Does cerclage location influence perinatal outcome?

Rust, Orion A.; Atlas, Robert; Meyn, Joseph; Wells, Mark D.; Kimmel, Sharon

doi:10.1016/s0002-9378(03)00779-8

Cited by 29 publications

(15 citation statements)

References 9 publications

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“…The authors suggested that there was no correlation between the length of the cervix bellow the level of cerclage and gestational age at delivery. 13 Our patients were also different from those described in a more recent study that compared the use of Shirodkar cerclage versus McDonald cerclage in women with short 15 the authors suggested that when compared with women followed expectantly, there was no benefit in placing a McDonald cerclage in women with sonographically proven preterm cervical dilation. The high success rate we reported probably also reflected the experience the authors had using the Shirodkar cerclage technique.…”

Section: Discussioncontrasting

confidence: 81%

Pregnancy outcome after placement of ‘rescue’ Shirodkar cerclage

et al. 2009

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Section: Discussioncontrasting

confidence: 81%

Pregnancy outcome after placement of ‘rescue’ Shirodkar cerclage

et al. 2009

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“…Rust et al [11] studied 74 women who had a suture placed due to a CL <25mm or the presence of funnelling, and did not demonstrate a correlation between ‘cerclage position’ and gestational age at birth. However, this study included women with funnelling but a CL >25mm who would not have received a cerclage in our practice, and the authors defined total CL as the distance from the external os to the level of maximal funnel width, rather than the length of total closed cervix.…”

Section: Discussionmentioning

confidence: 99%

Cerclage position, cervical length and preterm delivery in women undergoing ultrasound indicated cervical cerclage: A retrospective cohort study

et al. 2017

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ObjectiveThe objectives were to assess whether anatomical location of ultrasound (USS) indicated cervical cerclage and/or the degree of cervical shortening (cervical length; CL) prior to and following cerclage affects the risk of preterm birth (PTB).MethodA retrospective cohort study of 179 women receiving cerclage for short cervix (≤25mm) was performed. Demographic data, CL before and after cerclage insertion, height of cerclage (distance from external os) and gestation at delivery were collected. Relative risk (RR) and odds ratio (OR) of preterm delivery were calculated according to the anatomical location of the cerclage within the cervix and the CL before and after cerclage as categorical and continuous variables. Partition tree analysis was used to identify the threshold cerclage height that best predicts PTB.Results25% (n = 45) delivered <34 weeks and 36% (n = 65) delivered <37 weeks. Risk of PTB was greater with cerclage in the distal 10mm (RR2.37, 95% CI 1.45–3.87) or the distal half of a closed cervix (RR2.16, 95% CI 1.45–3.87). Increasing absolute cerclage height was associated with a reduction in PTB (OR 0.87, 95% CI 0.82–0.94). A cerclage height <14.5 mm best predicts PTB (70.8%). Increasing CL following cerclage was associated with a reduction in PTB (OR0.87, 95% CI 0.82–0.94). Conversely, the risk of PTB was increased where CL remained static or shortened further following cerclage (RR2.34, 95% CI 1.04–5.25).ConclusionThe higher a cerclage was placed within a shortened cervix, the lower the subsequent odds of PTB. Women whose cerclage is placed in the distal 10mm of closed cervix or whose cervix fails to elongate subsequently, should remain under close surveillance as they have the highest risk of PTB.

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“…18 However, an additional advantage of the abdominal cerclage is that there is no effect on fertility rates or perinatal outcomes. 19,20 One drawback of the abdominal cerclage is the potential migration of the suture or tape into the endocervical canal, leading to aggravation of the cervical insufficiency. Throughout the antenatal course this potential complication should be evaluated with replacement of the cerclage if indicated.…”

Section: Discussionmentioning

confidence: 99%

Preconceptional and postconception cerclage placement, dual case reports with review of literatures

Rezai¹,

Patel²,

Kochen³

et al. 2018

OGIJ

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BackgroundCervical incompetence is defined as cervical insufficiently during the second trimester. 1 This process is characterized by painless cervical dilation with subsequent prolapse of membranes into the vagina resulting in the expulsion of an immature fetus; with an increased risk for future pregnancies. 2 Individuals with exposure to diethylstilbestrol (DES), insufficient collagen and elastin, surgical trauma, mechanical dilation, and post-delivery trauma of the cervix are also at an increased risk for cervical incompetence. 3 Cervical incompetence does not typically occur without a history of a second trimester loss. A screening ultrasound is used to assess cervical length and the presence of a funnel shaped opening (funneling) of the internal os, every two weeks beginning at 16 weeks gestation. 1,4 Cervical length between 25-29mm warrants a screening interval of once a week. Cervical length less than 25mm denotes a short cervix, and measures are taken to decrease risk of fetal loss. 1,5 The definitive treatment for cervical incompetence is placement of a cervical cerclage; the cervix is closed and/or tightened with an encircling suture. Patients can benefit from postconceptional or rescue cerclage in the second trimester, if indicated (Table 1).With a known history of cervical incompetency in presence of transvaginal postconception cervical cerclage, for future pregnancy, one should may consider placement of pre-conceptional cerclage for improved perinatal outcomes (Table 1).Contraindications for cerclage placement include bleeding, contractions, or ruptured membranes. 2 Cervical cerclage placement will not improve perinatal outcomes or decrease the risk of premature birth for those pregnancies complicated by fetal anomalies incompatible with life, intrauterine infection, active bleeding or fetal demise in Abstract Background: Cervical incompetence is defined as cervical insufficiency during the second trimester; characterized by painless cervical dilation, leading to expulsion of an immature fetus, with increased risk for future pregnancies to be complicated by preterm delivery. A cervical length less than 25mm has been accepted as designating a short cervix and is an indication to implement measures to prevent fetal loss. Definitive treatment is placement of a cervical cerclage; to close, support, and/or strengthen the cervix by use of an encircling suture. There are two approaches for cervical cerclage placement -transvaginal, performed using the McDonald or Shirodkar technique, or transabdominal placed by laparoscope or laparotomy. The timing of placement can be either pre-conceptionally or post-conceptionally, dependent on patient presentation. We present a duel case report of cervical cerclage placement with a systematic review of cervical incompetency treated with pre-conceptional Shirodkar cerclage and postconceptional abdominal cerclage placement.Case 1: 37-year-old Gravida 3, Para 0120, with history of spontaneous abortions (SAB) x3 due to incompetent cervix resulting in one first trimester spon...

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Does cerclage location influence perinatal outcome?

Cited by 29 publications

References 9 publications

Pregnancy outcome after placement of ‘rescue’ Shirodkar cerclage

Pregnancy outcome after placement of ‘rescue’ Shirodkar cerclage

Cerclage position, cervical length and preterm delivery in women undergoing ultrasound indicated cervical cerclage: A retrospective cohort study

Preconceptional and postconception cerclage placement, dual case reports with review of literatures

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