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Abdulrahman N, Burger NB, van den Broek S, Kaaijk EM, Oudijk MA, de Boer MA, Huirne JAF. Patient perspectives and preferences on cerclage and preterm birth: a focus group study. Qual Life Res 2024; 33:2165-2179. [PMID: 38888673 PMCID: PMC11286660 DOI: 10.1007/s11136-024-03637-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 06/20/2024]
Abstract
AIM This qualitative focus group study aims to asses cerclage-related symptoms, the impact of a cerclage on daily functioning and patient perspectives of their healthcare experience. This study extends beyond the current focus on surgical and obstetric outcomes of a cerclage, thereby contributing to a more comprehensive understanding of the challenges faced by individuals in the context of extreme preterm birth and fetal loss and the impact of a cerclage on multiple facets in life. METHODS Participants were recruited from the Amsterdam University Medical Center, Amsterdam, the Netherlands or via the website of a Dutch patient organization for (extreme) preterm birth. Eligible participants were ≥ 18 years old with a previous vaginal and/or abdominal cerclage with a subsequent delivery at ≥ 34 weeks of gestation with neonatal survival. Two focus group discussions (FGD) were performed. A predefined format was used, which was identical for both the vaginal and abdominal cerclage group. The International Classification of Functioning, Disability and Health (ICF-DH) was used to provide structure. Outcomes were a broad range of participants reported perspectives on physical, emotional, and social-related quality of life. RESULTS In the Vaginal Cerclage Group (VCG) and Abdominal Cerclage Group (ACG), respectively, 11 and 8 participants were included. Fear for a subsequent pregnancy loss was the most limiting factor to perform daily activities during pregnancy in all participants with a cerclage. Fear to conceive again because of prior second-trimester fetal loss was experienced by 27% in the VCG and 13% in the ACG. The majority of participants experienced a reduction in anxiety after placement of their cerclage (VCG = 64%, ACG = 75%). Decreased mobility/bedrest (VCG = 100%, ACG = 75%) and blood loss (VCG = 55%, ACG = 13%) were frequently mentioned complaints during pregnancy with cerclage. Other aspects mentioned in both groups were social isolation, the lack of societal participation, and the perceived need to quit work and sports. All participants in the abdominal cerclage group reported a lack of comprehensible and unambiguous information about obstetric management and expectations during pregnancy in secondary care hospitals. Clear communication between secondary and tertiary care hospitals about obstetric management following an abdominal cerclage, for example, about the need for cervical length measurements by ultrasound, the need for bedrest or advice concerning sexual activity was missing (63%). Psychologic support was desired in half of all participants, but was not offered to them. CONCLUSIONS The fear of a subsequent pregnancy loss was reported as the most limiting factor in daily life by all participants. Cerclage placement resulted in the reduction of anxiety. Participants mentioned a significant impact of bedrest and activity restriction during pregnancy with cerclage on social participation and daily activities. Unfortunately, no high level evidence is available on this matter. Patients might even benefit from appropriate levels of physical activity throughout their pregnancy to promote their overall well-being. More evidence is needed to determine the optimal level of physical activity. There is a need for clear and unambiguous patient information about obstetric management.
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Affiliation(s)
- Nour Abdulrahman
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands.
- Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands.
- Department of Obstetrics and Gynaecology, OLVG, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands.
| | - Nicole B Burger
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Susan van den Broek
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Eugenie M Kaaijk
- Department of Obstetrics and Gynaecology, OLVG, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
| | - Martijn A Oudijk
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marjon A de Boer
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
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Chen C, Guo S, Fan C, Gao F. Nomogram-based risk assessment for emergency cervical cerclage failure in patients with cervical insufficiency. Heliyon 2024; 10:e32923. [PMID: 39027507 PMCID: PMC11255580 DOI: 10.1016/j.heliyon.2024.e32923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 06/06/2024] [Accepted: 06/12/2024] [Indexed: 07/20/2024] Open
Abstract
Background Cervical insufficiency can lead to preterm birth and neonatal mortality. Emergency cervical cerclage is a surgical intervention aimed at preventing preterm birth in patients with cervical insufficiency. However, some patients may experience cerclage failure. This study aimed to identify the risk factors associated with cerclage failure and develop a predictive nomogram model for patients with cervical insufficiency undergoing emergency cervical cerclage. Methods Data of 200 patients who underwent emergency cervical cerclage for cervical insufficiency were retrospectively analyzed. Patients were categorized into successful and failed groups based on their ability to take the infant home. Univariate and multivariate logistic regression analyses were performed to identify risk factors for cerclage failure. A nomogram model was developed based on multivariate logistic regression results, and its performance was assessed using receiver operating characteristic curves, calibration plots, and decision curve analysis (DCA). Results Univariate logistic regression analysis identified 11 potential risk factors for cerclage failure, including the presence of polycystic ovary syndrome (PCOS), vaginitis, cervical dilation, preoperative C-reactive protein, routine vaginal lavage after cervical cerclage, delivery, gestational age, extended days, chorioamnionitis, intrauterine infection, cervical laceration, and premature rupture of membranes. Multivariate logistic regression analysis revealed that PCOS, cervical dilation after cervical cerclage were independent risk factors for cerclage failure while routine vaginal lavage was a protective factor against failure. The nomogram predictive model demonstrated an area under the curve value of 0.975, indicating excellent discriminatory ability. The calibration plot showed good consistency between the nomogram predictions and actual observations. DCA demonstrated the strong clinical applicability of the nomogram. Conclusions This study successfully identified risk factors associated with emergency cervical cerclage failure in patients with cervical insufficiency and developed a predictive nomogram model. This model can assist clinicians in making informed decisions and accurately predicting the risk of cerclage failure in these patients.
