Cerclage: Shirodkar, McDonald, and Modifications

Wood, S. Lindsay; Owen, John

doi:10.1097/grf.0000000000000190

Cited by 33 publications

(15 citation statements)

References 30 publications

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“…One‐size cervical pessaries (65 × 25 × 32 mm) for preventing sPTB were purchased from Dr Arabin GmbH & Co. A pessary of a different size was used only in patients who had problems with the normal size. Cervical cerclage was performed with a Mersilene band by the modified Shirodkar technique 18 …”

Section: Methodsmentioning

confidence: 99%

“…Cervical cerclage was performed with a Mersilene band by the modified Shirodkar technique. 18 Patients assigned to the control group were encouraged to follow a low-risk approach during pregnancy. Patients assigned to the pessary or cerclage groups were given detailed information on potential side effects, such as vaginal discharge and other symptoms.…”

Section: Introductionmentioning

confidence: 99%

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Cervical pessary and cerclage placement for preterm birth prevention and cervicovaginal microbiome changes

Vargas

Yáñez

Elias

et al. 2022

Acta Obstet Gynecol Scand

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Introduction Our objective was to compare the vaginal microbiome in low‐risk and high‐risk pregnant women and to explore a potential association between vaginal microbiome and preterm birth. Material and methods A pilot, consecutive, longitudinal, multicenter study was conducted in pregnant women at 18–22 weeks of gestation. Participants were assigned to one of three groups: control (normal cervix), pessary (cervical length ≤25 mm) and cerclage (cervical length ≤25 mm or history of preterm birth). Analysis and comparison of vaginal microbiota as a primary outcome was performed at inclusion and at 30 weeks of gestation, along with a follow‐up of pregnancy and perinatal outcomes. We assessed the vaginal microbiome of pregnant women presenting a short cervix with that of pregnant women having a normal cervix, and compared the vaginal microbiome of women with a short cervix before and after placement of a cervical pessary or a cervical cerclage. Results The microbiome of our control cohort was dominated by Lactobacillus crispatus and inners. Five community state types were identified and microbiome diversity did not change significantly over 10 weeks in controls. On the other hand, a short cervix was associated with a lower microbial load and higher microbial richness, and was not correlated with Lactobacillus relative abundance. After intervention, the cerclage group (n = 19) had a significant increase in microbial richness and a shift towards community state types driven by various bacterial species, including Lactobacillus mulieris, unidentified Bifidobacterium or Enterococcus. These changes were not significantly observed in the pessary (n = 26) and control (n = 35) groups. The cerclage group had more threatened preterm labor episodes and poorer outcomes than the control and pessary groups. Conclusions These findings indicate that a short cervix is associated with an altered vaginal microbiome community structure. The use of a cerclage for preterm birth prevention, as compared with a pessary, was associated with a microbial community harboring a relatively low abundance of Lactobacillus, with more threatened preterm labor episodes, and with poorer clinical outcomes.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cervical pessary and cerclage placement for preterm birth prevention and cervicovaginal microbiome changes

Vargas

Yáñez

Elias

et al. 2022

Acta Obstet Gynecol Scand

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“…In addition to the more common McDonald and Shirodkar surgical techniques, 14 a cervicoisthmic approach is also used at our institution whereby a transvaginal cerclage is placed at the level of the internal cervical os after anterior and posterior colpotomy. Lastly, we abstracted details about whether an obstetrics-gynecology resident or a maternal-fetal medicine fellow was involved in the procedure based on documentation in the operative report as well as the experience of the attending surgeon, defined as the number of years in practice.…”

