Cervical stitch (cerclage) for preventing preterm birth in multiple pregnancy.

@article{Rafael2014CervicalS,
  title={Cervical stitch (cerclage) for preventing preterm birth in multiple pregnancy.},
  author={Timothy J. Rafael and Vincenzo Berghella and Zarko Alfirevic},
  journal={The Cochrane database of systematic reviews},
  year={2014},
  volume={9},
  pages={
          CD009166
        }
}
BACKGROUND Cervical cerclage is a surgical intervention involving placing a stitch around the uterine cervix. The suture material aims to prevent cervical shortening and opening, thereby reducing the risk of preterm birth. The effectiveness and safety of this procedure in multiple gestations remains controversial. OBJECTIVES To assess whether the use of a cervical cerclage in multiple gestations, either at high risk of pregnancy loss based on just the multiple gestation (history-indicated… Expand
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Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy.
TLDR
Overall, cerclage probably leads to a reduced risk of perinatal death when compared with no Cerclage, although the confidence interval crosses the line of no effect, and there were too few trials in these clinical subgroups to make meaningful conclusions and no evidence of differential effects. Expand
Cervical stitch (cerclage) in combination with other treatments for preventing spontaneous preterm birth in singleton pregnancies.
TLDR
Whether antibiotics administration, vaginal pessary, reinforcing or second cerclage placement, tocolytic, progesterone, or other interventions at the time of cervical cerClage placement prolong singleton gestation in women at high risk of pregnancy loss based on prior history and/or ultrasound finding of 'short cervix' and/ or physical examination is evaluated. Expand
Effectiveness of Cervical Cerclage on Preterm Delivery and Neonatal Outcome in Twin Pregnancies: Propensity Score Matching Analysis
TLDR
It appears that CC has an effective role in prevention of PTB, LBW, and RDS, because their prevalence in both groups was the same, and a clear conclusion regarding its role requires more research with a random clinical trial (RCT). Expand
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
Effectiveness of emergency cerclage in cervical insufficiency
TLDR
Emergency cerclage is a valid therapeutic option between the 14th and 24th gestational week in presence of cervical insufficiency when signs of premature labour or infection are not present, with lower expectations with a dilatation greater than 5 cm. Expand
Effectiveness of Prophylactic Cervical Cerclage in Prolonging Higher-Order Multiple Pregnancies.
TLDR
Overall, prophylactic cervical cerclage was not associated with prolongation of the pregnancy among women with higher-order multiple pregnancies in the current study. Expand
The place for prophylactic cerclage in the infertile patient with established cervical incompetence who conceived twins after septum reduction.
TLDR
The use of prophylactic cervical cerclage may be beneficial in improving reproductive outcomes in infertile patients with known cervical incompetence that subsequently conceived twin gestations via IVF-ET treatment. Expand
Clinical effect of emergency cervical cerclage and elective cervical cerclage on pregnancy outcome in the cervical-incompetent pregnant women
TLDR
This meta-analysis suggests that emergency Cerclage has lower gestation age and birth weight than elective cerclage, and it increases the risk of PROM. Expand
Relationship between vaginal microbial dysbiosis, inflammation, and pregnancy outcomes in cervical cerclage
TLDR
It is shown that braided cerclage increases the risk of preterm birth and intrauterine death compared to monofilament suture, and in vivo evidence is provided that a dynamic shift of the human vaginal microbiome toward dysbiosis correlates with pre term birth. Expand
FIGO good practice recommendations on cervical cerclage for prevention of preterm birth
TLDR
In women who present with exposed membranes prolapsing through the cervical os, a rescue cerclage can be considered on an individual case basis, taking into account the high risk of infective morbidity to mother and baby. Expand
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References

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Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy.
TLDR
The decision on how best to minimise the risk of recurrent preterm birth in women at risk, either because of poor history of a short or dilated cervix, should be 'personalised', based on the clinical circumstances, the skill and expertise of the clinical team and, most importantly, woman's informed choice. Expand
Cervical stitch (cerclage) for preventing pregnancy loss in women.
TLDR
The use of a cervical stitch should not be offered to women at low or medium risk of mid trimester loss, regardless of cervical length by ultrasound, and the role of therapeutic cerclage for women who have short cervix on ultrasound remains uncertain. Expand
Cervical stitch (cerclage) for preventing pregnancy loss: individual patient data meta‐analysis
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Cerclage may reduce the risk of pregnancy loss or neonatal death before discharge from hospital in singleton pregnancies thought to be at risk of preterm birth, but further large trials are needed to elucidate the risk-benefit ratio precisely. 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
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
Cerclage for Short Cervix on Ultrasonography: Meta-Analysis of Trials Using Individual Patient-Level Data
TLDR
In the subgroup analysis of singleton gestations with short cervical length, especially those with a prior pre term birth, cerclage may reduce preterm birth, and a well-powered trial should be carried out in this group of patients. Expand
Prophylactic cerclage in the management of triplet pregnancies.
TLDR
Prophylactic cerclage did not result in improved pregnancy or neonatal outcomes in triplet pregnancies without a history of cervical insufficiency and this study had 80% power to detect a 30% reduction in the primary outcome. Expand
Cervical incompetence prevention randomized cerclage trial (CIPRACT): study design and preliminary results.
TLDR
Transvaginal ultrasonographic serial follow-up examinations of the cervix in women at risk for cervical incompetence, with secondary intervention as indicated, appears to be a safe alternative to the traditional prophylactic cerclage. 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
Cerclage for prevention of preterm birth in women with a short cervix on transvaginal ultrasound: a randomized trial
TLDR
The non-significant reduction in PTB in singleton gestations with prior PTB < 35 weeks deserves further study by larger trials and meta-analysis of existing literature. Expand
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