Perioperative complications of history-indicated and ultrasound-indicated cervical cerclage

Drassinower, Daphnie; Poggi, Sarah; Landy, Helain J.; Gilo, Noridelle; Benson, James E.; Ghidini, Alessandro

doi:10.1016/j.ajog.2011.03.026

Cited by 22 publications

(17 citation statements)

References 8 publications

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“…According to the results of three randomised trials on history‐indicated cervical cerclage, only women with three‐ or more second‐trimester loses or prior preterm births benefited from history‐indicated cerclage. Today, many women start a family for the first time in their thirties and waiting for at least three losses before applying cervical cerclage may be unacceptable . Despite re‐evaluation, the subgroup analysis of the RCOG trial concurred with the original findings .…”

Section: Commentmentioning

confidence: 80%

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Effect of body mass index on latency periods after history-indicated cervical cerclage

Yalvaç

Esin

Koçak

et al. 2014

Aust N Z J Obstet Gynaecol

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Section: Commentmentioning

confidence: 80%

“…History‐indicated cerclage is usually performed between 12–14 and 12–16 gestational weeks. As we are a tertiary referral centre, some women were referred as late as 19th gestational week.…”

Section: Commentmentioning

confidence: 99%

Effect of body mass index on latency periods after history-indicated cervical cerclage

Yalvaç

Esin

Koçak

et al. 2014

Aust N Z J Obstet Gynaecol

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“…Cervical cerclage may be associated with procedure‐related morbidity, including the risks associated with anesthesia, PPROM, chorioamnionitis, preterm labor, cervical trauma and suture displacement. Thus, its utilization in twin pregnancy should be based on stringent standards.…”

Section: Discussionmentioning

confidence: 99%

“…The current study findings support first‐trimester cerclage as an effective method for lowering the risk of prematurity in the setting of twin pregnancy in appropriately selected women, whereas the use of cerclage for the sole indication of twin pregnancy is not recommended. Moreover, it is worth noting that ultrasound‐indicated or physical examination‐indicated cerclage in this subset of patients is associated with a higher rate of complications and, when performed in twin pregnancies, was found to correlate with an increased incidence of adverse perinatal outcome (for example, higher rates of perinatal death, low birth weight and RDS) and had no benefit in terms of the prevention of preterm birth. This has led to the SMFM recommendations in the ‘Choosing Wisely’ program advocating against the use of cerclage in twin pregnancy with a short cervix owing to the lack of appropriate studies.…”

Section: Discussionmentioning

confidence: 99%

“…Because of the paramount importance of achieving consensus on this issue, we strongly recommend performing randomized controlled trials targeting this subset of pregnant patients. Cervical cerclage may be associated with procedurerelated morbidity, including the risks associated with anesthesia, PPROM, chorioamnionitis, preterm labor, cervical trauma and suture displacement 21 . Thus, its utilization in twin pregnancy should be based on stringent standards.…”

Section: Discussionmentioning

confidence: 99%

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History‐indicated cervical cerclage in management of twin pregnancy

Rottenstreich

Kleinstern

Zigron

et al. 2019

Ultrasound in Obstet & Gyne

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Objective Cervical cerclage, when performed in twin gestation, has been reported to be associated with poor outcome. However, the role of first‐trimester history‐indicated cerclage among women with a twin pregnancy and a history of preterm birth has not been evaluated. The aim of this study was to assess pregnancy outcomes among women with a twin pregnancy who underwent first‐trimester history‐indicated cervical cerclage compared with outcomes in those managed expectantly. Methods This was a retrospective matched case–control study. The study group comprised all women with a twin pregnancy who had undergone first‐trimester history‐indicated cerclage during the period 2006 to 2017 at Hadassah‐Hebrew University Medical Center. A control group of women with a twin pregnancy who were managed expectantly was established by matching age, history of spontaneous preterm birth (20–36 weeks' gestation) and year of delivery. Pregnancy and delivery characteristics and neonatal outcomes were compared between the two groups. Results Data from 82 women with a twin gestation were analyzed, of whom 41 underwent first‐trimester history‐indicated cerclage and 41 were matched controls who were managed expectantly. Gestational age at delivery was higher in the cerclage group than in those managed expectantly (median 35 vs 30 weeks; P < 0.0001). Rates of spontaneous preterm birth before 24 weeks (2.4% vs 19.5%; odds ratio (OR), 0.10 (95% CI, 0.01–0.87); P = 0.03), before 28 weeks (12.2% vs 34.1%; OR, 0.27 (95% CI, 0.09–0.84); P = 0.03), before 32 weeks (22.0% vs 56.1%; OR, 0.22 (95% CI, 0.08–0.58); P = 0.003) and before 34 weeks (34.1% vs 82.9%; OR, 0.11 (95% CI, 0.04–0.30); P < 0.0001) were significantly lower in the cerclage group than in the control group. Median birth weight was higher in the cerclage group (2072 g vs 1750 g; P = 0.003), with lower rates of low birth weight (< 2500 g) (65.0% vs 89.4%; P = 0.001) and very low birth weight (< 1500 g) (21.3% vs 37.9%; P = 0.03) than in the group managed expectantly. Rates were also lower in the cerclage group for stillbirth, admission to the neonatal intensive care unit, respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, sepsis, neonatal mortality and composite adverse neonatal outcome. Conclusions History‐indicated cerclage performed in the first trimester, as compared with expectant management, in women with a twin pregnancy had an overall positive effect on pregnancy and neonatal outcomes. These findings suggest the need for adequate randomized trials on cerclage placement in this subset of women. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

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