Further experiences with the Shirodkar operation

Barter, Robert H.; Dusbabek, James A.; Tyndal, Charles M.; Erkenbeck, Richard V.

doi:10.1016/s0002-9378(16)35539-9

Cited by 22 publications

(5 citation statements)

References 9 publications

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“…The Shirodkar technique involves a transverse anterior colpotomy, dissection of the bladder up to the internal cervical os and a posterior colpotomy with dissection of areola and peritoneum upwards to the internal os. The suture is placed subcutaneously, and the knot tied in the posterior defect and buried under the vaginal epithelium 17,19,20 . Later modifications do not require a posterior colpotomy and place the knot exterior to the vaginal mucosal for ease of removal 21 .…”

Section: Methodsmentioning

confidence: 99%

“…The suture is placed subcutaneously, and the knot tied in the posterior defect and buried under the vaginal epithelium. 17,19,20 Later modifications do not require a posterior colpotomy and place the knot exterior to the vaginal mucosal for ease of removal. 21 While technically more challenging, the rationale of this technique is to allow more proximal placement of cerclage closer to the internal os.…”

Section: Shirodkar Cerclagementioning

confidence: 99%

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McDonald versus Shirodkar cerclage technique in the prevention of preterm birth: A systematic review and meta‐analysis

McAuliffe

Issah

Diacci

et al. 2023

BJOG

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Background Cervical cerclage has been used for decades to reduce preterm birth. The Shirodkar and McDonald cerclage are the most commonly used techniques with no current consensus on the preferred technique. Objective To compare the efficacy of the Shirodkar and McDonald cerclage techniques in preventing preterm birth. Search Strategy Studies were sourced from six electronic databases and reference lists. Selection Criteria Studies including women with a singleton pregnancy, requiring a cervical cerclage, using either the Shirodkar or McDonald technique that ran comparative analyses between the two techniques. Data Collection and Analysis The primary outcome was preterm birth before 37 weeks, with analyses at 28, 32, 34 and 35 weeks. Secondary data were also collected on neonatal, maternal and obstetric outcomes. Main Results Seventeen papers were included: 16 were retrospective cohort studies and one was a randomised controlled trial. The Shirodkar technique was significantly less likely to result in preterm birth before 37 weeks than the McDonald technique (relative risk [RR] 0.91, 95% CI 0.85–0.98). This finding was supported by a statistically significant reduction in rates of preterm birth before 35, 34 and 32 weeks, PPROM, difference in cervical length, cerclage to delivery interval, and an increase in birthweight in the Shirodkar group. No difference was seen in preterm birth rates <28 weeks, neonatal mortality, chorioamnionitis, cervical laceration or caesarean section rates. The RR for preterm birth prior to 37 weeks was no longer significant when sensitivity analyses were performed removing studies with a serious risk of bias. However, similar analyses removing studies that utilised adjunctive progesterone strengthened the primary outcome (RR 0.83, 95% CI 0.74–0.93). Conclusion Shirodkar cerclage reduces the rate of preterm birth prior to 35, 34 and 32 weeks’ gestation when compared with McDonald cerclage; however, the overall quality of the studies in this review is low. Further, large, well‐designed randomised controlled trials are required to address this important question to optimise care for women who may benefit from cervical cerclage.

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Section: Methodsmentioning

confidence: 99%

Section: Shirodkar Cerclagementioning

confidence: 99%

McDonald versus Shirodkar cerclage technique in the prevention of preterm birth: A systematic review and meta‐analysis

McAuliffe

Issah

Diacci

et al. 2023

BJOG

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“…The operation which has been carried out at The New York Hospital since 1958, is a modification of Shirodkar's technique described by Barter et al (1,2). Shirodkar used a fascia lata strip rather than a suture.…”

Section: Methodsmentioning

confidence: 99%

Experience with Shirodkar's Operation and Postoperative Alcohol Treatment¹

Lauersen

Fuchs

1973

Acta Obstet Gynecol Scand

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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.

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“…The Shirodkar technique involves a transverse anterior colpotomy, dissection of the bladder up to the internal cervical os and a posterior colpotomy with dissection of areola and peritoneum upwards to the internal os. The suture is placed subcutaneously and the knot tied in the posterior defect and buried under the vaginal epithelium (13,15,16). Later modifications do not require a posterior colpotomy and place the knot exterior to the vaginal mucosal for ease of removal (17).…”

Section: Shirodkar Cerclagementioning

confidence: 99%

McDonald versus Shirodkar cerclage technique in the prevention of preterm birth. A systematic review and meta-analysis

McAuliffe

Issah

Diacci

et al. 2021

Preprint

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Background: Cervical cerclage has been used for decades to decrease rates of preterm birth. The Shirodkar and McDonald cerclage are the two most commonly used cerclage techniques with no current consensus on the preferred technique. Objective: To compare the efficacy of the two techniques. Search strategy: Studies were sourced from six electronic databases and reference lists. Selection criteria: Studies including women with a singleton pregnancy, requiring a cervical cerclage, using either the Shirodkar or McDonald technique that ran comparative analyses between the two techniques. Data collection and analysis: The primary outcome was preterm birth before 37 weeks, with sub analyses at 28, 32, 34 and 35 weeks. Secondary data was also collected on neonatal, maternal and obstetric outcomes. Main results: Seventeen papers were included - analysis showed the Shirodkar group had significantly less chance of preterm birth before 37 weeks (RR 0.91, 95% CI 0.85-0.98). This finding is reinforced by statistically significant reduction in rates of preterm birth before 37, 35, 34 and 32 weeks, PPROM (RR 0.87 ,95% CI 0.77 – 0.99), difference in cervical length (mean difference 5.25, 95% CI 4.68–5.83), cerclage to delivery interval (mean difference 10.79, 95% CI 8.20-13.38), and an increase in birthweight (mean difference 348 grams, 95% CI 291–406) in the Shirodkar group. Conclusion: Shirodkar cerclage leads to a significant reduction in preterm birth and delivers better maternal and neonatal outcomes when compared to McDonald cerclage. Funding: No funding was required for this review. Keywords: Cervical, Stitch, Cerclage, McDonald, Shirodkar, Preterm birth

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Further experiences with the Shirodkar operation

Cited by 22 publications

References 9 publications

McDonald versus Shirodkar cerclage technique in the prevention of preterm birth: A systematic review and meta‐analysis

McDonald versus Shirodkar cerclage technique in the prevention of preterm birth: A systematic review and meta‐analysis

Experience with Shirodkar's Operation and Postoperative Alcohol Treatment¹

McDonald versus Shirodkar cerclage technique in the prevention of preterm birth. A systematic review and meta-analysis

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Further experiences with the Shirodkar operation

Cited by 22 publications

References 9 publications

McDonald versus Shirodkar cerclage technique in the prevention of preterm birth: A systematic review and meta‐analysis

McDonald versus Shirodkar cerclage technique in the prevention of preterm birth: A systematic review and meta‐analysis

Experience with Shirodkar's Operation and Postoperative Alcohol Treatment1

McDonald versus Shirodkar cerclage technique in the prevention of preterm birth. A systematic review and meta-analysis

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Experience with Shirodkar's Operation and Postoperative Alcohol Treatment¹