Introduction: In women with cervical incompetence, transvaginal cerclage may help prevent preterm birth. However, training for this procedure poses challenges due to the low number of cases and difficulties in visualizing the operative field. Furthermore, the objective criteria for a successful cerclage procedure are not well-described. Quality assessment relies heavily on self-assessment rather than objective criteria and feedback. To address this issue, training on a simulator may offer a solution. We aimed to objectively assess surgical performance and compare it to the self-assessed performance in transvaginal cerclage procedures.
Materials And Methods: During the Nordic Federation of Obstetrics and Gynecology (NFOG) congress in 2023, surgeons proficient in transvaginal cerclage procedures performed a transvaginal cerclage on a simulator. To compare the observed and self-assessed outcomes we obtained measurements on the cerclage height and number of bites from the detachable cervix, and from computed tomography scans we analyzed suture bite depth, reduction of cervix surface area, and whether cerclages had perforated the cervical canal. The same outcomes were self-assessed by each participant after the cerclage procedure. We visualized the continuous paired data in a Bland-Altman plot and compared these data with a paired t-test. Paired binary data was analyzed using McNemars test.
Results: 29 participants from eight different nationalities performed one transvaginal cerclage each. The mean height of the cerclage was 26.8 mm (SD 9 mm) and mean depth was 6.5 mm (SD 1.9 mm) across a mean of 4.1 (SD 0.8) bites. The mean reduction of the cervix surface area was 7.6 % (SD 5.9 %). Two sutures perforated the cervical canal. The participants significantly underestimated the height of their cerclage with a mean difference of 6.0 mm (95 % CI 2.1-9.9), (p 0.002), between the observed and the self-assessed height, but otherwise revealed good self-assessment of their performed procedure.
Conclusions: Overall, the experienced cerclage surgeons showed a genuine insight into their surgical performance of a transvaginal cerclage. These results could warrant development of a procedural guidelines with objective measures, now reassured that surgeons are capable of self-assessing their procedures.
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http://dx.doi.org/10.1016/j.ejogrb.2024.09.033 | DOI Listing |
J Obstet Gynaecol Res
January 2025
Juntendo University Urayasu Hospital, Chiba, Japan.
Aim: Our study aimed to evaluate the effectiveness of ultrasound-indicated cerclage in singleton pregnancies with cervical shortening (<25 mm), excluding those with a history of preterm birth (PTB) and infection/inflammation.
Materials And Methods: Among the 1556 women admitted for a cervix measuring <25 mm via transvaginal ultrasound at Juntendo University Urayasu Hospital between January 2001 and December 2023, our study focused on 47 singleton patients with no prior history of PTB. After receiving information on both risks and benefits, 25 patients opted for ultrasound-indicated cerclage (cerclage group), while 22 chose expectant management (expectant management group).
Int J Gynaecol Obstet
November 2024
Department of Obstetrics, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Objective: To evaluate the value of serial post-cerclage cervical length measurements in predicting preterm birth.
Methods: This was a retrospective study of women with a singleton pregnancy who underwent prophylactic transvaginal cerclage from 2017 to 2023. Prophylactic cerclage was performed in women with an obstetric history of cervical insufficiency.
Sci Rep
November 2024
Department of Obstetrics, Xiangya Hospital Central South University, 87 Xiangya Road, Changsha, 410008, China.
Cervical cerclage is an established procedure for treating cervical insufficiency; however, its efficacy in twin pregnancies remains uncertain. This study aimed to evaluate the effectiveness of transvaginal cervical cerclage in twin pregnancies complicated by cervical insufficiency. Data were retrospectively collected from 155 women with twin pregnancies diagnosed with cervical insufficiency.
View Article and Find Full Text PDFEur J Obstet Gynecol Reprod Biol
December 2024
Amsterdam Reproduction & Development, Amsterdam, Netherlands (the); Amsterdam UMC Location University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, Netherlands (the).
Objective: To assess the variation between countries for routine transvaginal ultrasound assessment of the cervical length and interventions offered to prevent preterm birth (PTB).
Study Design: An anonymous digital questionnaire was sent out between August and October 2023 to delegates of the European Spontaneous Preterm Birth Congress. Outcomes assessed included method, indications (i.
BMC Pregnancy Childbirth
October 2024
Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangdong, China.
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