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Affiliation(s)
- Caixia Chen
- Department of Obstetrics, Jinan Materrity and Child care Haspital Affiliated to Shandong First Medical University, Jinan, 250000, China
| | - Shun Guo
- Department of Obstetrics, Jinan Materrity and Child care Haspital Affiliated to Shandong First Medical University, Jinan, 250000, China
| | - Changyou Fan
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Shandong First Medical University, Jinan, 250000, China
| | - Fengchun Gao
- Department of Obstetrics, Jinan Materrity and Child care Haspital Affiliated to Shandong First Medical University, Jinan, 250000, China
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Huang L, Wang W, Wang Y, Chen J, Jin S, Qi X, Qian Y, Cheng Q. Effectiveness and pregnancy outcomes of ultrasound-indicated and physical examination-indicated cervical cerclage: a retrospective study from a single centre. BMC Pregnancy Childbirth 2024; 24:467. [PMID: 38977997 PMCID: PMC11229292 DOI: 10.1186/s12884-024-06659-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 06/25/2024] [Indexed: 07/10/2024] Open
Abstract
OBJECTIVE Preterm birth (PTB) is the leading cause of neonatal morbidity and mortality worldwide, and cervical incompetence (CIC) is a significant contribution. Cervical cerclage (CC) is an effective obstetric intervention. However, many clinical factors affect the success rate of surgery. The objective was to investigate and compare the pregnancy and neonatal outcomes of patients who underwent ultrasound- and physical examination-indicated cervical cerclage and to explore the influencing factors of preterm delivery before 34 weeks. METHODS The sociodemographic characteristics and clinical data of patients with a diagnosis of cervical incompetence who underwent ultrasound- and physical examination-indicated transvaginal cervical cerclage at Nanjing Maternal and Child Health Hospital from January 2020 to December 2022 were retrospectively analyzed. The pregnancy and neonatal outcomes of the patients were evaluated. Continuous variables were compared using Student's t test (for normally distributed data) or the Mann-Whitney U test (for nonnormally distributed data). Categorical variables were analysed using the chi-square test or Fisher's exact test. Additionally, logistic regression analyses and receiver operating characteristic curves were used to evaluate the associations of inflammatory markers with maternal and neonatal outcomes. RESULTS This study included 141 participants who underwent cervical cerclage, including 71 with ultrasound-indicated cerclage and 70 with physical examination-indicated cerclage. Compared to those in the ultrasound-indicated cerclage group, the duration from cerclage to delivery, birth weight, and APGAR score in the physical examination-indicated cerclage group were significantly lower, and the rates of delivery at < 28 weeks, < 32 weeks, < 34 weeks, and < 37 weeks of gestation and neonatal mortality were significantly higher (all P < 0.05). Compared to those in the physical ultrasound-indicated cerclage group, in the physical examination-indicated cerclage group, maternal blood inflammatory markers, such as C-reactive protein (CRP), the systemic immune-inflammation index (SII) and the systemic inflammation response index (SIRI) were significantly higher (P < 0.05). Additionally, maternal blood inflammatory markers, such as the CRP, white blood cell count, platelet to lymphocyte ratio (PLR), SII, and SIRI were significantly higher in the group with delivery before 34 weeks of gestation. Furthermore, the results demonstrated that twin pregnancy had the highest OR for preterm delivery before 34 weeks of gestation (OR = 3.829; 95% CI 1.413-10.373; P = 0.008), as well as the following: the SII level (OR = 1.001; 95% CI 1.000-1.002; P = 0.003) and CRP level (OR = 1.083; 95% CI 1.038-1.131; P = 0.022). The risk factors for preterm delivery before 34 weeks of gestation were twin gestation, an increased SII level and an increased CRP level, which had good combined predictive value. CONCLUSION In patients with cervical insufficiency, ultrasound-indicated cervical cerclage appears to lead to better pregnancy outcomes than physical examination-indicated cerclage. Twin pregnancy and maternal blood inflammatory markers, such as the CRP level and the SII, are associated with preterm delivery before 34 weeks of gestation.
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Affiliation(s)
- Linxiang Huang
- Department of Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210004, China
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Wenting Wang
- Department of Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210004, China
| | - Yuchuan Wang
- Department of Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210004, China
| | - Jie Chen
- Department of Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210004, China
| | - Shuping Jin
- Department of Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210004, China
| | - Xiaoxuan Qi
- Department of Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210004, China
| | - Yujia Qian
- Department of Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210004, China.
| | - Qing Cheng
- Department of Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210004, China.
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Binsted ACS, Nehme L, Abuhamad AZ, Kawakita T. Outcomes of Ultrasound or Physical Examination-Indicated Cerclage according to the Degree of Cervical Dilation. Am J Perinatol 2024; 41:684-689. [PMID: 37923387 DOI: 10.1055/a-2203-3696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
OBJECTIVE Pregnancy outcomes of individuals receiving cervical cerclage when the cervix is dilated are not well known. We sought to examine preterm birth rates after ultrasound or physical examination-indicated cerclage placement according to the degree of cervical dilation. STUDY DESIGN This was a retrospective cohort study of individuals with singleton pregnancies undergoing ultrasound or physical examination-indicated cerclage before 240/7 weeks of gestation from 2004 to 2018. Individuals were categorized based on the degree of cervical dilation at the time of cerclage. Our primary outcome was preterm delivery at less than 37 weeks of gestation. Multivariable logistic regression was performed to calculate adjusted odds ratios (aOR) with 95th confidence intervals (95% CI), controlling for predefined covariates. RESULTS Of 147 individuals undergoing ultrasound or physical examination-indicated cerclage, 90/147 (61%) had a closed or 0.5 cm dilated cervix at the time of cerclage placement, 45/147 (31%) had a cervical dilation of 1 to 2.5 cm, and 12/147 (8%) had a cervical dilation of 3 to 4 cm at the time of placement. Individuals with a cervical dilation of 1 to 2.5 cm compared with those who had a closed cervix did not have increased odds of preterm delivery (58 vs. 42%; aOR: 1.95; 95% CI: 0.93-4.07). However, individuals with a cervical dilation of 3 to 4 cm compared with individuals who had a closed cervix had significantly increased odds of preterm delivery (75 vs. 42%; aOR: 4.33; 95% CI: 1.05-17.77). CONCLUSION The rate of preterm birth increases with increasing cervical dilation at the time of cerclage placement. However, individuals who have a cerclage placed when the cervix is 1 to 2.5 cm can achieve an outcome that is not significantly different from those who had a cerclage placed when the cervix is closed. KEY POINTS · Time from cerclage placement to delivery decreases as cervical dilation increases.. · Individuals 1 to 2.5 cm dilated at the time of cerclage can achieve a favorable outcome.. · A cervical dilation of ≥3 cm at cerclage placement was associated with extreme prematurity..
