Pregnancy outcomes and superiorities of prophylactic cervical cerclage and therapeutic cervical cerclage in cervical insufficiency pregnant women

Liu, Yanyan; Ke, Zikan; Liao, Wanmin; Chen, Hanping; Wei, Song; Lai, Xiaoquan; Chen, Xi

doi:10.1007/s00404-018-4766-9

Cited by 18 publications

(20 citation statements)

References 15 publications

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“…Although previous publications have addressed maternal-neonatal outcomes associated with cerclage, these studies are primarily small cohort studies (ranging from 18 to 166), systematic reviews, or meta-analyses. 4,[7][8][9][10][13][14][15][16][19][20][21][22][23] Second, our study was derived from the U.S. vital statistics data from 2011 to 2013, which represented 83, 86, and 90% of live births in the United States, respectively. Therefore, compared with prior studies with small sample sizes, our study has increased generalizability.…”

Section: Discussionmentioning

confidence: 99%

“…9,12,14,15 Finally, our study's objective was to look at maternal and neonatal adverse outcomes remote from initial cerclage placement in contrast to most cerclage studies whose objective is to discriminate outcomes with respect to cerclage indication, type, location, and suture material used or to contrast outcomes between cerclage and expectant management, pessary placement, or progesterone supplementation. 4,5,7,8,[12][13][14][15][16][19][20][21][23][24][25] Despite these differences, our findings were consistent with existing data in several ways. For example, we demonstrated a relationship between prematurity (36.0-36.6 for the purposes of our study) and adverse neonatal outcomes, including low Apgar scores and need for assisted ventilation.…”

Section: Discussionmentioning

confidence: 99%

“…Among singletons, cerclage placement prolongs pregnancy, decreases sequela of prematurity, improves Apgar scores, and reduces perinatal death rates. 5,[10][11][12][14][15][16][17] A 2017 Cochrane review noted that rates of severe neonatal morbidity, "neonate discharged home healthy," and neonatal deaths before discharge were similar in those with and without cerclage. 5 Despite publications detailing mixed maternal outcomes and improved neonatal outcomes, there is biological plausibility that cerclage may impact maternal and neonatal outcomes beyond the immediate postoperative time.…”

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confidence: 99%

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Association of Cerclage with Composite Adverse Outcomes among Women Delivered at 36 Weeks or Later

et al. 2020

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Objective This study aimed to compare the maternal and neonatal adverse outcomes among singletons delivered at 36 weeks or later with cerclage during index pregnancy versus those without cerclage. Study Design This retrospective cohort study utilized the U.S. vital statistics datasets from 2011 to 2013. Inclusion criteria were women with nonanomalous singletons, with and without cerclage placement, without diabetes or hypertensive disorders, and delivered at 36 to 41 weeks. The coprimary outcomes were composite maternal and neonatal adverse outcomes. Composite maternal adverse outcome included admission to intensive care unit, maternal transfusion, ruptured uterus, unplanned hysterectomy, or unplanned operating room procedure. Composite neonatal adverse outcome included Apgar score less than 5 at 5 minutes, assisted ventilation for more than 6 hours, neonatal seizure, birth injury, or neonatal death. Secondary outcomes were chorioamnionitis and cesarean delivery. Multivariable Poisson's regression models with error variance were used while adjusting for confounders. Adjusted relative risk (aRR) with 95% confidence intervals (CIs) were calculated. Results Of the 8,508,228 women who met inclusion criteria, 0.2% had a cerclage and reached 36 weeks. Composite maternal (aRR: 2.04; 95% CI: 1.76–2.36) and neonatal (aRR: 1.28; 95% CI: 1.11–1.47) adverse outcomes were significantly higher among those with cerclage than those without cerclage. Chorioamnionitis (aRR: 1.47; 95% CI: 1.30–1.67) and cesarean delivery (aRR: 1.10; 95% CI: 1.08–1.12) were also significantly higher in women with cerclage than those without cerclage. Conclusion There is an association between increased composite maternal and neonatal adverse outcomes among women with cerclage who delivered at 36 to 41 weeks as compared with those without cerclage. Key Points

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Association of Cerclage with Composite Adverse Outcomes among Women Delivered at 36 Weeks or Later

et al. 2020

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“…14 The success rate of the prophylactic group was higher than the rescue group, similar to previous studies (78% vs 53%). 18,19 For clinical applications, The success rate can apply to counsel the pregnant women who has cervical incompetence and plan to do the cervical cerclage. Early identification of women at risk of cervical incompetence and early treatment will improve outcomes.…”

