Experience with Shirodkar's Operation and Postoperative Alcohol Treatment¹

Abstract

During the period 1960-1970, the post-conceptional cerclage of the cervix as first described by Shirodkar was used in 143 patients with cervical incompetence. The majority of the patients received heavy sedation with sodium amytal and demerol postoperatively, a smaller group was treated prophylactically with alcohol intravenously, and another small group was treated with alcohol after failure of the sedation regime to prevent uterine activity. The success rate was the same in groups 1 and 2 (83%); in the cases where alcohol was given after the occurrence of uterine contractions, the success rate was 71%. 1959.14. Mann, E. C., Symposium: The incompetent cervix.Bull Sloane Hosp Women 8: 1962.

Emergency Cervical Cerclage: Relation between Its Success, Preoperative Serum Level of C-Reactive Protein and WBC Count, and Degree of Cervical Dilatation

“…Although no randomized controlled studies on the efficacy of emergency cerclage during midtrimester are available, the present and previous results suggest that some women have benefited from cerclage [2][3][4][5][6][7][8]. However, it has not been determined which patients will benefit from emergency cerclage.…”

“…As suggested by previous studies [2][3][4][5][6][7][8], pregnancy is unlikely to be prolonged in the presence of chorioamnionitis. In fact, chorioamnionitis may lead to premature delivery.…”

“…Although the placement of Minakami/Matsubara/Izumi/Kosuge/ Watanabe/Iwasaki/Sato a cerclage under such unfavorable circumstances is less successful than when the procedure is performed prophylactically, studies have reported fetal salvage rates ranging from 47 to 91% in selected and unselected cases [2][3][4][5][6][7][8]. These studies have usually excluded patients with clinical chorioamnionitis [2][3][4][5][6][7][8]. However, clinical chorioamnionitis is not well defined.…”

“…The strong association between infection within the vagina and uterus and premature birth suggests that microbial factors play an important role in a large percentage of previously unexplained preterm births [9][10][11]. Therefore, subclinical chorioamnionitis may have been present in patients who benefited from emergency cervical cerclage [2][3][4][5][6][7][8].…”

Multicentred controlled trial of cervical cerclage in women at moderate risk of preterm delivery

“…High rates of this complication have been reported particularly for the Shirodkar method, as it involves the use of a large tape suture, but these studies have been based on uncontrolled case reports and case series (Kubinyi et al 1976;Hager 1980). Another reported risk is intrauterine infection, sometimes followed by septic shock of acute chorioamnionitis and abortion (Hofmeister et al 1968;Lauersen & Fuchs 1973).…”