Cerclage for Short Cervix on Ultrasonography: Meta-Analysis of Trials Using Individual Patient-Level Data

@article{Berghella2005CerclageFS,
  title={Cerclage for Short Cervix on Ultrasonography: Meta-Analysis of Trials Using Individual Patient-Level Data},
  author={V. Berghella and A. Odibo and M. To and O. Rust and S. Althuisius},
  journal={Obstetrics \& Gynecology},
  year={2005},
  volume={106},
  pages={181-189}
}
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. Data Sources: MEDLINE, PubMed, EMBASE, and the Cochrane Library were searched with the terms “cerclage,” “cervical cerclage,” “short cervix,” “ultrasound,” and “randomized trial.” We included… Expand
Cerclage for Short Cervix on Ultrasonography in Women With Singleton Gestations and Previous Preterm Birth: A Meta-Analysis
TLDR
In women with previous spontaneous preterm birth, singleton gestation, and cervical length less than 25 mm, cerclage significantly prevents pre term birth and composite perinatal mortality and morbidity. Expand
Cervix on Ultrasound in Singleton Gestations without Prior Spontaneous Preterm Birth : a Systematic Review and Meta-analysis of 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 aExpand
Does cervical cerclage decrease preterm birth in twin pregnancies with a short cervix?
TLDR
Cerclage placement for cervical length ≤2.5 cm in twin gestations with mid-trimester short cervix did not decrease the rate of preterm birth at <35 weeks; however, cerclage placements for cervicallength was associated with a significantly decreased rate ofPreterm birth<35 weeks when compared to patients managed without cerclages. Expand
Cerclage position, cervical length and preterm delivery in women undergoing ultrasound indicated cervical cerclage: A retrospective cohort study
TLDR
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 preterm birth. Expand
Short cervix on ultrasound: does indomethacin prevent preterm birth?
TLDR
Indomethacin therapy for asymptomatic women who have a short cervical length on transvaginal ultrasound at 14 to 27 weeks and do not receive a cerclage did not prevent spontaneousPTB <35 weeks, but did prevent PTB <24 weeks. Expand
Assessment of cervical length by transvaginal ultrasonography to predict preterm delivery in twin pregnancy
  • N. Asnafi, Z. Basirat, K. Hajian-Tilaki, S. Dadvar
  • Medicine
  • The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
  • 2013
TLDR
Transvaginal sonographic measurement of cervical length is recommended for assessment of CL between 22–24 weeks for prediction of SPD in twin pregnancy to predict preterm birth in twin pregnant women. Expand
No. 257-Ultrasonographic Cervical Length Assessment in Predicting Preterm Birth in Singleton Pregnancies.
  • K. Lim, K. Butt, J. Crane
  • Medicine
  • Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC
  • 2018
TLDR
Use of the ultrasonographic technique reviewed in this guideline may help identify women at risk of pre term birth and, in some circumstances, lead to interventions that may reduce the rate of preterm birth. Expand
Evaluation of cervical cerclage for sonographically incompetent cervix in at high risk patients.
TLDR
Cervical sonography can be a valuable adjunct to clinical evaluation of patients with history of two or more recurrent midtrimester abortions/preterm deliveries with high success rate of cervical cerclage on properly selected patients with sonographic evidence of cervical changes. Expand
Cerclage for women with twin pregnancies: a systematic review and metaanalysis.
TLDR
A metaanalysis indicates that cerclage placement is beneficial for the reduction of preterm birth and the prolongation of pregnancy in twin pregnancies with a cervical length of <15 mm or dilated cervix of >10 mm. Expand
The Value of Late Mid-Trimester Ultrasound Cervical Assessment after Cerclage for the Prediction of Preterm Birth
TLDR
Transvaginal ultrasound for cervical assessment can be a helpful tool in the prediction of preterm birth after cerclage insertion and can guide the addition of interventions such, progesterone and antenatal corticosteroids for fetal lung maturation. Expand
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References

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Effectiveness of cervical cerclage for a sonographically shortened cervix: a systematic review and meta-analysis.
TLDR
The available evidence does not support cerclage for a sonographically detected short cervix and a randomized controlled trial is needed to determine whether this intervention will reduce adverse neonatal outcomes. Expand
Prevention of Preterm Birth by Cervical Cerclage Compared With Expectant Management:: A Systematic Review
TLDR
There is a trend toward cervical cerclage reducing preterm births before 34 weeks, and the use of cerclages is, however, associated with an increased risk of postpartum fever. Expand
Cervical cerclage for prevention of preterm delivery in woman with short cervix:randomised controlled trial
TLDR
This multicentre randomised controlled trial investigated whether, in women with a short cervix identified by routine transvaginal scanning at 22-24 weeks' gestation, the insertion of a Shirodkar suture reduces early preterm delivery. Expand
Cervical cerclage for prevention of preterm delivery in women with a short cervix: A randomized, controlled trial
TLDR
In this trial, placing a cervical suture in women with a short cervix did not lower the risk of early preterm delivery in a substantial proportion of cases, but routinely measuring cervical length at 22 to 24 weeks gestation by transvaginal sonography does identify women who are at high risk of first-time delivery. Expand
Does cervical cerclage prevent preterm delivery in patients with a short cervix?
TLDR
Cervical cerclage in patients with a short cervix did not reduce the rate of spontaneous preterm delivery and increased the risk of preterm premature rupture of membranes. Expand
Cervical Cerclage for Prevention of Preterm Delivery: Meta‐analysis of Randomized Trials
TLDR
The effectiveness of prophylactic cerclage in preventing preterm delivery in women at low or medium risk for second-trimester pregnancy loss has not been proven and the role of cerclages in women whose ultrasound reveals short cervix remains uncertain. Expand
Cerclage for prevention of preterm birth in women with a short cervix found on transvaginal ultrasound examination: a randomized trial.
TLDR
Cerclage did not prevent preterm birth in women with a short cervix, and there was no difference in any obstetric or neonatal outcomes. Expand
Revisiting the short cervix detected by transvaginal ultrasound in the second trimester: why cerclage therapy may not help.
TLDR
The sonographic findings of second trimester internal os dilation, membrane prolapse, and distal cervical shortening likely represent a common pathway of several pathophysiologic processes. Expand
Prediction of preterm delivery with transvaginal ultrasonography of the cervix in patients with high-risk pregnancies: does cerclage prevent prematurity?
TLDR
Transvaginal ultrasonography of the cervix between 14 and 24 weeks' gestation is a good predictor of pre term delivery in high-risk pregnancies and cerclage may not prevent preterm delivery in patients identified to be at high risk for this outcome by transvaginal Ultrasonography. Expand
Effect of cerclage on obstetrical outcome in twin gestations with a shortened cervical length.
TLDR
Midtrimester cerclage does not alter the risks of prematurity associated with a shortened cervical length in twin gestations, and decreasing cervical length was significantly associated with shorter length of gestation. Expand
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