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Affiliation(s)
| | - Lea Nehme
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Alfred Z Abuhamad
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Tetsuya Kawakita
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
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Hulshoff CC, Bosgraaf RP, Spaanderman MEA, Inthout J, Scholten RR, Van Drongelen J. The efficacy of emergency cervical cerclage in singleton and twin pregnancies: a systematic review with meta-analysis. Am J Obstet Gynecol MFM 2023; 5:100971. [PMID: 37084870 DOI: 10.1016/j.ajogmf.2023.100971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/31/2023] [Accepted: 04/09/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE An emergency (rescue) cervical cerclage can be offered to pregnant women presenting with dilatation and prolapsed membranes in the second trimester of pregnancy because of cervical insufficiency. This study aimed to investigate the effectiveness of an emergency cerclage in both singleton and twin pregnancies in the prevention of extreme premature birth. DATA SOURCES We performed a systematic literature search in PubMed and Embase from inception to June 2022 for transvaginal cervical emergency cerclages. STUDY ELIGIBILITY CRITERIA All studies on transvaginal cervical emergency cerclages with at least 5 patients and reporting survival were included. METHODS Included studies were assessed for quality and risk of bias with an adjusted Quality In Prognosis Studies tool. Random-effects meta-analyses and meta-regressions were performed for the primary outcome: survival. RESULTS Our search yielded 96 studies, incorporating 3239 women, including 14 studies with an expectant management control group, incorporating 746 women. Overall survival after cervical emergency cerclage was 74%, with a fetal survival of 88% and neonatal survival of 90%. Singleton and twin pregnancies showed similar survival, with a pregnancy prolongation of 52 and 37 days and a gestational age at delivery of 30 and 28 weeks, respectively. Meta-regression analyses indicated a significant inverse association between mean gestational age at diagnosis and pregnancy prolongation and no association between dilatation or gestational age at diagnosis and gestational age at delivery. Compared with expectant management, emergency cerclage significantly increased overall survival by 43%, fetal survival by 17% and neonatal survival by 22%, along with a significant pregnancy prolongation of 37 days and reduction in delivery at <28 weeks of gestation of 55%. These effects were more profound in singleton pregnancies than in twin pregnancies. CONCLUSION This systematic review indicates that, in pregnancies threatened by extreme premature birth because of cervical insufficiency, emergency cerclage leads to significantly higher survival, accompanied by significant pregnancy prolongation and reduction in delivery at <28 weeks of gestation, compared with expectant management. The mean gestational age at delivery was 30 weeks, independent of dilatation or gestational age at diagnosis. Survival was similar for singleton and twin pregnancies, implying that emergency cerclage should be considered in both.
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Affiliation(s)
- Cecile C Hulshoff
- Departments of Obstetrics and Gynecology (Drs Hulshoff, Bosgraaf, Spaanderman, Scholten, and Drongelen).
| | - Remko P Bosgraaf
- Departments of Obstetrics and Gynecology (Drs Hulshoff, Bosgraaf, Spaanderman, Scholten, and Drongelen); Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, The Netherlands (Dr Bosgraaf)
| | - Marc E A Spaanderman
- Departments of Obstetrics and Gynecology (Drs Hulshoff, Bosgraaf, Spaanderman, Scholten, and Drongelen); Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands (Dr Spaanderman)
| | - Joanna Inthout
- Health Evidence (Dr Inthout), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ralph R Scholten
- Departments of Obstetrics and Gynecology (Drs Hulshoff, Bosgraaf, Spaanderman, Scholten, and Drongelen)
| | - Joris Van Drongelen
- Departments of Obstetrics and Gynecology (Drs Hulshoff, Bosgraaf, Spaanderman, Scholten, and Drongelen)
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Hong S, Ko HS, Kim S, Jo YS, Park IY. Effects of Amnioreduction before Physical Examination-Indicated Cerclage on Pregnancy Outcomes: A Propensity Score Matched Study. J Clin Med 2023; 12:jcm12072480. [PMID: 37048563 PMCID: PMC10095065 DOI: 10.3390/jcm12072480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 04/14/2023] Open
Abstract
This study investigated the effects of amnioreduction before physical examination-indicated cerclage on pregnancy outcomes using a propensity score matching analysis. This multicenter retrospective cohort study included women who underwent cerclage operations due to painless cervical dilation in the second trimester (14-28 weeks). The primary outcome was the time from operation until delivery. Secondary outcomes included preterm birth rate and neonatal outcomes. Primary and secondary outcomes were compared between those with amnioreduction and those without amnioreduction. Of 103 women, 31 received preoperative amnioreduction (amnioreduction group) and 72 women did not (no-amnioreduction group). Since there were differences in baseline characteristics and preoperative ultrasound findings between the two groups, we matched 25 women with amnioreduction and 25 women without amnioreduction using a propensity score. In the matched cohort, the amnioreduction group showed a shorter time from operation to delivery than the group without amnioreduction and the hazard ratio of amnioreduction was 2.5 (95% confidence interval; 1.4-4.7). In addition, the preterm birth rate before 28 weeks of gestation and the neonatal composite outcome were higher in the amnioreduction group than that in the group without amnioreduction. Amnioreduction before physical examination-indicated cerclage was associated with poor pregnancy and neonatal outcomes. Therefore, careful consideration is required when performing amnioreduction before cerclage operation.
