Multicenter randomized trial of cerclage for preterm birth prevention in high-risk women with shortened midtrimester cervical length

Owen, John; Hankins, Gary D.V.; Iams, Jay D.; Berghella, Vincenzo; Sheffield, Jeanne S.; Perez-Delboy, Annette; Egerman, Robert; Wing, Deborah A.; Tomlinson, Mark; Silver, Richard K.; Ramin, Susan M.; Guzman, Edwin R.; Gordon, Michael; How, Helen; Knudtson, Eric; Szychowski, Jeff M.; Cliver, Suzanne P.; Hauth, John C.

doi:10.1016/j.ajog.2009.08.015

Cited by 362 publications

(202 citation statements)

References 24 publications

Supporting

Mentioning

190

Contrasting

Unclassified

Order By: Relevance

“…In a large multicenter randomized study, Owen et al [6] demonstrated benefits of mid-trimester cerclage placement for patients with singleton pregnancies and a shortened cervix of less than 25 mm. In this study, women with a prior preterm birth and shortened cervix were less likely to have previable births.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Mid-Trimester Emergency Cerclage in Twin Pregnancies

et al. 2012

View full text Add to dashboard Cite

Introduction: Placement of emergency cerclage at mid-trimester is controversial. At present, clinical trials comparing outcomes of mid-trimester cerclage to bed rest in twin pregnancies are lacking. Our aim was to examine the efficacy, safety and outcomes of mid-trimester cerclage in patients carrying twin gestations. Material and Methods: We retrospectively studied the outcomes of 14 patients carrying twin gestations with significant cervical dynamics who underwent cerclage. Outcomes of patients with cervical effacement only and patients with bulging membranes through the external os were examined. The interval between cerclage and delivery and the complication rates were calculated. Results: The average time interval between cerclage placement and delivery was 71.1 days overall. Patients with cervical shortening or effacement only (n = 10) gave birth an average of 80.2 days after the procedure, while 4 patients with bulging membranes gave birth an average of 48.5 days after cerclage placement. The overall procedure failure rate, defined as delivery before 28 completed weeks, was 14.2%. Discussion: Patients carrying twin gestations with advanced cervical changes might benefit from therapeutic cerclage. Further studies are required to demonstrate whether there is a difference compared to bed rest alone.

show abstract

Section: Discussionmentioning

confidence: 99%

Outcomes of Mid-Trimester Emergency Cerclage in Twin Pregnancies

et al. 2012

View full text Add to dashboard Cite

show abstract

“…Vaginal progesterone has been shown to reduce the rate of preterm birth in women with a short cervix with or without a history of previous preterm birth (34, 48–50). Progesterone is as effective as cervical cerclage in women with a prior history of preterm birth and a short cervix (51, 52). Accordingly, additional parameters to cervical length are needed to improve the identification of women at risk of preterm delivery.…”

Section: Introductionmentioning

confidence: 99%

Cervical strain determined by ultrasound elastography and its association with spontaneous preterm delivery

Hernández‐Andrade¹,

Romero²,

Korzeniewski³

et al. 2013

Journal of Perinatal Medicine

View full text Add to dashboard Cite

Objective To determine if there is an association between cervical strain, evaluated using ultrasound elastography, and spontaneous preterm delivery (sPTD) <37 weeks of gestation. Methods One hundred and eighty nine (189) women at 16–24 weeks of gestation were evaluated. Ultrasound elastography was used to estimate cervical strain in three anatomical planes: one mid-sagittal in the same plane used for cervical length measurement, and two cross sectional images: one at the level of the internal cervical os, and the other at the level of the external cervical os. In each plane, two regions of interest (endocervix and entire cervix) were examined; a total of six regions of interest were evaluated. Results The prevalence of sPTD was 11% (21/189). Strain values from each of the six cervical regions correlated weakly with cervical length (r= −0.24, p<0.001 to r= −0.03, p=0.69). Strain measurements obtained in a cross sectional view of the internal cervical os were significantly associated with sPTD. Women with strain values ≤25th centile in the endocervical canal (0.19) and in the entire cervix (0.14) were 80% less likely to have a sPTD than women with strain values >25th centile (endocervical: odds ratio [OR] 0.2; 95% confidence interval [CI], 0.03–0.96; entire cervix: OR 0.17; 95% CI, 0.03–0.9). Additional adjustment for gestational age, race, smoking status, parity, maternal age, pre-pregnancy body mass index and previous preterm delivery did not appreciably alter the magnitude or statistical significance of these associations. Strain values obtained from the external cervical os and from the sagittal view were not associated with sPTD. Conclusion Low strain values in the internal cervical os were associated with a significantly lower risk of spontaneous preterm delivery <37 weeks of gestation.

show abstract

“…Controversies arise in the placement of a cerclage in the presence of a short cervix (<2.5 cm) but not shorter than 1.5 cm, a clinical setting where most experts consider that cervical cerclage can be offered 32 33. Several studies compare expectant versus placement of a physical examination-indicated cerclage showing that, in a very specific population (ie, those with cervical dilation in the absence of labour, bleeding, preterm premature ruptura of membranes or any signs of chorioamnionitis clinically or by amniocentesis), cerclage prolongs gestation and improves neonatal outcomes compared with expectant management 34–36.…”

Section: Discussionmentioning

confidence: 99%

“…Although emergency cerclage with fetal membranes prolapsed into the vagina is actually a salvage operation, there is increasing evidence that it also prolongs gestation and improves neonatal survival compared with expectant management 36–39. In general emergency, cervical cerclage for cervical incompetence is a very difficult procedure with fatal complications like iatrogenic preterm rupture of membranes and chorioamnionitis 14 33 37. Advanced dilation (>3 to 4 cm) and early gestational age (22–24 weeks) are associated with poorer outcomes 36.…”

Section: Discussionmentioning

confidence: 99%

Non-invasive emergent cerclage using a plastic sling: case series

Azpurua¹,

Paredes

Navas

et al. 2017

BMJ Innov

View full text Add to dashboard Cite

Cervical incompetence represents a controversial problem for the modern obstetrician. Treatment modalities since its description have changed with time. Shirodkar and McDonald cerclage techniques have remained the mainstay in the treatment of women with incompetent cervices performed either electively or emergently. The most feared complication of an emergency cervical cerclage is the rupture of membranes during the procedure, especially when the cervix is wide open and the membranes are protruding. To decrease that complication, some methods to reduce the prolapsed membranes have been used: filling the bladder with 0.45% saline solution through a Foley catheter, performing an amniocentesis to decrease intra-amniotic pressure and subsequent reduction of the prolapsed membranes as well as the use of balloons to push the membranes back into the uterus before the placement of a suture. Nevertheless, the introduction of such a sharp instrument like a needle in order to place the suture is a very risky step. Lately, a silicone pessary has also been used to perform cerclages but with disparate results. We present the successful use of an innovative method in 3 patients with cervical incompetence who presented with pregnancies <24 weeks and cervical effacement with protruding membranes into the vagina.

show abstract

Multicenter randomized trial of cerclage for preterm birth prevention in high-risk women with shortened midtrimester cervical length

Cited by 362 publications

References 24 publications

Outcomes of Mid-Trimester Emergency Cerclage in Twin Pregnancies

Outcomes of Mid-Trimester Emergency Cerclage in Twin Pregnancies

Cervical strain determined by ultrasound elastography and its association with spontaneous preterm delivery

Non-invasive emergent cerclage using a plastic sling: case series

Contact Info

Product

Resources

About