Could a cervical occlusion suture be effective at improving perinatal outcome?

Abstract

Cervical weakness and infection have long been regarded as major causes of preterm birth. Cervical cerclage has been used extensively to reduce the risk of preterm birth arising as a result of cervical weakness, but increasing evidence suggests that the cervix plays more than just a mechanical role. Immunological function of the cervix and mucus plug is thought to be important in minimising the ingress of microbes, which can lead to chorioamnionitis and rupture of the amniotic membranes. In this review, we examine the background of traditional cervical cerclage and introduce the concept of the occlusion suture and its potential benefit in reducing the risk of recurrent preterm prelabour rupture of membranes.

Randomised trial of cervical cerclage, with and without occlusion, for the prevention of preterm birth in women suspected for cervical insufficiency

“…Noori et al. found a take‐home baby rate of 93% in a descriptive study of 53 women with at least one prior mid‐trimester loss . We found similar results in our preliminary study .…”

“…The procedure involved the surgical removal of the epithelial lining of the cervical canal in a similar fashion to conisation. A simpler, less traumatic technique has been developed, whereby the external cervical os is occluded using a continuous suture at the time that the cerclage is applied . In comparison with a historical cohort, we found that cerclage in which suture occlusion was applied was associated with a higher success rate (take‐home baby rate) .…”

“…Two small descriptive studies of 53 and 26 women with cerclage and the less traumatic cervical occlusion recently showed take‐home baby rates of 93 and 96%, respectively . As stated in the first of these reports, this take‐home baby rate was superior to that reported in historical cohorts of abdominal cerclage, which gave an overall success rate of only 84% …”

Cerclage: Shirodkar, McDonald, and Modifications

“…18 Proponents hypothesized that diminished mechanical support in the cervical stroma might foster ascending infection, and act synergistically to precipitate the spontaneous preterm birth syndrome.Adescriptivestudyofthistechnique supported its beneficial role, describing a ''take-home baby'' rate of 93% in women withatleast1priormidtrimesterloss. 18 One RCT comparing the efficacy of historyindicated or ultrasound-indicated cerclage withcervicalocclusionversuscerclagewithout occlusion, however, found no difference in rates of preterm birth before 34 and 28 weeks, gestational age at delivery, ''takehome baby'' rate, or neonatal intensive care unit admission between the groups. 19 Although mode of delivery was not assessed in this study, cervical occlusion is likely associated with scarring that may preclude vaginal delivery.…”

Viable Extreme Preterm Birth and Some Neonatal Outcomes in Double Cerclage versus Traditional Cerclage: A Randomized Clinical Trial

“…The most common pathway for intrauterine infection is the ascending route from vagina and cervix [6]. Increasing evidence suggests that cervical mucus plug plays more than just a mechanical role in protecting the fetoplacental unit against ascending infection from the vagina [7]. Although in many cases it is impossible to determine whether weakness of the cervix or ascending infection is the primary cause, application of a procedure to prevent both mechanisms seemed to be promising.…”