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Affiliation(s)
- Subeen Hong
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Hyun Sun Ko
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Seonok Kim
- Department of Clinical Epidemiology and Biostatistics, ASAN Medical Center, Seoul 05505, Republic of Korea
| | - Yun Sung Jo
- Department of Obstetrics and Gynecology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Republic of Korea
| | - In Yang Park
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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Zhang Y, Wang Q, Tan Z, Zhou J, Zhang P, Hou H, Yin Y, Han Z. The Role of Amnioreduction in Emergency Cervical Cerclage with Bulging Membranes: A Retrospective Comparative Study. Front Surg 2022; 9:928322. [PMID: 35903258 PMCID: PMC9314748 DOI: 10.3389/fsurg.2022.928322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/22/2022] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to investigate the role of amnioreduction in patients who underwent emergency cervical cerclage (ECC) with bulging membranes during the second trimester. This retrospective comparative study included 46 singleton pregnant women who had cervical dilation at least 1 cm with bulging membranes beyond the external cervical os and underwent ECC at the Third Affiliated Hospital of Sun Yat-sen University between December 2016 and December 2021. Cases were categorized as amnioreduction group (n = 16) and non-amnioreduction group (n = 30) according to whether amnioreduction was performed prior to ECC. The gestational age and cervical dilation at cerclage, operative time, prolongation of pregnancy, and outcomes of pregnancy were compared between the two groups. All 46 patients underwent successful ECC excepted one case with intraoperative rupture of membrane in non-amnioreduction group. In the amnioreduction group, the cervical dilation at cerclage was larger than that in the non-amnioreduction group (4.5 ± 2.2 vs. 2.2 ± 1.2 cm, P < 0.001), and had more patients with cervical dilation ≥4 cm (50.0% vs. 10.0%, P = 0.004). However, the gestational age at cerclage, operative time, prolongation of pregnancy, gestational age at delivery were not significantly different between the two groups (22.9 ± 2.8 vs. 22.9 ± 3.2 weeks, 31.1 ± 9.2 vs. 27.9 ± 11.4 min, 21.3 ± 21.5 vs. 38.7 ± 40.2 days, 25.9 ± 4.5 vs. 28.4 ± 6.1 weeks; P > 0.05). The rates of delivery ≥28 weeks, ≥32 weeks, and live birth were 20.0% vs. 80.0%, 12.5% vs. 26.7%, 56.3% vs. 66.7% (P > 0.05) in amnioreduction group and non-amnioreduction group, respectively. In conclusion, even in cases with larger cervical dilation, the application of amnioreduction with ECC is possible to get the acceptable pregnancy outcomes. These findings suggested that amnioreduction may be a safe and feasible option to be applied before ECC, especially for those with advanced cervical dilation and bulging membranes.
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Affiliation(s)
| | | | | | | | | | | | - Yuzhu Yin
- Correspondence: Zhenyan Han Yuzhu Yin
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Wei M, Yang Y, Jin X, Yang J, Huang D, Zhang S. A comparison of pregnancy outcome of emergency modified transvaginal cervicoisthmic cerclage performed in twin and singleton pregnancies. Arch Gynecol Obstet 2021; 303:1197-1205. [PMID: 33386955 DOI: 10.1007/s00404-020-05852-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 10/17/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the pregnancy outcome of emergency cerclage performed in twin and singleton pregnancies. METHODS A retrospective trial was carried out in the Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital in Zhejiang, China, from January 2013 to December 2018. A total of 89 women with acute cervical incompetence underwent the emergency cerclage. Main outcome measures were gestational age at delivery and the fetal outcome. RESULTS There were 31 twin and 58 singleton pregnancies that underwent emergency cerclage. In singleton pregnancies, gestational age at delivery (31.57 ± 6.11 vs 28.81 ± 4.34, p = 0.016), and prolongation of pregnancy (8.69 ± 6.13 vs 5.41 ± 3.72, p < 0.001) were greater, and the preterm delivery rate before 34 weeks was lower (53.4% vs 80.6%, p = 0.011) compared with twin pregnancies. Fetal weight was greater in singletons than in twins (2377.3 ± 862.1 vs 1630.3 ± 557.6, p < 0.001), but the fetal survival rate was similar. The proportion of twin gestations was significantly higher in the group with preterm delivery before 34 weeks (44.6% vs 18.2%, p = 0.011) and the proportion of previous term delivery was higher in the group with delivery at or after 34 weeks (30.3% vs 12.5%, p = 0.039). The group with preterm delivery before 34 weeks had a significantly larger size of visible membranes at cerclage than the group with delivery at or after 34 weeks (2.23 ± 0.86 vs 1.64 ± 0.80, p = 0.001). In binary logistic regression analysis, twin gestations and a larger size of visible membranes were associated with an increased risk of preterm delivery. CONCLUSION The pregnancy outcome of emergency cerclage appears to have a better prognosis in singleton pregnancies than in twin pregnancies, and twin pregnancy is a risk factor for preterm delivery.
