Cervical cerclage for short cervix at 24 to 26 weeks of gestation: systematic review and meta-analysis of randomized controlled trials using individual patient-level data.

Objective: This study aimed to determine whether cervical cerclage for a transvaginal ultrasound-detected short cervical length after 24 weeks of gestation in singleton pregnancies reduces the risk for preterm birth.

Data Sources: Ovid MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials were searched using the following terms: "cerclage, cervical," "uterine cervical incompetence," "obstetrical surgical procedures," "cervix uteri," "randomized controlled trial," and "controlled clinical trial."

Study Eligibility Criteria: All randomized controlled trials comparing cerclage placement with no cerclage in singleton gestations with a transvaginal ultrasound-detected short cervical length ≤25 mm between 24+0/7 and 29+6/7 weeks of gestation were eligible for inclusion.

Cerclage for sonographic short cervix in singleton gestations without prior spontaneous preterm birth: systematic review and meta-analysis of randomized controlled trials using individual patient-level data.

Objective: The aim of this systematic review and meta-analysis was to quantify the efficacy of cervical cerclage in preventing preterm birth (PTB) in asymptomatic singleton pregnancies with a short mid-trimester cervical length (CL) on transvaginal sonography (TVS) and without prior spontaneous PTB.

Methods: Electronic databases were searched from inception of each database until February 2017. No language restrictions were applied.

Cerclage for short cervix in twin pregnancies: systematic review and meta-analysis of randomized trials using individual patient-level data.

Objective: To evaluate the efficacy of cerclage for preventing preterm birth in twin pregnancies with a short cervical length.

Design: We performed an individual patient data meta-analysis. Searches were performed in electronic databases.

Effectiveness of cerclage according to severity of cervical length shortening: a meta-analysis.

Objectives: To estimate the effectiveness of cerclage according to degree of cervical length (CL) shortening.

Methods: A meta-analysis was carried out of trials of women with singleton gestations and second-trimester transvaginal sonographic CL < 25 mm randomized to cerclage or no cerclage. The degree of CL shortening was correlated to the efficacy of cerclage in preventing preterm birth.

Shirodkar versus McDonald cerclage for the prevention of preterm birth in women with short cervical length.

The efficacy of Shirodkar cerclage was compared with that of the McDonald procedure for the prevention of preterm birth (PTB) in women with a short cervix. Secondary analysis using data from all published randomized trials including women with a short cervical length (CL) was performed comparing the use of Shirodkar versus McDonald sutures. Analysis was limited to singletons with short CL on transvaginal ultrasound.

The short and funneling cervix: when to use cerclage?

Purpose Of Review: The diagnosis of cervical incompetence remains extremely difficult because there is no diagnostic test available prior to, during or after pregnancy. This review will summarize the latest publications on the use of transvaginal ultrasonography to identify women at high risk of preterm delivery and the use of cervical cerclage in these women.

Recent Findings: Cervical length is not only inversely related to the risk of preterm delivery but also inversely related to the risk of intrauterine infection in women with preterm labor.

Cerclage for short cervix on ultrasonography: meta-analysis of trials using individual patient-level data.

Objective: Preterm birth is the main cause of perinatal morbidity and mortality. A short cervical length on transvaginal ultrasonography predicts preterm birth. Our aim was to estimate by meta-analysis of randomized trials whether cerclage prevents preterm birth in women with a short cervical length.

A five century evolution of cervical incompetence as a clinical entity.

Since cervical incompetence was introduced in the English literature in 1678, our understanding and obstetric management of this clinical entity, have changed tremendously over the years. This review shows the historical perspective of the development of cervical incompetence as a distinct clinical entity and an all or nothing phenomenon to cervical incompetence as part of a spectrum leading to preterm delivery, which can express differently in subsequent pregnancies. These changes in our understanding imply consequences for the obstetric management of cervical incompetence.

Strategies for prevention--cervical cerclage.

Transvaginal cervical cerclage was introduced as a treatment for cervical incompetence in 1951. Over the years, our understanding of this clinical entity has changed tremendously, which has implications for obstetric management. This review focuses on the obstetric management of women considered to be at high risk of preterm delivery due to cervical incompetence at different stages of pregnancy.

Controversies regarding cervical incompetence, short cervix, and the need for cerclage.