Section: Methodsmentioning

confidence: 99%

Suture thickness and transvaginal cervical cerclage outcomes

Battarbee

Pfister

Manuck

2019

American Journal of Obstetrics & Gynecology MFM

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BACKGROUND: Cervical cerclage placement has been shown to benefit women who have cervical insufficiency; however, the best type of suture to use for transvaginal cerclage placement is unknown. OBJECTIVE: The objective of the study was to evaluate the association between transvaginal cerclage suture thickness and pregnancy outcomes. STUDY DESIGN: This was a retrospective cohort study of women with a singleton, nonanomalous gestation who underwent history-, ultrasound-, or physical examinationeindicated transvaginal cerclage at a single tertiary care center (2013e2016). The primary outcome was gestational age at delivery. Secondary outcomes included preterm birth less than 34 weeks, chorioamnionitis, neonatal intensive care unit admission, and composite neonatal morbidity. Baseline characteristics and outcomes were compared by thickness of suture material: thick 5 mm braided polyester fiber (Mersilene tape) vs thin polyester braided thread (Ethibond) or polypropylene nonbraided monofilament (Prolene) with selection of suture type at the discretion of the provider. The association between thick suture and gestational age at delivery was estimated using Cox proportional hazard regression. Multivariable logistic regression was used to estimate the association between thick suture and the secondary outcomes. Effect modification of cerclage indication was also assessed. RESULTS: A total of 203 women met inclusion criteria: 120 with thick suture (59%) and 83 with thin suture (41%). Of these, 130 women had history-indicated, 35 had ultrasound-indicated, and 38 had examination-indicated cerclages. Compared with women who had thin suture, women with thick suture were more likely to have had a history-or ultrasoundindicated cerclage, rather than examination-indicated cerclage, and more likely to have had a Shirodkar or cervicoisthmic approach, rather than McDonald. Women with thick suture were also more likely to have received progesterone and had placement at earlier gestational age, but there were no differences in cervical examination at placement. After adjusting for confounding factors, thick suture was associated with longer pregnancy duration among women with ultrasound-indicated cerclage (adjusted hazard risk, 0.61, 95% confidence interval, 0.41e0.91) and examination-indicated cerclage (adjusted hazard risk, 0.30, 95% confidence interval, 0.15e0.58) but not with history-indicated cerclage (adjusted hazard risk, 1.27, 95% confidence interval, 0.83e1.94). Thick suture was also associated with lower odds of preterm birth <34 weeks, chorioamnionitis, and neonatal intensive care unit admission, compared with thin suture. CONCLUSION: Thick, compared with thin suture, for transvaginal cervical cerclage, was associated with longer duration of pregnancy among women with ultrasound-and examination-indicated cerclages and lower odds of chorioamnionitis and neonatal intensive care unit admission among all women, regardless of cerclage indication.

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“…За методами хірургічної корекції шийковий серкляж можна розділити на трансвагінальний серкляж, який в основному включає методики за Широдкаром, Макдональдом та їхні модифікації [32], та трансабдомінальний серкляж, що в основному включає лапаротомічну та лапароскопічну малоінвазивну хірургію. Останніми роками також проводять роботизоване лапароскопічне втручання.…”

Section: хірургічне лікуванняunclassified

The role of isthmic-cervical insufficiency in miscarriage

Golyanovskiy

Morozova

Supruniuk

et al. 2023

RHW

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Cervical insufficiency (CI) is one of the main pathological conditions that leads to pregnancy loss, in particular, recurrence miscarriages and premature births, which account for up to 5 % of all obstetric cases. Recurrence pregnancy losses caused by CI lead to serious psychological trauma for both the woman and her family members, as well as significant economic losses for the society. However, many women in some regions of the world still do not know about this pathology, and clinicians do not always diagnose this condition in time.At the same time, etiology of CI remains uncertain, and there are still ambiguous points regarding the diagnosis of this pathology and its treatment. The diagnosis of CI should be established by analyzing the medical history, clinical manifestations and results of ultrasound examination. Treatment of CI mainly includes surgical and conservative methods. Surgical treatment is performed with cervical cerclage, while conservative techniques mainly include the use of vaginal progesterone and insertion of various types cervical pessaries. This article summarizes the potential risk factors associated with cervical insufficiency that are of great attention and may be useful for future researches. Also, the review of the literature considers modern methods of diagnosis and treatment of CI to understand this pathology of the cervix better. From a modern standpoint, a consensus and problematic issues are presented in accordance with the recently updated recommendations, which are of practical importance, and are also important for further deeper research on this topical issue of modern obstetrics.

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Cerclage: Shirodkar, McDonald, and Modifications

Cited by 33 publications

References 30 publications

Cervical pessary and cerclage placement for preterm birth prevention and cervicovaginal microbiome changes

Cervical pessary and cerclage placement for preterm birth prevention and cervicovaginal microbiome changes

Suture thickness and transvaginal cervical cerclage outcomes

The role of isthmic-cervical insufficiency in miscarriage

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