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Affiliation(s)
- Minling Wei
- Center of Reproductive Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3# Qingchun East Road, Hangzhou, 310016, People's Republic of China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou, 310016, People's Republic of China
| | - Yang Yang
- Center of Reproductive Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3# Qingchun East Road, Hangzhou, 310016, People's Republic of China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou, 310016, People's Republic of China
| | - Xiaoying Jin
- Center of Reproductive Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3# Qingchun East Road, Hangzhou, 310016, People's Republic of China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou, 310016, People's Republic of China
| | - Jingyan Yang
- Center of Reproductive Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3# Qingchun East Road, Hangzhou, 310016, People's Republic of China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou, 310016, People's Republic of China
| | - Dong Huang
- Center of Reproductive Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3# Qingchun East Road, Hangzhou, 310016, People's Republic of China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou, 310016, People's Republic of China
| | - Songying Zhang
- Center of Reproductive Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3# Qingchun East Road, Hangzhou, 310016, People's Republic of China.
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou, 310016, People's Republic of China.
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Chen R, Huang X, Li B. Pregnancy outcomes and factors affecting the clinical effects of cervical cerclage when used for different indications: A retrospective study of 326 cases. Taiwan J Obstet Gynecol 2020; 59:28-33. [PMID: 32039796 DOI: 10.1016/j.tjog.2019.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2019] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To compare pregnancy outcomes resulting from the use of cervical cerclage for different indications and investigate factors that might influence the clinical effects of cervical cerclage. MATERIALS AND METHODS This was a retrospective study of pregnant women who received cervical cerclage in The Women's Hospital, Zhejiang University School of Medicine, China. Patients were divided into three groups: a history-indicated group; an ultrasound-indicated group and a physical examination-indicated group. The pregnancy outcomes of the three groups were then compared. Univariate and multivariate logistic regression analysis were performed to assess the independent risk factors. RESULTS Statistical differences were evident when the history-indicated group and the ultrasound-indicated group were compared with the physical examination-indicated group for gestational age at delivery [37.3(33.3-38.9), 35.4(28.9-38.4) vs. 26.1 (24.3-28.4) weeks, respectively, P < 0.05], percentage of cases delivered at < 28 weeks of gestation (13.4%, 20.3% vs. 74.3%, respectively, P < 0.05), percentage of cases delivered at < 37 weeks of gestation (42.7%, 54.2% vs. 91.4%, respectively, P < 0.05) and fetal survival rate (88.4%, 81.4% vs. 40.0%, respectively, P < 0.05). The history-indicated group and the ultrasound-indicated group were similar with regards to these outcomes. The independent risk factors affecting the clinical effects of cervical cerclage include age, body mass index (BMI), history of prior preterm birth and second-trimester loss, C-reactive protein (CRP) >5 mg/L and cervical dilation ≥3 cm (P < 0.05). CONCLUSION Pregnancy outcomes were similar when compared between history-indicated and ultrasound-indicated cerclage. Serial cervical surveillance is beneficial for pregnant with a history of cervical insufficiency, and the placement of cervical cerclages in response to ultrasonographically detected shortening of the cervical length is a medically acceptable alternative to the use of history-indicated cerclage.
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Affiliation(s)
- Ruizhe Chen
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Xiaoxiu Huang
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Baohua Li
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China.
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Chatzakis C, Efthymiou A, Sotiriadis A, Makrydimas G. Emergency cerclage in singleton pregnancies with painless cervical dilatation: A meta-analysis. Acta Obstet Gynecol Scand 2020; 99:1444-1457. [PMID: 32757297 DOI: 10.1111/aogs.13968] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/24/2020] [Accepted: 07/30/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Emergency cerclage is the most common active intervention in pregnant women with cervical insufficiency. This meta-analysis aimed to compare the effectiveness of emergency cerclage vs expectant management on maternal and perinatal outcomes, and to assess the current status of evidence. MATERIAL AND METHODS A search was conducted from 1 June 2019 until 1 September 2019 and eligible studies were identified in the MEDLINE, Scopus, Cochrane and US clinical trials registry without limitations concerning the publication dates and languages. Randomized controlled trials (RCTs), non-RCTs and observational studies comparing emergency cerclage with no cerclage/expectant management, in women presenting with painless cervical dilatation were included. RESULTS The electronic search yielded 3607 potential studies, of which 38 were fully reviewed and 12 observational studies (1021 participants) were included. Cerclage was superior to expectant management for the primary outcomes of preterm birth before 28 and 32 gestational weeks, OR 0.25 (95% CI 0.16-0.39, five studies, N = 392, I2 = 41%, low quality) and 0.08 (95% CI 0.02-0.29, four studies, N = 176, I2 = 51%, low quality), respectively. Cerclage was also superior to expectant management for the secondary outcomes of fetal loss OR 0.26 (95% CI 0.12-0.56, 8 studies, N = 455, I2 = 46%, very low-quality), pregnancy prolongation in days mean difference 47.45 (95% CI 39.89-55.0, 12 studies, N = 1027 I2 = 86%, very low quality), gestational age at birth in weeks mean difference 5.68 (95% CI 4.69-6.67, 9 studies, N = 892, I2 = 73%, very low quality), admission to neonatal intensive care OR 0.21 (95% CI 0.07-0.70, two studies, N = 79, I2 = 36%, very low quality) and neonatal death OR 0.12 (95% CI 0.04-0.34, five studies, N = 130, I2 = 0%, very low quality). There were no differences between cerclage and expectant management concerning premature rupture of membranes during or after the procedure OR 0.68 (95% CI 0.31-1.48, two studies, N = 155, I2 = 85%, very low quality) and chorioamnionitis OR 1.14 (95% CI 0.31-4.25, three studies, N = 88, I2 = 33%, very low quality). CONCLUSIONS Emergency cerclage in pregnant women with painless cervical dilatation seems to decrease preterm births, prolong the pregnancy, and decrease the neonatal deaths and fetal losses, but does not increase the risk of chorioamnionitis and premature rupture of membranes. Despite the extremely favorable estimates for cerclage, the results should be viewed with caution because, as a result of the lack of randomized control trials, the quality of evidence is low to very low.
