Cervical stitch (cerclage) in combination with other treatments for preventing spontaneous preterm birth in singleton pregnancies

Eleje, George Uchenna; Eke, Ahizechukwu C.; Ikechebelu, Joseph Ifeanyichukwu; Ezebialu, Ifeanyichukwu U.; Okam, Princeston Chukwuemeka; Ilika, Chito P

doi:10.1002/14651858.cd012871.pub2

Cited by 23 publications

(19 citation statements)

References 149 publications

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“…Most guidelines do not recommend the combination of more than two of the three therapeutic options (P, Pess and C). This is supported by a Cochrane review [ 42 ].…”

Section: Discussionmentioning

confidence: 69%

Progesterone, cervical cerclage or cervical pessary to prevent preterm birth: a decision-making analysis of international guidelines

Putora

Hornung

Kinkel

et al. 2022

BMC Pregnancy Childbirth

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Objective The aim of this study was to investigate guidelines on preterm birth, analyze decision-criteria, and to identify consensus and discrepancies among these guidelines. Design Objective consensus analysis of guidelines. Sample Ten international guidelines on preterm birth. Methods Relevant decision criteria were singleton vs. twin pregnancy, history, cervical length, and cervical surgery / trauma or Mullerian anomaly. Eight treatment recommendations were extracted. For each decision-making criteria the most commonly recommended treatment was identified, and the level of consensus was evaluated. Main outcome measures Consensus and Discrepancies among recommendations. Results In a case of singleton pregnancies with no history of preterm birth and shortened cervix, most guidelines recommend progesterone. In singleton pregnancies with a positive history and shortened cervix, all guidelines recommend a cerclage as an option, alternative or conjunct to progesterone. The majority of the guidelines advise against treatment in twin pregnancies. Conclusions A shortened cervix and a history of preterm birth are relevant in singleton pregnancies. In twins, most guidelines recommend no active treatment. Tweetable abstract Among international guidelines a shortened cervix and a history of preterm birth are relevant in singleton pregnancies. With no history of preterm birth and with a shortened cervix most guidelines recommend progesterone treatment.

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“…Most guidelines do not recommend the combination of more than two of the three therapeutic options (P, Pess and C). This is supported by a Cochrane review [ 42 ].…”

Section: Discussionmentioning

confidence: 69%

Progesterone, cervical cerclage or cervical pessary to prevent preterm birth: a decision-making analysis of international guidelines

Putora

Hornung

Kinkel

et al. 2022

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

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“…Despite the biologic plausibility of their utility, data supporting adjunct therapies are lacking, and current guidelines do not currently recommend use of adjuncts. 1,13,14,33 In the meta-analysis by Ehsa-nipoor et al with informed use of examination-indicated cerclage, there was significant clinical heterogeneity between included studies for use of adjunct therapies, including antibiotics, tocolytics, and bed rest, precluding extension of the findings to support a specific periprocedure approach for adjuncts. 10 In our study, we aimed to systematically review the literature to provide an updated evaluation of available data addressing the use of antibiotic or tocolytic adjuncts.…”

Section: Discussionmentioning

confidence: 99%

Adjunct Therapy at Time of Examination-Indicated Cervical Cerclage in Singleton Pregnancies: A Systematic Review and Meta-analysis

et al. 2022

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Objective: Physical exam-indicated cerclage for cervical insufficiency prolongs gestation, but evidence on the addition of adjuncts to further prolong latency is limited. The aim of this systematic review and meta-analysis was to compare gestational latency between those who did and did not receive adjunct antibiotic or tocolytic therapy at the time of exam-indicated cerclage. Study Design: Electronic databases (1966 to 2020) were searched for randomized controlled trials (RCT) and cohort studies comparing adjunct antibiotic or tocolytic use versus non-use at time of exam-indicated cerclage, defined as placement for cervical dilation ≥ 1 cm, in a current singleton pregnancy. Studies including individuals with intra-amniotic infection, cerclage in place, non-viable gestation, or ruptured membranes were excluded. The primary outcome was latency from cerclage placement to delivery. Secondary outcomes included preterm birth, preterm premature rupture of membranes, birth weight and neonatal survival. Risk of bias was assessed using standardized tools. Heterogeneity was assessed using X2 and I2 tests. Results were pooled and analyzed using a random-effects model. PROSPERO registration (CRD42021216370). Results: Of 923 unique records, 163 were reviewed in full. Three met inclusion criteria: one RCT and two retrospective cohorts. The RCT was nested within one of the cohorts, and therefore only one of these two studies was utilized for any given outcome to eliminate counting individuals twice. Risk of bias was “critical” for one cohort, “moderate” for one cohort, and “some concerns” for the RCT. Gestational latency could not be pooled and meta-analyzed. Adjunct tocolytic-antibiotic therapy was not associated with a decrease in risk of preterm delivery <28 weeks (RR 0.90, 95% CI 0.65-1.26; X2=0.0, I2=0.0%) or neonatal survival to discharge (RR 1.11, 95% CI 0.91-1.35; X2=0.05, I2=0.0%). Conclusion: There is not enough evidence to robustly evaluate the use of adjunct tocolytics or antibiotics at time of exam-indicated cerclage to prolong la

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“…Another comparable therapy, the vaginal progesterone gel Crinone ® , has failed to receive FDA approval because its efficacy in preventing PTB was not significantly greater than a placebo [ 7 ]. Thus, there is opportunity for a pharmaceutical approach to provide an alternative to mechanical interventions such as a cervical cerclage or pessary [ 31 , 32 , 33 ].…”

Section: Impediments To Treat Ptbmentioning

confidence: 99%

Vaginal Nanoformulations for the Management of Preterm Birth

et al. 2022

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Preterm birth (PTB) is a leading cause of infant morbidity and mortality in the world. In 2020, 1 in 10 infants were born prematurely in the United States. The World Health Organization estimates that a total of 15 million infants are born prematurely every year. Current therapeutic interventions for PTB have had limited replicable success. Recent advancements in the field of nanomedicine have made it possible to utilize the vaginal administration route to effectively and locally deliver drugs to the female reproductive tract. Additionally, studies using murine models have provided important insights about the cervix as a gatekeeper for pregnancy and parturition. With these recent developments, the field of reproductive biology is on the cusp of a paradigm shift in the context of treating PTB. The present review focuses on the complexities associated with treating the condition and novel therapeutics that have produced promising results in preclinical studies.

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Cervical stitch (cerclage) in combination with other treatments for preventing spontaneous preterm birth in singleton pregnancies

Abstract: Cervical stitch (cerclage) in combination with other treatments for preventing spontaneous preterm birth in singleton pregnancies.

Cited by 23 publications

References 149 publications

Progesterone, cervical cerclage or cervical pessary to prevent preterm birth: a decision-making analysis of international guidelines

Progesterone, cervical cerclage or cervical pessary to prevent preterm birth: a decision-making analysis of international guidelines

Adjunct Therapy at Time of Examination-Indicated Cervical Cerclage in Singleton Pregnancies: A Systematic Review and Meta-analysis

Vaginal Nanoformulations for the Management of Preterm Birth

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