Cervical cerclage and type of suture material: a survey of UK consultants’ practice

Israfil‐Bayli, Fidan; Toozs‐Hobson, Philip; Lees, Christoph; Slack, Mark; Daniels, Jane; Vince, Alexandra; Ismail, Khaled

doi:10.3109/14767058.2013.870551

Cited by 17 publications

(15 citation statements)

References 16 publications

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“…Interestingly, patient characteristics do not consistently elicit its prescription, even for women visiting the same clinic [ 14 , 24 ]. Other studies also reported that there is significant variation in clinical practice in progesterone for PTB prevention even amongst those working in the same clinic serving women with high-risk pregnancies [ 14 , 16 – 18 ]. However, two surveys found that most healthcare providers would be willing to take part in hypothetical progesterone trials to further evaluate its effects on PTB prevention [ 21 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…A previous cross-sectional survey [ 15 ] and two chart review studies [ 16 , 17 ] focused on the acceptability of and concerns about progesterone. We identified one healthcare provider survey on cerclage [ 18 ], but most studies have focused on counselling practices on progesterone [ 15 , 18 – 24 ]. The need to consider women’s preferences is important because evidence has shown that most women reported greater satisfaction with their pregnancy when they were actively involved in medical decisions [ 25 ], and satisfaction, in turn, has been linked to increased confidence in their ability to take better care of themselves and their infants [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pregnant women’s preferences for and concerns about preterm birth prevention: a cross-sectional survey

Ha¹,

McDonald²

2017

BMC Pregnancy Childbirth

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BackgroundAlthough there is a call for patient-centred prenatal care, women’s preferences for and concerns about preterm birth (PTB) prevention have not been well-studied. Therefore, we conducted a cross-sectional survey to determine women’s preferences for PTB prevention and their likelihood of following their healthcare provider’s recommendations for PTB prevention, as well as factors associated with these responses.MethodsA piloted self-administered questionnaire was completed by pregnant women who could read English. Data were collected about their preferences for and concerns about PTB prevention, and the likelihood of following their healthcare provider’s recommendations, using multivariable logistic regression to control for other factors.ResultsThree hundred and eleven women at a median of 32-weeks of gestation completed the survey, a response rate of 85.2%. Most women reported that if they were told they were at increased risk for PTB, they preferred not to use PTB prevention (65.8%), of whom almost all (93.4%) reported they preferred close-monitoring and 6.6% preferred neither monitoring nor prevention. A much smaller proportion of women reported that they would not follow their healthcare provider’s recommendation for progesterone (10.9%) compared to pessary (28.7%) or cerclage (50.2%). Women who were neither married nor in a common-law relationship were more likely to report that they would not follow recommendations for progesterone (aOR = 5.88 [95% CI: 1.72, 20.00]). Most women (84.5%) reported they would use other sources of information other than their main healthcare provider to learn more about PTB prevention, with the most popular source being the internet.ConclusionsMost women reported that if they were told they were at increased risk of PTB, they preferred close-monitoring over using PTB prevention. Their reported likelihood of not following their healthcare provider’s recommendations for PTB prevention varied from 10.9% for progesterone to 50.2% for cerclage. These findings suggest that more education about the risk of PTB, PTB preventions, as well as compliance with progesterone is needed and that the internet would be an important source of information. However as our study was completed by women at a median of 32 weeks of gestation, future surveys targeted at women earlier in their pregnancy are needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-017-1221-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pregnant women’s preferences for and concerns about preterm birth prevention: a cross-sectional survey

Ha¹,

McDonald²

2017

BMC Pregnancy Childbirth

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“…As these reports were exclusively in cohorts in which braided suture was used for cerclage, we hypothesized the reported lack of cerclage efficacy in pregnancy post-conization, relates to the effects of ‘foreign’ material (cerclage) on the vaginal microenvironment[23–25] and the immune system[33]. Braided suture is the current material of choice for the cervical cerclage despite a lack of evidence to support its preferential use [17, 21, 22]. This is the first study to reveal an advantage of using a monofilament suture in pregnancies post-conization for CIN with a shortened cervix to <25mm.…”

Section: Discussionmentioning

confidence: 99%

“…However these were studies in cohorts in whom cerclage was performed using braided suture material; a reflection of current global clinical practice. In the UK Mersilene™, a non-absorbable braided polyester suture, is used by over 80% of obstetricians in preference to a monofilament alternative such as Nylon or Prolene [21], despite a lack of evidence-base. The only study to report on the effect of suture material on cerclage efficacy compared two types of braided suture, Ethibond™ and Mersilene™, and excluded all monofilament cerclages.…”