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Affiliation(s)
- Christos Chatzakis
- 2nd Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athina Efthymiou
- Department of Obstetrics and Gynecology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Alexandros Sotiriadis
- 2nd Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Makrydimas
- Department of Obstetrics and Gynecology, School of Medicine, University of Ioannina, Ioannina, Greece
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Lv M, Zhao B, Chen Y, Xi F, Zhan Q, Wang Y, Pu Y, Luo Q. Balloon tamponade for successful emergency cervical cerclage. J Obstet Gynaecol Res 2020; 46:418-424. [PMID: 31922306 DOI: 10.1111/jog.14186] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 12/08/2019] [Indexed: 11/30/2022]
Abstract
AIM To illustrate the method of emergency cerclage with the balloon tamponade and demonstrate the efficacy of this surgery method. METHODS Procedures of the balloon tamponade assisted emergency cerclage were reviewed in detail and outcomes of 39 patients treated with this way were evaluated. RESULTS From 2017 to 2019, emergency cerclage was successfully performed in 39 patients with a dilated cervix and bulging fetal membranes, assisted by the balloon tamponade. The diameter of the bulging prolapsed membranes ranged from 0.0-10.0 cm, with a median of 2.0 cm. Prolongation of the pregnancy period was from 8 to 138 days, with a median of 29 days. No maternal complications including infections, cervical laceration and cervical bleeding were observed perioperative period. CONCLUSION Emergency cerclage is an effective way to prolong gestational period in patients with advanced cervical dilatation and bulging membranes. The balloon tamponade assisted emergency cerclage makes the replacement of fetal membranes back into the uterine cavity easier and effectively, then a successful and convenient emergency cerclage can be performed.
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Affiliation(s)
- Min Lv
- Key laboratory of Reproductive Genetics (Ministry of Education) and Department of Obstetrics, Women's Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Baihui Zhao
- Key laboratory of Reproductive Genetics (Ministry of Education) and Department of Obstetrics, Women's Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Yuan Chen
- Key laboratory of Reproductive Genetics (Ministry of Education) and Department of Obstetrics, Women's Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Fangfang Xi
- Key laboratory of Reproductive Genetics (Ministry of Education) and Department of Obstetrics, Women's Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Qitao Zhan
- Key laboratory of Reproductive Genetics (Ministry of Education) and Department of Obstetrics, Women's Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Yayun Wang
- Key laboratory of Reproductive Genetics (Ministry of Education) and Department of Obstetrics, Women's Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Yuqun Pu
- Key laboratory of Reproductive Genetics (Ministry of Education) and Department of Obstetrics, Women's Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Qiong Luo
- Key laboratory of Reproductive Genetics (Ministry of Education) and Department of Obstetrics, Women's Hospital, Zhejiang University, School of Medicine, Hangzhou, China
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12
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Pang Q, Jia X, Chen L. Perinatal Outcomes After Emergency Cervical Cerclage for Cervical Insufficiency with Prolapsed Membranes. Med Sci Monit 2019; 25:4202-4206. [PMID: 31168048 PMCID: PMC6568028 DOI: 10.12659/msm.916480] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background To study the clinical effective of emergency cervical cerclage (ECC) in pregnant women who have cervical insufficiency with prolapsed membranes. Material/Methods This study was devised as a retrospective cohort in a single medical center, in which we collected clinical data from patient records. Inclusion criteria were: physical examination indicated ECC was performed at 15 to 25 gestational weeks at the Sixth Medical Center of the PLA General Hospital, and singleton pregnancy. The collected clinical data included: duration of pregnancy at delivery, interval between ECC and delivery, neonatal weight, neonatal mortality, neonatal morbidity, and Neonatal Intensive Care Unit (NICU) admission. Results We included 50 women with singleton pregnancies. No surgical complications occurred in any patients. The gestational age at cerclage was 21.3±2.2 weeks. No patients had membrane damage due to surgery. No surgical complications were reported. Five (10%) patients underwent chorioamnionitis. The time interval between ECC and delivery was 11.2±7.1 weeks. The mean gestational age at delivery was 34.1 weeks. The rate of vaginal delivery was 96%. Ten patients had pregnancy lasting longer than 36 weeks. The mean neonate delivery weight was 2510.7 g. Twenty neonates were admitted to the Neonatal Intensive Care Unit (NICU), and the mean NICU stay was 21 days. Conclusions ECC has good perinatal results. Our results provide clinical evidence for the efficacy and risks of ECC.
