A new technique for emergency cerclage: Guard suture method

Karakuş, Resul; Akalın, Münip; Dizdaroğulları, Gizem Elif; Demirci, Oya; Kılıccı, Cetin

doi:10.1016/j.jogoh.2021.102250

Cited by 4 publications

(3 citation statements)

References 20 publications

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“…Zhi-Min Xu et al 33 conducted a retrospective case-control study compare the efficacy of two stitches versus one stitch in women with ECC in singleton pregnancies and indicated that the procedure with two stitches can prolong the pregnancy and improve the neonatal prognosis more effectively, and it was similar to our research that we also use two stitches in case group. Resul Karakus et al 34 reported a new a technique , using a combination of the Shirodkar and McDonald's techniques to trying to place the Mersilene tape as high as possible on the uterine cervix for ECC and proposed this method is safe, effective, and had better fetal and neonatal outcomes in singleton pregnancies compared with McDonald method. But their study had a small sample size and all the cases in the study were singleton pregnancies.…”

Section: Commentmentioning

confidence: 99%

Comparison of two emergency cervical cerclage techniques in twin pregnancies: a retrospective cohort study matched with cervical dilation

Qiu

Luo

et al. 2023

Preprint

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Background: Emergency cervical cerclage (ECC) is of potential value in twin pregnancy, when the cervix is dilated to >1cm. McDonald and Shirodkar were two main techniques of transvaginal cerclage at present. As ECC at extremely high risk of spontaneous preterm birth (sPTB) especially for twins with cervical dilated ≥ 3cm and prolapsed membranes, so which technique has more advantages is still uncertain. Objectives: The aim of our study was to evaluate the effectiveness of ECC performed with combined McDonald-Shirodkar technique in twin pregnancies between 18–26 weeks with painless cervical dilation 1-6cm. Methods: A retrospective, cohort study matched with the degree of cervical dilation was conducted. The study group (case group) included twin pregnancies who underwent combined McDonald-Shirodkar approach with cervical dilation ≥1 cm between 18–26 weeks of gestation at four institutions, from December 2015 to December 2022. To minimize confounding factors, we elucidated the causality structure using a DAG (Figure 1) and performed 1:1 case-control Matching. A control group performed McDonald approach. The primary outcome was gestational age (GA) at delivery. The secondary outcomes were pregnancy latency, the rates of sPTB at <28, <30, <32, <34 weeks, and neonatal outcomes. Additional sub-analysis was performed by dividing the patients into two subgroups of cervical dilation ≥ 3cm and < 3cm. Results: 84 twin pregnancies were managed with either combined McDonald-Shirodkar approach (case group: n=42) or McDonald approach (control group: n=42). Demographic characteristics were not significantly different in two groups(p>0.05). After adjusting for confounders which were represented by a directed acyclic graph (DAG, Figure 1), median GA at delivery was significantly higher (30.5 vs 27 weeks, Bate: 3.40, 95% confidence interval (CI): 2.13-4.67, p<0.001) and median pregnancy latency was significantly longer (56 vs 28 days, Bate: 24.04, 95% CI: 13.31-34.78, p<0.001) in the case group compared with the control group. Rates of sPTB at <28, <30, <32, and <34 weeks were significantly lower in the case group than in the control group. For neonatal outcomes, there were higher birth weight (BW) (1543.75 vs 980g, Bate: 420.08, 95%CI: 192.18-647.98, p<0.001) and significantly lower overall perinatal mortality (7.1% vs 31%, aOR: 0.16, 95% CI: 0.04-0.70, p=0.014) in the case group compared with the control group. And when cervical dilation ≥ 3cm, combined McDonald-Shirodkar procedure can significantly reduce perinatal mortality (8.3% vs 46.7%, aOR:0.09, 95%CI: 0.01-0.77, p=0.028), significantly decrease the risk of delivery at <28, <30weeks, prolong GA at delivery and pregnancy latency compared with McDonald procedure. Conclusions: ECC performed with the combined McDonald-Shirodkar procedure in twin pregnancies with cervical dilation 1-6 cm in mid-trimester pregnancy may reduce the rate of sPTB and improve perinatal and neonatal outcomes compared with McDonald procedure, especially for twins with cervical dilation of 3-6 cm and prolapsed membranes.

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Section: Commentmentioning

confidence: 99%

Comparison of two emergency cervical cerclage techniques in twin pregnancies: a retrospective cohort study matched with cervical dilation

Qiu

Luo

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…32 Xu et al conducted a retrospective case-control study comparing the efficacy of two stitches versus one stitch in women with ECC in singleton pregnancies and indicated that the procedure with two stitches can prolong the pregnancy and improve the neonatal prognosis more effectively, which is similar to our research wherein we used two stitches in the case group. 33 Karakus et al 34 reported a new a technique, using a combination of the Shirodkar and McDonald techniques to try to place the Mersilene tape as high as possible on the uterine cervix for ECC and proposed that this method is safe and effective and had better fetal and neonatal outcomes in singleton pregnancies compared with the McDonald method. However, their study had a small sample size and all of the cases in the study were singleton pregnancies.…”

Section: Ta B L Ementioning

confidence: 99%

Comparison of two emergency cervical cerclage techniques in twin pregnancies: A retrospective cohort study matched with cervical dilation

