A randomised controlled trial of outpatient versus inpatient cervical cerclage

Abstract

Fifty patients with cervical incompetence were randomised to have cervical cerclage either as inpatients, spending 3 days in hospital post-procedure on supervised bed rest or as outpatients spending the time at home on bed rest. Both groups had a clinical diagnosis of cervical incompetence and both had either McDonald or Shirodkar cerclage with mersilene tape. Both groups were given salbutamol tablets for tocolysis, postoperatively. There were no significant difference in the demographic variables between the groups such as previous cerclage, gestational age at insertion, parity and gestational age at delivery. There were also no significant differences in early complications such as bleeding. Most late complications were also not different, including the spontaneous abortion rate, premature rupture of membranes, cervical dystocia and preterm delivery. However, more patients in the outpatient group had premature contractions (26.1% vs. 4.3% P=0.0479). More patients in the inpatient group had a delivery of a live neonate, 86.9% vs. 78.3%, but the difference was not statistically significant. In conclusion, out patient cerclage appears to be a valid option, the higher rate of premature contraction in this group is not a cause for concern in view of the similar mean gestational age at delivery.

Adjunctive Therapies to Cerclage for the Prevention of Preterm Birth: A Systematic Review

“…We also excluded 5 articles whose focus were rescue or emergent cerclage, 2 questionnaire surveys, 18 articles on unrelated topics, and 17 studies that did not report the use of bedrest as an adjunct to a standard treatment of cerclage in comparison to a reference group of women who received cerclage without bedrest. Eleven studies were selected to review in detail as they specifically addressed the issue of cerclage and bedrest: five randomized controlled studies [21, 26–29], five prospective cohort studies [15, 17, 30–32], and one retrospective cohort study [33]. However, none of them specifically reported outcome differences of women who received cerclage with bedrest compared to women who received cerclage without activity restriction.…”

Systematic review: Cervical stitch (cerclage) for preventing pregnancy loss: individual patient data meta‐analysis

“…Studies retrieved (n = 10)Studies excluded since comparison of inpatient vs outpatient cerclage (n =1) (Blair et al21 )Studies included in the review (n = 9) Quorum diagram.Cervical cerclage for preventing pregnancy lossª 2007 The Authors Journal compilation ª RCOG 2007 BJOG An International Journal of Obstetrics and Gynaecology…”

Prophylactic cervical cerclage, fully embedded, for twin pregnancies following fertility treatment

“…Following the procedure, all women in the study remained in hospital overnight for monitoring. Studies have shown that, if the procedure is performed in an outpatient setting, there is a higher rate of premature contractions, whereas cases where women remained in hospital had a higher rate of delivery of a live neonate [31]. Of the 43 pregnant women included in this study, only one showed signs of infection with an increase in CRP level at 18 weeks of gestation that is, four weeks following the procedure and was treated conservatively with antibiotics.…”