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Affiliation(s)
- Qi Pang
- Department of Obstetrics and Gynecology, Sixth Medical Center of the People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Xiaoning Jia
- Department of Obstetrics and Gynecology, Sixth Medical Center of the People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Lei Chen
- Department of Obstetrics and Gynecology, Sixth Medical Center of the People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
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13
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Costa MMF, Amorim Filho AGD, Barros MFD, Rodrigues AS, Zugaib M, Francisco RPV, Carvalho MHBD. Emergency cerclage: gestational and neonatal outcomes. ACTA ACUST UNITED AC 2019; 65:598-602. [PMID: 31166434 DOI: 10.1590/1806-9282.65.5.598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/03/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The gestational and neonatal outcomes of women with early cervical dilatation undergoing emergency cerclage were evaluated and compared with women treated with expectant management and bed rest. METHODS Retrospective analysis of pregnant women admitted between 2001 and 2017 with a diagnosis of early cervical dilatation and/or bulging membranes. Patients with a singleton pregnancy of a fetus without malformations, between 16 and 25 weeks and 6 days, with cervical dilatation of 1 to 3 cm were included; patients who delivered or miscarried within 2 days after admission were excluded. RESULTS The study enrolled 30 patients: 19 in the cerclage group and 11 in the rest group. There was a significant difference, with the cerclage group showing better results concerning gestational age at delivery (28.7 vs. 23.3 weeks; p=0.031) and latency between hospital admission and delivery (48.6 vs. 16 days; p=0.016). The fetal death rate was lower in the cerclage group (5.3% vs. 54.5%, p=0.004). Considering gestational age at delivery of live newborns, no difference was observed between the cerclage and rest groups (29.13 vs. 27.4 weeks; p=0.857). CONCLUSIONS Emergency cerclage was associated with longer latency, a significant impact on gestational age at delivery and reduction in the fetal death rate.
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Affiliation(s)
| | | | | | | | - Marcelo Zugaib
- Department of Obstetrics and Gynecology, University of São Paulo Medical School, São Paulo, Brasil
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14
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Govia RNM, Birse KD, Sepehri S, Khafipour E, Menticoglou SM, Burgener AD, Poliquin V. Amniotic fluid proteomic signatures of cervical insufficiency and their association with length of latency. Am J Reprod Immunol 2018; 80:e13030. [PMID: 30076666 DOI: 10.1111/aji.13030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/09/2018] [Accepted: 07/11/2018] [Indexed: 01/16/2023] Open
Abstract
PROBLEM Cervical insufficiency is a precursor of preterm birth. Treatment with emergency cervical cerclage is contraindicated in the presence of intra-amniotic infection. Detecting infection with Gram stain and culture of amniotic fluid lacks sensitivity. Proteomic profiling of amniotic fluid in cervical insufficiency may help identify pregnancies best suited for emergency cerclage. METHOD OF STUDY Thirty-two pregnant women underwent amniocentesis for routine genetic testing (n = 22) or after diagnosis of cervical insufficiency (n = 10). The proteomic profiles of the amniotic fluid samples were compared in a cross-sectional fashion, including sub-analyses of women with cervical insufficiency and latency periods of <1 week and >1 week post-diagnosis. RESULTS Mean gestational age at diagnosis of cervical insufficiency was 21.4 weeks (95% CI 20.6-22.1). Proteomic analysis yielded 40 (7.2%, P < 0.05) differentially expressed proteins between women with delivery <1 week (n = 6) vs. >1 week (n = 4). Women who delivered <1 week had activated inflammatory response (z = 2.3, P = 6.71E-09), chemotaxis of immune cells (z = 2.9, P = 2.01E-08), and inhibited bacterial growth (z = -2.2, P = 5.82E-05). A multivariate model of eight biomarkers positively associated with cases of <1 week latency and distinguished cases from controls (97.8%, cross-validation accuracy 92.7%, P = 0.0009). CONCLUSION In this pilot study, significant differences in the amniotic fluid proteomic profiles in cases of cervical insufficiency compared to genetic amniocentesis were observed. Proteomic signatures were predictive of achieving latency > 1 week after diagnosis of cervical insufficiency. These preliminary findings suggest that proteomic analysis may be of value in predicting outcome following cervical insufficiency and warrants further validation in larger studies.
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Affiliation(s)
- Rachelle N M Govia
- Department of Obstetrics, Gynaecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kenzie D Birse
- National HIV and Retrovirology Laboratories, JC Wilt Infectious Disease Research Centre, Public Health Agency of Canada, Winnipeg, Manitoba, Canada.,Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shadi Sepehri
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Ehsan Khafipour
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,Department of Animal Science, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Savas M Menticoglou
- Department of Obstetrics, Gynaecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Adam D Burgener
- National HIV and Retrovirology Laboratories, JC Wilt Infectious Disease Research Centre, Public Health Agency of Canada, Winnipeg, Manitoba, Canada.,Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Medicine, Solna, Unit of Infectious Diseases, Center for Molecular Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Vanessa Poliquin
- Department of Obstetrics, Gynaecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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15
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Mitric C, Ponette V. Successful Rescue Cerclage in a Monochorionic Diamniotic Twin Pregnancy at 20 Weeks: Case Report and Overview of Literature. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:473-475. [PMID: 29503249 DOI: 10.1016/j.jogc.2017.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/22/2017] [Accepted: 10/25/2017] [Indexed: 10/17/2022]
Abstract
BACKGROUND In twin pregnancies, elective cerclage placement based on obstetrical history or ultrasound findings has been shown to be ineffective and even harmful. There are currently no guidelines for the use of rescue cervical cerclage in twin pregnancies. CASE The current report presents the case of a 33-year-old patient with monochorionic diamniotic twins (MCDA) found to have dilated cervix at 3.5cm with exposed membranes upon physical examination at 19 weeks and 3 days. An emergency McDonald cerclage was placed at 20 weeks and the patient carried the current pregnancy until 35weeks 6 days. CONCLUSION Rescue cerclage represents an important option to consider in order to preserve twin pregnancies regardless of chorionicity.