Qiu,

Lv,

Chen

et al. 2023

Intl J Gynecology & Obste

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ObjectivesThis retrospective cohort study aimed to assess the efficacy of emergency cervical cerclage (ECC) performed with the combined McDonald‐Shirodkar technique in twin pregnancies between 18 and 26 weeks of pregnancy with painless cervical dilation 1 to 6 cm.MethodsA retrospective cohort study matched with the degree of cervical dilation was conducted. The study group (case group) included women with twin pregnancies undergoing combined McDonald‐Shirodkar approach with cervical dilation ≥1 cm between 18 to 26 weeks of gestation at four institutions, from December 2015 to December 2022. To minimize confounding factors, we elucidated the causality structure using a directed acyclic graph and performed 1:1 case–control matching. A control group underwent the McDonald approach. The primary outcome was gestational age (GA) at delivery. The secondary outcomes were pregnancy latency; the rates of spontaneous preterm birth at <28, <30, <32, and <34 weeks; and neonatal outcomes. Additional subanalysis was performed by dividing the patients into two subgroups of women with cervical dilation ≥3 cm and <3 cm.ResultsA total of 84 twin pregnancies were managed with either the combined McDonald‐Shirodkar approach (case group: n = 42) or the McDonald approach (control group: n = 42). Demographic characteristics were not significantly different in the two groups (P > 0.05). After adjusting for confounders that were represented by a directed acyclic graph, median GA at delivery was significantly higher (30.5 vs 27 weeks; Bate: 3.40 [95% confidence interval (CI), 2.13–4.67], P < 0.001) and median pregnancy latency was significantly longer (56 vs 28 days; Bate: 24.04 [95% CI, 13.31–34.78], P < 0.001) in the case group compared with the control group. Rates of spontaneous preterm birth at <28, <30, <32, and <34 weeks were significantly lower in the case group than in the control group. For neonatal outcomes, there was higher birth weight (1543.75 vs 980 g; Bate: 420.08 [95% CI, 192.18–647.98], P < 0.001) and significantly lower overall perinatal mortality (7.1% vs 31%; adjusted odds ratio, 0.16 [95% CI, 0.04–0.70], P = 0.014) in the case group compared with the control group. When cervical dilation was ≥3 cm, the combined McDonald‐Shirodkar procedure can significantly reduce perinatal mortality (8.3% vs 46.7%; adjusted odds ratio, 0.09 [95% CI, 0.01–0.77], P = 0.028), significantly decrease the risk of delivery at <28 and <30 weeks, and prolong GA at delivery and pregnancy latency compared with the McDonald procedure.ConclusionsECC performed with the combined McDonald‐Shirodkar procedure in women with twin pregnancies who have cervical dilation 1 to 6 cm in midtrimester pregnancy may reduce the rate of spontaneous preterm birth and improve perinatal and neonatal outcomes compared with the McDonald procedure, especially for twin pregnancies in women with cervical dilation of 3 to 6 cm and prolapsed membranes.

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“…Elective (prophylactic) cerclage is performed between 12 and 14 weeks of pregnancy in women with a history of cervical insufficiency. On the other hand, pregnant women whose cervixes are progressively shortening and expanding have the option of emergency cerclage [5] .…”

Section: Introductionmentioning

confidence: 99%

Effect of implementing educational program on pregnant women's knowledge, and practice regarding cervical cerclage

Abdalla¹,

Mohamed²,

Mahmoud³

2023

Int. J. Obstetrics Gynaecological Nurs.

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Cervical cerclage is the principal treatment for women with a history of cervical insufficiency. In general, there are three major cerclage types: prophylactic, therapeutic, and emergency. Aim of the study:To evaluate the effect of implementing an educational program on pregnant women's knowledge and practice regarding cervical cerclage. Research design: Quasi-experimental design was used. Setting: The study was conducted in outpatient departments at Minia university hospital for maternity and child health. Subjects: A purposive sample of one-hundred pregnant women who had undertaken cervical cerclage were recruited and divided equally into study and control groups using a simple random sample. Tools of data collection: Three tools were used: 1-A structured Interviewing Questionnaire, 2knowledge Assessment, and 3-Assessment tool for practices. Results: The current study reveals; that most of the study and control groups respectively had poor knowledge regarding cervical cerclage pre-program, decreased post-program, and the minority of study and control groups had a satisfactory level of practice regarding cervical cerclage procedure preprogram, compared to most and minority of study and control groups had a satisfactory level of practice regarding cervical cerclage procedure post-program, respectively. Conclusion & Recommendation:Implementing the educational program effectively and significantly improved pregnant women's knowledge and practice regarding cervical cerclage. Women undergoing cervical cerclage should be provided with educational programming as part of their standard hospital care.

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A new technique for emergency cerclage: Guard suture method

Cited by 4 publications

References 20 publications

Comparison of two emergency cervical cerclage techniques in twin pregnancies: a retrospective cohort study matched with cervical dilation

Comparison of two emergency cervical cerclage techniques in twin pregnancies: a retrospective cohort study matched with cervical dilation

Comparison of two emergency cervical cerclage techniques in twin pregnancies: A retrospective cohort study matched with cervical dilation

Effect of implementing educational program on pregnant women's knowledge, and practice regarding cervical cerclage

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