Section: Median (Iqr)mentioning

confidence: 99%

Success Rate of Cervical Cerclage at Siriraj Hospital

Maneeratprasert

Sutchritpongsa

Boriboonhirunsarn

2019

Smj

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Objective: To determine the success rate of cervical cerclage at Siriraj Hospital and the associated factors. Methods: The study included 90 pregnant women who received cervical cerclage procedures at Siriraj Hospital during 2007-2016. Clinical information and the cerclage procedures were evaluated. Successful cervical cerclage was defined as delivery at 34 weeks' gestation or more. Results: The mean maternal age was 31.8 ± 5 years. The most common indication was history of second trimester abortion (76.7%). The mean gestational age (GA) at cervical cerclage was 18.0 ± 4.3 weeks. The mean cervical length was 25.2 ± 12.0 mm. Most of the patients had no cervical dilatation (76.7%). Almost all the cervical cerclage procedures were performed using McDonald's technique (98.9%). Of the 90 women, 66 (73.3%) delivered at >34 weeks' gestation, while 59.9% delivered at >37 weeks' gestation. The mean birth weight was 2404.9 ± 991.7 grams. The success rate of cervical cerclage increased significantly among women with greater cervical length (28.2±10.5 vs. 18.0±14.9 mm., p=0.002), without cervical dilatation (83.3% vs. 58.3%, p=0.046), without bulging of membranes (92.5% vs. 66.7%, p=0.002), and prophylactic operations (89.4% vs. 58.3%, p=0.001). Maternal complications were significantly lower in women with successful cervical cerclage (9.1% vs. 45.8%, p<0.001). Conclusion: The success rate of cervical cerclage at Siriraj Hospital was 73.3%. Possible associated factors included cervical length, cervical dilatation, bulging of membranes, and the prophylactic procedure.

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“…Meta-analyses of trials of cerclage in women with singleton pregnancies who had a short cervix have not shown a significantly lower rate of preterm delivery overall than the rate without cerclage; however, they have shown benefit in the subgroup of women who had a previous preterm delivery. 15 16 17 18 19 Several studies, including three randomized controlled trials, have demonstrated that cervical cerclage placement in women with placenta previa may reduce antepartum hemorrhage and prolong gestation. 20 21 22 The Cochrane Review of Randomized Controlled Trials (Neilson, Issue 4, 2009) concluded that these trials using cervical cerclage in women with placenta previa, collectively show a relative risk (RR) of delivery at < 36 weeks' gestation of 0.45 with cerclage, an average entry to delivery prolongation RR of 0.35 for an interval of < 6 weeks with cerclage, and a RR of blood transfusion of 0.59 for the cerclage group.…”

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confidence: 99%

Cervical Pessary versus Expectant Management for the Prevention of Delivery Prior to 36 Weeks in Women with Placenta Previa: A Randomized Controlled Trial

Stafford

Garite

Maurel

et al. 2019

AJP Rep

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Objective This multicenter randomized controlled trial compared cervical pessary (CP) versus expectant management (EM) in women with placenta previa between 22.0 and 32.0 in prolonging gestation until ≥ 36.0 weeks' gestation. Study Design This study took place from November 2016 to June 2018. Women were randomized to receive either the Bioteque CP or EM. The pessary was removed at ≥ 36.0 weeks unless indicated. The primary outcome was gestational age (GA) at delivery, with secondary outcomes including need for transfusion, number and duration of antepartum admissions, type of delivery, and neonatal outcomes. A total of 140 patients were needed to show a 3-week prolongation of pregnancy in the pessary group; however, the trial was stopped early due to budgetary issues. Results Of the 33 eligible women, 17 were enrolled. Although not statistically significant, the mean GA at delivery in the CP group was greater than women in the EM group (36.5 ± 1.23 vs. 36.0 ± 2.0; p = 0.1673). The number and duration of antepartum admissions was greater in the EM group (2.7 ± 0.58 vs. 16.0 ± 22.76 days; p = 0.1264) as well. Conclusion Although the study was underpowered to determine the primary outcome, safety and feasibility of CP in pregnancies complicated with previa were demonstrated.

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Pregnancy outcomes and superiorities of prophylactic cervical cerclage and therapeutic cervical cerclage in cervical insufficiency pregnant women

Cited by 18 publications

References 15 publications

Association of Cerclage with Composite Adverse Outcomes among Women Delivered at 36 Weeks or Later

Association of Cerclage with Composite Adverse Outcomes among Women Delivered at 36 Weeks or Later

Success Rate of Cervical Cerclage at Siriraj Hospital

Cervical Pessary versus Expectant Management for the Prevention of Delivery Prior to 36 Weeks in Women with Placenta Previa: A Randomized Controlled Trial

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