Cervical incompetence (CI) is not an all or nothing phenomenon but a continuous variable. CI and preterm labor are not distinct entities but rather part of a spectrum leading to preterm delivery. Cervical length (CL) is an independent variable in the prediction of preterm delivery, to which it is inversely related.

Modern management of preterm labour.

Preterm birth is the leading cause of neonatal morbidity and mortality. Cervical insufficiency is not an all or nothing phenomenon but a continuous variable which can lead to preterm deliveries at different gestational ages. The relationship between shortened cervical length and spontaneous preterm birth is consistent in several studies.

Cervical incompetence prevention randomized cerclage trial: emergency cerclage with bed rest versus bed rest alone.

Objective: The purpose of this study was to compare preterm delivery rates and neonatal morbidity/mortality rates for women with cervical incompetence with membranes at or beyond a dilated external cervical os that was treated with emergency cerclage, bed rest plus indomethacin, versus just bed rest.

Study Design: Women with cervical incompetence with membranes at or beyond a dilated external cervical os, before 27 weeks of gestation, were treated with antibiotics and bed rest and randomly assigned for emergency cerclage and indomethacin or bed rest only.

Results: Twenty-three women were included; 13 women were allocated randomly to the emergency cerclage and indomethacin group, and 10 women were allocated randomly to the bed rest-only group.

Cervical Incompetence Prevention Randomized Cerclage Trial (CIPRACT): effect of therapeutic cerclage with bed rest vs. bed rest only on cervical length.

Objective: To compare the effects of therapeutic cerclage and bed rest vs. just bed rest on cervical length and to relate these effects to the risk of preterm delivery.

Design: Cervical length was measured in patients at high risk of cervical incompetence.

Cervical incompetence: a reappraisal of an obstetric controversy.

Unlabelled: Cervical incompetence is not a categoric but rather a continuous variable, meaning that there are various degrees in the competency of the cervix. Furthermore, a certain degree of competency of the cervix can be expressed differently in subsequent pregnancies. Women with risk factors for cervical incompetence in their gynecological/obstetric history should be followed by transvaginal ultrasonography.

Final results of the Cervical Incompetence Prevention Randomized Cerclage Trial (CIPRACT): therapeutic cerclage with bed rest versus bed rest alone.

Objective: To compare preterm delivery rates (before 34 weeks of gestation) and neonatal morbidity and mortality in patients with risk factors or symptoms of cervical incompetence managed with therapeutic McDonald cerclage and bed rest versus bed rest alone.

Study Design: Cervical length was measured in patients with risk factors or symptoms of cervical incompetence. Risk factors for cervical incompetence included previous preterm delivery before 34 weeks of gestation that met clinical criteria for the diagnosis of cervical incompetence, previous preterm premature rupture of membranes before 32 weeks of gestation, history of cold knife conization, diethylstilbestrol exposure, and uterine anomaly.

Loop electrosurgical excision procedure of the cervix and time of delivery in subsequent pregnancy.

Objective: To study the effect of the loop electrosurgical excision procedure (LEEP) on gestational age at delivery in the subsequent pregnancy.

Method: Identification of women with LEEP. Chart analysis and inquiry into gestational age at the subsequent delivery.

Cervical incompetence prevention randomized cerclage trial (CIPRACT): study design and preliminary results.

Objective: The objective of this study was to compare different management strategies for women at risk for cervical incompetence.

Study Design: In an ongoing randomized trial patients with a previous preterm delivery at <34 weeks' gestation who met clinical criteria for the diagnosis of cervical incompetence are allocated to receive a prophylactic cerclage (prophylactic cerclage group) or not (observational group) in a proportion of 1:2. Transvaginal ultrasonographic follow-up examination of the cervix is performed in both groups.

Change in paternity: a risk factor for preeclampsia in multiparous women?

Background: Preeclampsia is often thought of as being a disease of first pregnancies. The incidence of preeclampsia in subsequent pregnancies, after a previous normal pregnancy is lower. However, it has been reported that this beneficial effect of multiparity is lost with a change in paternity.

The effect of therapeutic McDonald cerclage on cervical length as assessed by transvaginal ultrasonography.

Objective: Our goal was to study the effect of therapeutic McDonald cerclage on cervical length with the use of transvaginal ultrasonography.

Study Design: Cervical length was measured serially in singleton pregnancies in which there were doubts regarding cervical competence. When shortening of the cervix was substantial before 27 weeks' gestation a McDonald cerclage was applied.