Effectiveness and safety of late midtrimester cervical cerclage

Diamant, Hagit; Mastrolia, Salvatore Andrea; Weintraub, Adi Y.; Sheizaf, Boaz; Zilberstein, Tali; Yohay, David

doi:10.1080/14767058.2018.1454426

Cited by 7 publications

(11 citation statements)

References 19 publications

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“…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: Discussionsupporting

confidence: 90%

“…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%

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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: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…Emergency cervical cerclage is sometimes performed in patients with cervical dilation, but infections and postoperative contractions with subsequent miscarriage may also happened. There is still a lack of a well-defined population for whom the procedure is clearly beneficial [7].…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a model for individualized prediction of cervical insufficiency risks in patients undergoing IVF/ICSI treatment

Wu¹,

Liang²,

Cai³

et al. 2021

Reprod Biol Endocrinol

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Background Women who conceived with in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) are more likely to experience adverse pregnancy outcomes than women who conceived naturally. Cervical insufficiency (CI) is one of the important causes of miscarriage and premature birth, however there is no published data available focusing on the potential risk factors predicting CI occurrence in women who received IVF/ICSI treatment. This study aimed to identify the risk factors that could be integrated into a predictive model for CI, which could provide further personalized and clinically specific information related to the incidence of CI after IVF/ICSI treatment. Patients and methods This retrospective study included 4710 patients who conceived after IVF/ICSI treatment from Jan 2011 to Dec 2018 at a public university hospital. The patients were randomly divided into development (n = 3108) and validation (n = 1602) samples for the building and testing of the nomogram, respectively. Multivariate logistic regression was developed on the basis of pre-pregnancy clinical covariates assessed for their association with CI occurrence. Results A total of 109 patients (2.31%) experienced CI among all the enrolled patients. Body mass index (BMI), basal serum testosterone (T), gravidity and uterine length were associated with CI occurrence. The statistical nomogram was built based on BMI, serum T, gravidity and uterine length, with an area under the curve (AUC) of 0.84 (95% confidence interval: 0.76–0.90) for the developing cohort. The AUC for the validation cohort was 0.71 (95% confidence interval: 0.69–0.83), showing a satisfactory goodness-of-fit and discrimination ability in this nomogram. Conclusion The user-friendly nomogram which graphically represents the risk factors and a pre-pregnancy predicted tool for the incidence of CI in patients undergoing IVF/ICSI treatment, provides a useful guide for medical staff on individualized decisions making, where preventive measures could be carried out during the IVF/ICSI procedure and subsequent pregnancy.

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“…применения цервикального циркляжа у женщин с одноплодной беременностью. ряд серьезных рандомизированных контролируемых исследований и метаанализов показал связь применения циркляжа со значительным снижением преждевременных родов, перинатальной заболеваемости и смертности при одноплодной беременности [5,7].…”

Section: профилактический циркляжunclassified

Prevention and therapy of threatened preterm birth in multiple pregnancy

et al. 2019

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Preterm birth in multiple pregnancy is an important medical, economic and social problem. Currently, more than half of twins are born prematurely, which puts them at high risk of developing neonatal diseases causing lifelong disability and social maladjustment. In this regard, reducing the frequency of preterm multiple births is an important task of modern obstetrics. Improving perinatal outcomes of multiple pregnancies can only be achieved using the most effective measures that have a good evidence base. At the same time, numerous studies on the effectiveness of therapeutic interventions aimed at prolonging multiple pregnancies have reported contradictory results. This review included most of the randomized controlled trials of methods for the prevention and treatment of threatening preterm birth in multiple pregnancies, as available in PubMed, Google Academy, Elibrary, and the Cochrane Central Register of Controlled Trials. Thus far, studies on the use of bed rest, prophylactic tocolysis, most of the progestins, and cervical cerclage in multiple pregnancy have shown no efficacy in reducing the risk of premature birth. However, encouraging data were obtained on improving neonatal outcomes of multiple pregnancies using vaginal progesterone and an obstetric pessary, but these results require additional confirmation in larger multicenter randomized studies. Further clinical trials are needed to develop algorithms for timely diagnosis and adequate treatment of threatened preterm birth in case of multiple pregnancy, including the use of the most rational preventive and therapeutic methods that have a high evidence level.

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Effectiveness and safety of late midtrimester cervical cerclage

Cited by 7 publications

References 19 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

Development and validation of a model for individualized prediction of cervical insufficiency risks in patients undergoing IVF/ICSI treatment

Prevention and therapy of threatened preterm birth in multiple pregnancy

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