Evaluation of Maternal-Fetal Outcomes After Emergency Vaginal Cerclage Performed With Shirodkar-McDonald Combined Modified Technique

Ciancimino, Leonarda; Laganà, Antonio Simone; Imbesi, Giovanna; Chiofalo, Benito; Mancuso, Alfredo; Triolo, Onofrio

doi:10.14740/jocmr2108w

Cited by 12 publications

(7 citation statements)

References 24 publications

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“…Positive results of the emergency suture application were also confirmed in a study of Ciancimino et al [ 69 ]. A total of 12 patients underwent emergency suture placement.…”

Section: Rescue Suture Effectivenesssupporting

confidence: 59%

“…A total of 12 patients underwent emergency suture placement. Pregnancy was extended by an average of 89.9 days, and neonatal survival was 83.3% [ 69 ]. Equally good results were obtained by Cavus et al [ 70 ], who analyzed pregnancy outcomes in 20 patients who experienced cervical cerclage in the second trimester with an average of 4.3 cm cervical dilation.…”

Section: Rescue Suture Effectivenessmentioning

confidence: 99%

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Emergency Cervical Cerclage

Wierzchowska-Opoka

Kimber-Trojnar

Leszczyńska‐Gorzelak

2021

JCM

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Despite the progress of medicine in the last decades, recurrent pregnancy loss, premature birth, and related complications are still a vast problem. The reasons for recurrent pregnancy loss and preterm delivery are diverse and multifactorial. One of the main reasons for these complications is cervical insufficiency, which means that the cervix is weak and unable to remain closed until the date of delivery. It manifests as painless softening and shortening of the cervix without contractions. The aim of the study was to review the available literature on rescue sutures, which are an emergency treatment in pregnancies with premature cervical dilatation and protrusion of the fetal membranes in the second trimester of pregnancy. This review confirms that emergency cerclage reduces the rate of preterm birth in patients with advanced cervical insufficiency. This procedure prolongs gestational age and improves the chances of survival of the newborn without increasing the risk of chorioamnionitis and preterm premature rupture of membranes.

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“…Positive results of the emergency suture application were also confirmed in a study of Ciancimino et al [ 69 ]. A total of 12 patients underwent emergency suture placement.…”

Section: Rescue Suture Effectivenesssupporting

confidence: 59%

Section: Rescue Suture Effectivenessmentioning

confidence: 99%

Emergency Cervical Cerclage

Wierzchowska-Opoka

Kimber-Trojnar

Leszczyńska‐Gorzelak

2021

JCM

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“…This study is similar to the study of Stupin et al (2008). In the series of Ciancimino et al (2015), a total of 12 patients underwent emergency suture placement. Pregnancy was extended upto 89.9 days and neonatal survival was 83.3%.…”

Section: Resultssupporting

confidence: 68%

Rescue Cerclage - Is It Effective

Pandey¹,

Kumari²

2021

Indian Journal of Scientific Research

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Cervical incompetence leads to abortion and preterm delivery. Cervical rescue cerclage has been tried to prevent this. This study was performed to study the efficacy and safety of rescue cerclage in women with advanced cervical dilatation and bulging membranes. This study was performed on 11 women presenting with second trimester painless dilatation of cervix. Suture with Sutu Pak was put around the internal os. The pregnancy was prolong with a gain of about 5.5 weeks and survival and birth weight of the neonate improved. Rescue cerclage is an useful procedure to prevent preterm birth and improve birth weight and survival of the new born.

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“…[15][16][17][18][19][20] Currently, two of the most commonly performed cerclage procedures are modifications of Shirodkar and McDonald. 21,22 ECC may have a higher chance of failure, and other complications such as preterm premature rupture of membranes (PPROM) and chorioamnionitis are more common. 23,24 It has been suggested that cerclage placement closer to the internal os may be associated with improved perinatal outcome.…”

Section: Introductionmentioning

confidence: 99%

Comparison of two emergency cervical cerclage techniques in twin pregnancies: A retrospective cohort study matched with cervical dilation

Qiu,

Lv,

Chen

et al. 2023

Intl J Gynecology & Obste

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ObjectivesThis retrospective cohort study aimed to assess the efficacy of emergency cervical cerclage (ECC) performed with the combined McDonald‐Shirodkar technique in twin pregnancies between 18 and 26 weeks of pregnancy with painless cervical dilation 1 to 6 cm.MethodsA retrospective cohort study matched with the degree of cervical dilation was conducted. The study group (case group) included women with twin pregnancies undergoing combined McDonald‐Shirodkar approach with cervical dilation ≥1 cm between 18 to 26 weeks of gestation at four institutions, from December 2015 to December 2022. To minimize confounding factors, we elucidated the causality structure using a directed acyclic graph and performed 1:1 case–control matching. A control group underwent the McDonald approach. The primary outcome was gestational age (GA) at delivery. The secondary outcomes were pregnancy latency; the rates of spontaneous preterm birth at <28, <30, <32, and <34 weeks; and neonatal outcomes. Additional subanalysis was performed by dividing the patients into two subgroups of women with cervical dilation ≥3 cm and <3 cm.ResultsA total of 84 twin pregnancies were managed with either the combined McDonald‐Shirodkar approach (case group: n = 42) or the McDonald approach (control group: n = 42). Demographic characteristics were not significantly different in the two groups (P > 0.05). After adjusting for confounders that were represented by a directed acyclic graph, median GA at delivery was significantly higher (30.5 vs 27 weeks; Bate: 3.40 [95% confidence interval (CI), 2.13–4.67], P < 0.001) and median pregnancy latency was significantly longer (56 vs 28 days; Bate: 24.04 [95% CI, 13.31–34.78], P < 0.001) in the case group compared with the control group. Rates of spontaneous preterm birth at <28, <30, <32, and <34 weeks were significantly lower in the case group than in the control group. For neonatal outcomes, there was higher birth weight (1543.75 vs 980 g; Bate: 420.08 [95% CI, 192.18–647.98], P < 0.001) and significantly lower overall perinatal mortality (7.1% vs 31%; adjusted odds ratio, 0.16 [95% CI, 0.04–0.70], P = 0.014) in the case group compared with the control group. When cervical dilation was ≥3 cm, the combined McDonald‐Shirodkar procedure can significantly reduce perinatal mortality (8.3% vs 46.7%; adjusted odds ratio, 0.09 [95% CI, 0.01–0.77], P = 0.028), significantly decrease the risk of delivery at <28 and <30 weeks, and prolong GA at delivery and pregnancy latency compared with the McDonald procedure.ConclusionsECC performed with the combined McDonald‐Shirodkar procedure in women with twin pregnancies who have cervical dilation 1 to 6 cm in midtrimester pregnancy may reduce the rate of spontaneous preterm birth and improve perinatal and neonatal outcomes compared with the McDonald procedure, especially for twin pregnancies in women with cervical dilation of 3 to 6 cm and prolapsed membranes.

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Evaluation of Maternal-Fetal Outcomes After Emergency Vaginal Cerclage Performed With Shirodkar-McDonald Combined Modified Technique

Cited by 12 publications

References 24 publications

Emergency Cervical Cerclage

Emergency Cervical Cerclage

Rescue Cerclage - Is It Effective

Comparison of two emergency cervical cerclage techniques in twin pregnancies: A retrospective cohort study matched with cervical dilation

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