Repeat cerclage prolongs pregnancy in women with prolapsed membranes

Abstract

We evaluated repeat cerclage in women with prolapsed membranes. Twenty-two women with bulging membranes after primary cerclage were offered repeat cerclage; 11 chose a repeat cerclage and 11 chose bed rest. The median gestational age at delivery, birthweight and survival rates were significantly higher in the repeat cerclage group compared to the bed rest group (mean 26.8 weeks vs. 21.7 weeks, p= 0.04, mean birthweight 1180 g vs. 491 g, p= 0.01 odds ratio for survival 22.0, 95% CI, 2.1-236). Early repeat cerclage under antibiotic cover may be beneficial in women with bulging membranes after a prior failing cerclage attempt.

Adjunctive Therapies to Cerclage for the Prevention of Preterm Birth: A Systematic Review

“…Similar findings were reported in women with reinforcing cerclage after ultrasound evidence of prolapsing membranes [16]. Two studies reported a prolonged latency to delivery and live birth rate in women with reinforcing cerclage compared to a reference group of women without second cerclage placement following the finding of prolapsed membranes upon direct visualization [15, 17]. Although latency and live birth rates were increased in one study, all pregnancies ended in preterm birth <28 weeks gestation without the mention of neonatal outcomes [17].…”

“…Articles were excluded from this paper for the following reasons: 3 were review articles, 3 did not specifically report pregnancy outcome, 14 did not include patients with reinforcing cerclage placement during the study period, 4 articles focused on the topic of cerclage technique, 2 articles focused on cerclage complications such as infection and stromal erosion, 2 were case series of reinforcing cerclage without a reference group, and 1 publication was a study protocol without outcome results available. After exclusions, 4 remaining articles were included in this systematic review [14–17]. …”

“…It has been suggested that these women may possibly benefit from a second or “reinforcing cerclage” in an attempt to delay delivery but there is a paucity of published data addressing the risks, benefits, and outcomes of this concept. The 4 studies included in this paper reported inconsistent findings of the incidence of early preterm birth and previable abortions with reinforcing cerclage (Table 2) [14–17]. Reinforcing cerclage placement when based on the finding of shortened cervical length on ultrasound was reported to be associated with a significantly increased risk for preterm birth and previable abortions [14].…”

“…Two studies reported a prolonged latency to delivery and live birth rate in women with reinforcing cerclage compared to a reference group of women without second cerclage placement following the finding of prolapsed membranes upon direct visualization [15, 17]. Although latency and live birth rates were increased in one study, all pregnancies ended in preterm birth <28 weeks gestation without the mention of neonatal outcomes [17]. A study by Fox et al included all women with prolapsing membranes on physical exam who chose to have a reinforcing cerclage compared to women with no cervical change and no repeat cerclage.…”

“…We also excluded 5 articles whose focus were rescue or emergent cerclage, 2 questionnaire surveys, 18 articles on unrelated topics, and 17 studies that did not report the use of bedrest as an adjunct to a standard treatment of cerclage in comparison to a reference group of women who received cerclage without bedrest. Eleven studies were selected to review in detail as they specifically addressed the issue of cerclage and bedrest: five randomized controlled studies [21, 26–29], five prospective cohort studies [15, 17, 30–32], and one retrospective cohort study [33]. However, none of them specifically reported outcome differences of women who received cerclage with bedrest compared to women who received cerclage without activity restriction.…”