Effectiveness of cerclage according to severity of cervical length shortening: a meta‐analysis

Berghella, Vincenzo; Keeler, Sean; To, Meekai; Althuisius, Sietske M.; Rust, Orion A.

doi:10.1002/uog.7547

Cited by 84 publications

(36 citation statements)

References 14 publications

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“…Ultrasound indicated cerclage seems to be associated with a reduction in PTB in women with a previous PTB who are carrying singleton gestations and develop a short cervical length in the second trimester 40 . More rarely, a rescue cervical suture may be inserted when the patient presents with a cervix that is already dilated with the membranes bulging into the vagina but not signs of labour, infection or heavy bleeding 41 …”

Section: Introductionmentioning

confidence: 99%

Cervical length for predicting preterm birth and a comparison of ultrasonic measurement techniques

O'Hara

Zelesco²,

Sun

2013

Australas J Ultrason Med

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Introduction: Preterm birth is the leading cause of neonatal morbidity and mortality not attributable to congenital anomalies or aneuploidy. It has been shown that a shortened cervix is a powerful indicator of preterm births in women with singleton and twin gestations – the shorter the cervical length, the higher the risk of spontaneous preterm birth. Ultrasound measurements of the cervix are a more accurate way of determining cervical length (CL) than using a digital method. Background: There are three approaches that may be used to perform ultrasound measurements of the cervix; these are the transabdominal (TA), transperineal (TP) and the transvaginal (TV) approach. The TV approach is considered to be the gold standard. In women who are considered to be at a high risk of preterm birth it is now recommended that the cervix is measured at the mid‐trimester ultrasound using the TV ultrasound approach. For women considered to be at a historical low risk the TV scan is not recommended, however it has been found that many women who deliver a preterm baby have no known risk factors. Conclusion: There is contradictory evidence in the literature with regard to the correlation between TA, TP and TV measurements. This article provides an overview of these three approaches with a focus on the clinical value for the assessment of the maternal cervix.

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Section: Introductionmentioning

confidence: 99%

Cervical length for predicting preterm birth and a comparison of ultrasonic measurement techniques

O'Hara

Zelesco²,

Sun

2013

Australas J Ultrason Med

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“…However, this meta-analysis also included women with a prior PTB 85. A meta-analysis from 2010 assessing the effect of a cerclage in women with a cervix <25 mm showed no beneficial effect in preventing PTB before 35 weeks in the subgroup of women without a previous PTB (RR 0.84; 95% CI 0.60–1.18) 86. Therefore, a cerclage is not recommended in women with a short cervix without a prior PTB.…”

Section: Prevention Of Ptbmentioning

confidence: 99%

Prevention of preterm delivery: current challenges and future prospects

Zijl

Koullali

Mol

et al. 2016

IJWH

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Preterm birth (PTB), defined as delivery at <37 weeks of gestation, is the most important cause of neonatal morbidity and mortality. Therefore, preventing PTB is one of the main goals in obstetric care. In this review, we provide an overview of the current available literature on screening for risk factors for PTB and a summary of preventive strategies in both low-risk and high-risk women with singleton or multiple gestations. Furthermore, current challenges and future prospects on PTB are discussed. For an optimal prevention of PTB, risk stratification should be based on a combination of (maternal) risk factors, obstetric history, and screening tools. Cervical length measurements can help identify women at risk. Thereafter, preventive strategies such as progesterone, pessaries, and cerclage may help prevent PTB. Effective screening and prevention of PTB vary between the different pregnancy populations. In singleton or multiple pregnancies with a short cervix, without previous PTB, a pessary or progesterone might prevent PTB. In women with a (recurrent) PTB in the past, progesterone and a cerclage may prevent recurrence. The effect of a pessary in these high-risk women is currently being studied. A strong collaboration between doctors, patients’ organizations, pharmaceutical companies, and (international) governments is needed to reduce the morbidity and mortality as a result of spontaneous PTB.

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“…On the one hand, the chance of preterm birth before 35 weeks is about 25% in women with singleton pregnancy and a cervical length of 11 mm, in the absence of a history of spontaneous preterm birth (SPTB) [11]. That risk can be reduced to 13% by cerclage [11]. The larger uterine distension in a twin pregnancy may be expected to increase the risk.…”

Section: Discussionmentioning

confidence: 99%

Abdominal Cerclage in Twin Pregnancy after Radical Surgical Conization

Kyvernitakis

Lotgering

Arabin³

2014

Case Reports in Obstetrics and Gynecology

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Radical and repeated cone biopsies are associated with a high risk of spontaneous preterm birth. A 30-year-old gravida 1 presented with a spontaneous dichorionic twin pregnancy. She had a history of two radical surgical conizations. By speculum examination, no cervical tissue was detected. A history-indicated transabdominal cervicoisthmic cerclage was performed at 12 + 4/7 gestational weeks because of assumed cervicoisthmic insufficiency. The pregnancy continued until 34 + 3/7 weeks when the patient developed preeclampsia indicating Cesarean delivery. Transabdominal cerclage in twin pregnancy has rarely been described, but it may be considered in case of extreme cervical shortening after radical cervical surgery, as it would in singleton pregnancy.

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Effectiveness of cerclage according to severity of cervical length shortening: a meta‐analysis

Abstract: Objectives

Cited by 84 publications

References 14 publications

Cervical length for predicting preterm birth and a comparison of ultrasonic measurement techniques

Cervical length for predicting preterm birth and a comparison of ultrasonic measurement techniques

Prevention of preterm delivery: current challenges and future prospects

Abdominal Cerclage in Twin Pregnancy after Radical Surgical Conization

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