The significance of transvaginal ultrasonographic evaluation of the cervix in women treated with emergency cerclage

Guzman, Edwin R.; Houlihan, Christopher; Vintzileos, Anthony M.; Ivan, Joseph; Benito, Carlos; Kappy, Kenneth A.

doi:10.1016/s0002-9378(96)70164-3

Cited by 78 publications

(55 citation statements)

References 12 publications

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“…Therefore, the potentially improved outcomes of many ‘high’ cerclages (>50% CL, >10mm to external os) could be combined with those with more superficial stitches resulting in a dilution of any improvement. Guzman et al [12] assessed cerclage position in 29 women treated with emergency cerclage where the cervix was ≥2cm dilated. The authors found no correlation between proximity of cerclage to the internal os and gestation at delivery.…”

Section: Discussionmentioning

confidence: 99%

Cerclage position, cervical length and preterm delivery in women undergoing ultrasound indicated cervical cerclage: A retrospective cohort study

et al. 2017

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ObjectiveThe objectives were to assess whether anatomical location of ultrasound (USS) indicated cervical cerclage and/or the degree of cervical shortening (cervical length; CL) prior to and following cerclage affects the risk of preterm birth (PTB).MethodA retrospective cohort study of 179 women receiving cerclage for short cervix (≤25mm) was performed. Demographic data, CL before and after cerclage insertion, height of cerclage (distance from external os) and gestation at delivery were collected. Relative risk (RR) and odds ratio (OR) of preterm delivery were calculated according to the anatomical location of the cerclage within the cervix and the CL before and after cerclage as categorical and continuous variables. Partition tree analysis was used to identify the threshold cerclage height that best predicts PTB.Results25% (n = 45) delivered <34 weeks and 36% (n = 65) delivered <37 weeks. Risk of PTB was greater with cerclage in the distal 10mm (RR2.37, 95% CI 1.45–3.87) or the distal half of a closed cervix (RR2.16, 95% CI 1.45–3.87). Increasing absolute cerclage height was associated with a reduction in PTB (OR 0.87, 95% CI 0.82–0.94). A cerclage height <14.5 mm best predicts PTB (70.8%). Increasing CL following cerclage was associated with a reduction in PTB (OR0.87, 95% CI 0.82–0.94). Conversely, the risk of PTB was increased where CL remained static or shortened further following cerclage (RR2.34, 95% CI 1.04–5.25).ConclusionThe higher a cerclage was placed within a shortened cervix, the lower the subsequent odds of PTB. Women whose cerclage is placed in the distal 10mm of closed cervix or whose cervix fails to elongate subsequently, should remain under close surveillance as they have the highest risk of PTB.

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Section: Discussionmentioning

confidence: 99%

Cerclage position, cervical length and preterm delivery in women undergoing ultrasound indicated cervical cerclage: A retrospective cohort study

et al. 2017

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“…However, it seems reasonable to use a short course of broad-spectrum prophylactic antibiotics as in any other surgical procedure involving the vagina. On the other hand, tocolysis is not used systematically as some authors [7,9,16,17] do not use tocolysis at all while others use indomethacin [5,14,18] or ritodrine [19,20,21]. Finally, amniocentesis prior to the indication of cerclage has been suggested by Mays et al [22] who showed that selection of women according to the results of the amniocentesis improved perinatal results.…”

Section: Discussionmentioning

confidence: 99%

Emergency Cerclage: Improvement of Outcomes by Standardization of Management

et al. 2015

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Introduction: Cervical dilatation followed by prolapse and ballooning of membranes into the vagina at mid-gestation is a critical situation. The aim of this study was to describe the outcome of emergency cerclage in a tertiary referral center during a 10-year period (2001-2010) in which a defined selection of women and standard protocol were introduced. Subjects and Methods: Thirty-nine cases of emergency cervical cerclage performed before 24 completed weeks were retrospectively reviewed. Data related to maternal history, diagnosis, procedure details, postoperative management and perinatal outcome were recorded. Maternal characteristics and perinatal outcomes are described. Results: Gestational age at cerclage (mean ± SD) was 22.1 ± 2.0 weeks with 61% (24/39) of women presenting bulging membranes. Gestational age at delivery and cerclage-to-delivery time (mean ± SD) were 28.6 ± 6.2 weeks and 49.1 ± 36.5 days, respectively. Only 38.5% (15/39) of the whole group and 44.1% (15/34) of those who reached 24.0 weeks delivered beyond 28 weeks of gestational age. Neonatal survival before discharge was 82.4% (28/34). Discussion: Perinatal outcomes after emergency cerclage are still poor with more than half of the cases delivering before 28 weeks. A standard protocol may help in the management of these rare cases.

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“…In the study by Fuchs et al, 32 preoperative ultrasonic cervical length measurement did not improve prediction of early 384 Obstetrical and Gynecological Survey preterm birth over clinically assessed cervical dilatation in women undergoing an emergency cerclage. On the other hand, Guzman et al 39 found that preoperative funnel width correlated with gestational age at birth, whereas preoperative digital assessments of cervical dilatation did not.…”

Section: Cervical Sonographymentioning

confidence: 98%