Funneling to the stitch: an informative ultrasonographic finding after cervical cerclage

Abstract

Funneling to the cerclage is significantly associated with earlier preterm delivery in patients who have undergone cervical cerclage. Serial sonography up to 28 weeks' gestation is useful in identifying patients at higher risk for premature rupture of the membranes and preterm delivery.

Factors associated with spontaneous preterm birth risk assessed by transvaginal ultrasound following cervical cerclage

“…We initially believed that this disparity might be due to differences in the timing of cervical length measurements. However, examination of our data revealed that most of the nine women had cervical lengths measurements performed within 14 days after cerclage insertion which is comparable to other reports where cervical lengths were measured at three days, six days, or 14 days postcerclage insertion. In a recent study, Gundabattula et al .…”

Comparison of transvaginal sonography in recumbent and standing maternal positions to predict spontaneous preterm birth in singleton and twin pregnancies

“…In such pregnancies, a cerclage might actually induce the risk of preterm premature rupture of membranes (PPROM) 35 and SPB as suggested for twin pregnancies by a recent meta-analysis 36 . However, there will still remain patients with a reasonable indication for a cerclage, as shown by a meta-analysis using individual patient-level data 36 , although the membranes may still descend to the level of the suture, indicating an increased postoperative risk for SPB 37 . An opening of the internal os and descent of membranes after vaginal cerclage are recognized earlier with the woman in an upright position 34 .…”

Emergency Cerclage

“…In the study by Guzman et al, 39 there was a correlation between postoperative endocervical canal length, length of the lower cervix and the cervical index (1 + funnel length / endocervical canal length), and gestational age at birth. Moreover, postoperative funneling to the cervical stitch was significantly associated with preterm delivery in a study by O'Brien et al 47 Time of Intervention Various retrospective series have found cerclage placement before 22 weeks to be associated with better outcomes when compared with later procedures. 38,40 On the other hand, Gupta et al 27 found no relationship between perinatal outcome and gestational age at suture insertion.…”