage. Other factors that could affect the outcome and complications were also assessed. Out of 196 patients who had the operation, 154 patients had adequate records available and therefore comprised the study population. There were 139 (90%) live births of which 76·6% weighed more than 2000 g. The outcome was not influenced by the experience of the surgeon, type of cerclage or the use of prophylactic antibiotics. There were no complications in 138 (90%) of the cases, and no cases of ruptured uterus, cervical lacerations and severe infections were encountered. The complications were seen more in multiple-order pregnancy and when the operation was performed as an emergency. The future role of cervical cerclage in the management of cervical incompetence in our community is discussed.

Advanced Cervical Dilatation: The Role of Cervical Cerclage

The patient who presents with advanced cervical dilatation and herniating membranes without clear signs of preterm labor prior to the time of fetal viability represents an obstetric dilemma. Nonintervention can be expected to result in inevitable preterm delivery and 20% fetal survival. This study represents the use of a McDonald cerclage in patients with advanced dilatation and herniation of membranes. The study population comprised 14 singleton pregnancies between 17 and 25 weeks gestation at 4 cm dilatation or greater. The operative technique included Foley catheter membrane retraction and McDonald cerclage with 5 mm mersilene tape. Results: The cervix was successfully closed in 13/14 patients (93%). Perioperative complication rate was 21%. Ten of 13 patients in whom the cerclage was successfully placed were delivered of healthy neonates who are alive and well (fetal survival rate 77%). The average duration of pregnancy after successful cerclage placement was 9.3 weeks (range 2 days-17 weeks). Conclusi...

239 Advanced cervical dilatation: The role of cervical cerclage

239 Advanced cervical dilatation: The role of cervical cerclage

Preoperative evaluation of serum CA 125 levels in premenopausal and postmenopausal patients with pelvic masses: Discrimination of benign from malignant disease

antimicrobial agents during pregnancy. Rev Infect Dis 1985;7:287-313. 12. Garite TJ, Keegan KA, Freeman RK, Nageotte MP. A randomized trial of ritodrine tocolysis versus expectant management in patients with premature rupture of membranes at 25 to 30 weeks of gestation. AM J OBSTET GYNECOL 1987; 157:388-93. 14. Quinn PA, Bauty J, Taylor J, Hannah W. Chorioamnionitis: Its association with pregnancy outcome and microbial infection. AM j 0BSTET GYNECOL 1987;156:37987. 15. Yeast JD, Garite TR. The role of cervical cerclage in the management of preterm premature rupture of the membranes. AM j 0BSTET GYNECOL 1988; 158:106-10. 13. Morales WJ. The effect of chorioamnionitis on the developmental outcome of preterm infants at one year. Obstet Gynecol 1987;70:183-6.

The role of cervical cerclage in the management of preterm premature rupture of the membranes

The presence of a cervical cerclage at the time of preterm premature rupture of the membranes potentially complicates this already difficult management problem. An analysis of 44 patients presenting with preterm premature rupture of the membranes and cervical cerclage was conducted. Twelve patients were immediately delivered because of fetal distress, labor, or mature fetal pulmonary studies. Thirty-two patients entered an expectant management protocol. The cervical cerclage was removed on admission to the study. These patients were compared with 32 matched control subjects. There appears to be no difference in neonatal or maternal outcome between the study and control groups. The latency period from premature rupture of the membranes until delivery was not affected by the presence or removal of the cerclage. There was no difference in infectious complications. These data suggest that the presence of a cervical cerclage at the time of preterm premature rupture of the membranes does not increase the risk of delivery or infectious morbidity as long as the cerclage is removed early in the management protocol.