Section: Introductionmentioning

confidence: 99%

Preterm Birth Prevention Post-Conization: A Model of Cervical Length Screening with Targeted Cerclage

et al. 2016

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Women with a history of excisional treatment (conization) for cervical intra-epithelial neoplasia (CIN) are at increased risk of preterm birth, perinatal morbidity and mortality in subsequent pregnancy. We aimed to develop a screening model to effectively differentiate pregnancies post-conization into low- and high-risk for preterm birth, and to evaluate the impact of suture material on the efficacy of ultrasound indicated cervical cerclage. We analysed longitudinal cervical length (CL) data from 725 pregnant women post-conization attending preterm surveillance clinics at three London university Hospitals over a ten year period (2004–2014). Rates of preterm birth <37 weeks after targeted cerclage for CL<25mm were compared with local and national background rates and expected rates for this cohort. Rates for cerclage using monofilament or braided suture material were also compared. Of 725 women post-conization 13.5% (98/725) received an ultrasound indicated cerclage and 9.7% (70/725) delivered prematurely, <37weeks; 24.5% (24/98) of these despite insertion of cerclage. The preterm birth rate was lower for those that had monofilament (9/60, 15%) versus braided (15/38, 40%) cerclage (RR 0.7, 95% CI 0.54 to 0.94, P = 0.008). Accuracy parameters of interval reduction in CL between longitudinal second trimester screenings were calculated to identify women at low risk of preterm birth, who could safely discontinue surveillance. A reduction of CL <10% between screening timepoints predicts term birth, >37weeks. Our triage model enables timely discharge of low risk women, eliminating 36% of unnecessary follow-up CL scans. We demonstrate that preterm birth in women post-conization may be reduced by targeted cervical cerclage. Cerclage efficacy is however suture material-dependant: monofilament is preferable to braided suture. The introduction of triage prediction models has the potential to reduce the number of unnecessary CL scan for women at low risk of preterm birth.

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“…We conducted a national survey of Obstetrics and Gynaecology consultants in the UK, which confirmed variability in practice - the majority of respondents were using multifilament/braided sutures, whereas only 16.6% used monofilament non-braided sutures. Significantly, 75% of respondents stated that there was no guidance for which suture material to use within their unit [5]. We subsequently conducted a systematic review, which identified only two non-randomised studies (NRS).…”

Section: Introductionmentioning

confidence: 99%

Cerclage outcome by the type of suture material (COTS): study protocol for a pilot and feasibility randomised controlled trial

Israfil‐Bayli

Toozs‐Hobson

Lees

et al. 2014

Trials

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BackgroundCervical incompetence is one of the causes of preterm birth and mid-trimester pregnancy loss. Cervical cerclage is a surgical procedure to treat cervical incompetence. Cervical cerclage reduces the incidence of preterm birth in women at risk of recurrent preterm birth, without a statistically significant reduction in perinatal mortality or neonatal morbidity. Multifilament/braided sutures such as Mersilene tape have been traditionally used for cervical cerclage. Braided sutures, particularly mesh-like non-absorbable sutures, have been associated with an increased risk of infection and, hence, some obstetricians prefer to use monofilament/non-braided sutures. However, these claims are not substantiated by any scientific or clinical evidence.We propose a pilot/feasibility study which will provide the necessary information for planning a definitive trial investigating the clinical effectiveness of monofilament non-braided suture materials in reducing pregnancy loss rate following cervical cerclage compared to the traditional multifilament braided sutures.Methods/DesignWomen eligible for elective or ultrasound-indicated cerclage at 12 to 21 + 6 weeks of gestation will be randomised to having the procedure using either a monofilament non-braided suture (Ethilon) or a Multifilament braided suture (Mersilene tape) inserted using a McDonald technique. Consent for participation in the Cerclage outcome by the type of suture (COTS) study will be obtained from each eligible participant.Clinical trials registrationCOTS is registered with the International Standard Research for Clinical Trials (ISRCTN17866773). Registered on 27 March 2013.

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Cervical cerclage and type of suture material: a survey of UK consultants’ practice

Cited by 17 publications

References 16 publications

Pregnant women’s preferences for and concerns about preterm birth prevention: a cross-sectional survey

Pregnant women’s preferences for and concerns about preterm birth prevention: a cross-sectional survey

Preterm Birth Prevention Post-Conization: A Model of Cervical Length Screening with Targeted Cerclage

Cerclage outcome by the type of suture material (COTS): study protocol for a pilot and feasibility randomised controlled trial

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