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.

The Short Cervix: A Critical Analysis of Diagnosis and Treatment.

A short cervix in the second trimester is a significant risk factor for spontaneous preterm birth, preterm prelabor rupture of membranes, and subsequent adverse perinatal outcome. The pathophysiology is complex and multifactorial with inflammatory and/or infectious processes often involved. Biomarkers have been developed in an effort to predict preterm birth with varying degrees of success.

History- or ultrasound-based cerclage placement and adverse perinatal outcomes.

Objective: To determine whether cerclage based on serial transvaginal ultrasound (STVUS) vs. cerclage based on obstetric history (prior multiple midgestation losses) is superior for treatment of cervical insufficiency.

Study Design: This retrospective study evaluated all history-based or ultrasound-based cerclages in singleton pregnancies over a 5-year period at the University of Mississippi Medical Center.

Cerclage for short cervix on ultrasonography in women with singleton gestations and previous preterm birth: a meta-analysis.

Objective: To estimate if cerclage prevents preterm birth and perinatal mortality and morbidity in women with previous preterm birth, singleton gestation, and short cervical length in a meta-analysis of randomized trials.

Data Sources: MEDLINE, PUBMED, EMBASE, and the Cochrane Library were searched using the terms "cerclage," "short cervix," "ultrasound," and "randomized trial."

Methods Of Study Selection: We included randomized trials of cerclage in women with short cervical length on transvaginal ultrasonography, limiting the analysis to women with previous spontaneous preterm birth and singleton gestation.

Controlled fine needle biopsy of the uterine cervix during pregnancy.

Objective: Cervical sampling could furnish tissue-based information regarding premature cervical ripening and effacement. This report assesses the effect of cervical fine needle biopsy (FNB) in the evaluation of cervical shortening.

Methods: Retrospective cohort study evaluating adverse events during the first week following FNB in women with short cervix.

Randomized controlled trial of wound complication rates of subcuticular suture vs staples for skin closure at cesarean delivery.

Objective: The purpose of this study was to determine the wound complication rates and patient satisfaction for subcuticular suture vs staples for skin closure at cesarean delivery.

Study Design: This was a randomized prospective trial. Subjects who underwent cesarean delivery were assigned randomly to stainless steel staples or subcuticular 4.

Comprehensive amniotic fluid cytokine profile evaluation in women with a short cervix: which cytokine(s) correlates best with outcome?

Objective: The objective of this study was to determine whether an expanded amniotic fluid cytokine profile predicts spontaneous preterm birth in patients with short cervix in the midtrimester.

Study Design: Amniocentesis was performed on singleton gestations between 16-24 weeks with a cervical length View Article and Find Full Text PDF

Is midtrimester short cervix a sign of intraamniotic inflammation?

Objective: We sought to determine the relationship between the degree of cervical shortening and intraamniotic inflammation in patients presenting with a midtrimester short cervix.

Study Design: Amniocentesis was performed on singleton pregnancies between 16-24 weeks' gestation with a sonographic cervical length (CL) View Article and Find Full Text PDF

Fetal fibronectin testing in patients with short cervix in the midtrimester: can it identify optimal candidates for ultrasound-indicated cerclage?

Objective: The objective of the study was to determine the relationship between fetal fibronectin (fFN) testing prior to ultrasound-indicated cerclage and obstetric outcome.

Study Design: Singleton pregnancies between 18 and 24 weeks' gestation with an ultrasound-diagnosed short cervix (< 25 mm) and funneling (> 25%) of the chorioamniotic membranes into the endocervical canal were analyzed. The fFN testing was performed and patients were randomized to cerclage or no-cerclage.

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.

Does cerclage prevent preterm birth?

Cerclage procedures can be classified according to timing, (elective, urgent, emergent), and anatomic approach (transvaginal and transabdominal). The most current clinical data and the evidence-based recommendations for each type of cerclage procedure are listed.

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.

Does the presence of a funnel increase the risk of adverse perinatal outcome in a patient with a short cervix?

Objective: This study was undertaken to determine whether the presence of a dilated internal os (funneling or beaking) alters the outcome of patients with a short cervix documented by transvaginal ultrasound in the second trimester.

Study Design: Between January 1998 and May 2004, all singleton pregnancies with a short cervix (< or =2.5 cm) and no funnel between 16 and 24 weeks' gestational age were identified by query and review of the Lehigh Valley Perinatal Ultrasound Database.

Does cerclage location influence perinatal outcome?

Objective: The study was undertaken to measure cerclage location within the cervix and to determine whether placement closer to the internal os is related to perinatal outcome.

Study Design: We analyzed data collected during a randomized trial of cervical cerclage versus no cerclage that was conducted at Lehigh Valley Hospital between May 1998 and June 2001 in women with ultrasound findings of short cervix less than 25 mm or funneling between 16 and 24 weeks' gestation. Women who were randomly assigned to the cerclage arm had cervical measurements performed before cerclage, including dilation of the internal os, depth of membrane prolapse into the endocervical canal, cervical length below any funnel (distal length), and total cervical length (including any funnel).

Preterm delivery: risks versus benefits of intervention.

The objective of this report is to examine the evidence that supports obstetric intervention to prevent preterm birth and to assess the associated neonatal outcomes. The different causes of preterm birth are identified and reviewed. The evidence to support obstetric intervention is examined, and the current protocols for therapy are listed.

Risk factors for preterm delivery in patients demonstrating sonographic evidence of premature dilation of the internal os, prolapse of the membranes in the endocervical canal and shortening of the distal cervical segment by second trimester ultrasound.

Objective: To investigate the outcomes and risk factors associated with the second trimester sonographic findings of premature dilation of the internal cervical os, prolapse of the membranes into the endocervical canal and shortening of the distal segment.

Study Design: Retrospective chart review to identify patients who met the following criteria: (i) gestational age between 16 and 24 weeks; (ii) a vaginal probe ultrasound documenting dilatation of the internal os, prolapsed membranes into the endocervical canal but not extending beyond the external os, and a shortened distal cervix; and (iii) no evidence of increased uterine activity

Methods: Sonographic measurements obtained included: (i) the width of the internal os dilation; (ii) the depth of membranes prolapsed into endocervix (funneling); (iii) the distal cervical length; and (iv) the total cervical length. Patients were stratified into two groups according to gestational age at delivery: the preterm group (< 34 weeks) and the near-term group (> or = 34 weeks).