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Affiliation(s)
- Cristina Mitric
- Department of Obstetrics and Gynecology, McGill University, Montreál, QC.
| | - Vincent Ponette
- Department of Obstetrics and Gynecology, McGill University, Montreál, QC
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16
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Song JE, Park SJ, Lee KY, Lee WJ. Amniotic fluid HIF1α and exosomal HIF1α in cervical insufficiency patients with physical examination-indicated cerclage. J Matern Fetal Neonatal Med 2018; 32:2287-2294. [PMID: 29357727 DOI: 10.1080/14767058.2018.1432037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Hypoxia inducible factor 1α (HIF1α) has been reported to activate inflammatory cascade. Recently, exosomes have been known to have pivotal roles in intercellular communication. The aim of this study was to compare the concentration of amniotic fluid (AF) HIF1α, exosomal HIF1α, and inflammatory cytokines such as interleukin 1α (IL1α), interleukin 1β (IL1β), interleukin 6 (IL6), and tumor necrosis factor α (TNFα) between physical examination-indicated cerclage (PEIC) and control group. We also investigated the associations between biomarkers and amniocentesis-to-delivery interval and the correlations of inflammatory cytokines, HIF1α, and exosomal HIF1α. METHODS Case-control study was performed. Cases are defined as 16 patients who underwent PEIC and controls are 19 women who underwent amniocentesis for confirming chromosomal abnormalities. The concentration of IL1α, IL1β, IL6, TNFα, HIF1α, and exosomal HIF1α were measured using enzyme-linked immunosorbent assay (ELISA). Exosomes were confirmed by tumor susceptibility Gene 101 (TSG 101) and transmission electron microscopy (TEM). RESULTS The mean HIF1α in PEIC group was higher than control group (PEIC, 15.03 ± 9.60-pg/mL versus control, 2.96 ± 1.99 pg/mL; p < .01). There were significant differences in inflammatory cytokines between two groups. A significant difference in exosomal HIF1α was shown between two groups (PEIC, 27.97 ± 28.61-µg/mL versus control, 12.42 ± 8.20 µg/mL; p < .01). HIF1α, IL1α, IL6, TNFα, and exosomal HIF1α showed significantly negative association with cerclage-to-delivery interval. However, IL1β was not associated with cerclage-to-delivery interval. HIF1α was positively correlated with exosomal HIF1α (rho = 0.93, p < .01). Both HIF1α and exosomal HIF1α were significantly associated with TNFα (rho = 0.94, p < .01; rho = 0.97, p < .01). Both HIF-1α and exosomal HIF1α had positive correlation with IL1α (rho = 0.96, p < .01; rho = 0.91, p < .01). However, IL1β showed no correlations with HIF1α and exosomal HIF1α. A positive correlation between HIF-1α and IL6 was observed (rho = 0.58, p = .01.) Exosomal HIF1α also had correlation with IL6 (rho = 0.52, p = .03). CONCLUSIONS This study demonstrated that amniotic fluid (AF) HIF1α and AF exosomal HIF1α were higher in physical examination-indicated cerclage (PEIC) group than control group. AF HIF1α and AF exosomal HIF1α were associated with shorter amniocentesis-to-delivery interval. More importantly, they had positive correlations with AF inflammatory cytokines such as IL1α, IL6, and TNFα. Our results may indicate that AF HIF1α and AF exosomes interact with AF inflammatory cytokines and contribute inflammatory cascade in complicated pregnancies.
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Affiliation(s)
- Ji Eun Song
- a Department of Obstetrics and Gynecology , Hallym University School of Medicine , Seoul , Republic of Korea
| | - Seok Ju Park
- b Ilsong Institute of Life Science , Hallym University , Anyang , Republic of Korea
| | - Keun Young Lee
- a Department of Obstetrics and Gynecology , Hallym University School of Medicine , Seoul , Republic of Korea
| | - Wang Jae Lee
- c Department of Anatomy , Seoul National University College of Medicine , Seoul , Republic of Korea
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Chen Q, Chen G, Li N. Clinical effect of emergency cervical cerclage and elective cervical cerclage on pregnancy outcome in the cervical-incompetent pregnant women. Arch Gynecol Obstet 2017; 297:401-407. [PMID: 29222640 DOI: 10.1007/s00404-017-4602-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 11/20/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare the clinical effect of emergency cervical cerclage and elective cervical cerclage on pregnancy outcome in the cervical-incompetent pregnant women. METHODS Literature was searched from the databases of Pubmed, Embase and Google scholar. The fixed or random effects model was used to calculate pooled risk ratios on the basis of heterogeneity. Meta-regression, sensitive analysis, subgroup analysis, and publication bias assessment were also conducted to confirm the results according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009. RESULTS The meta-analysis results showed that there were significant associations between cerclage operations and pregnancy outcomes in gestation age, birth weight, and PROM rate. Gestation age was significantly higher in women with elective cerclage than those with emergency cerclage, and birth weight was significantly higher in newborns for the elective group as compared with emergency group. The rate of PROM in elective group was lower than emergency group. However, there were no differences between the emergency cerclage group and the elective cerclage group regarding the rate of vaginal delivery. CONCLUSIONS This meta-analysis suggests that emergency cerclage has lower gestation age and birth weight than elective cerclage, and it increases the risk of PROM. Further well-designed studies are warranted to confirm these results.
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Affiliation(s)
- Qin Chen
- Department of Obstetrica, Tengzhou Central People's Hospital, No. 181 Xingtan Road, Tengzhou, 277599, Shandong, China.
| | - Guiying Chen
- Department of Pharmacy, Tengzhou Central People's Hospital, Tengzhou, 277599, China
| | - Nan Li
- Department of Obstetrica, Tengzhou Central People's Hospital, No. 181 Xingtan Road, Tengzhou, 277599, Shandong, China
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Wang S, Feng L. A single-center retrospective study of pregnancy outcomes after emergency cerclage for cervical insufficiency. Int J Gynaecol Obstet 2017. [PMID: 28639273 DOI: 10.1002/ijgo.12244] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Sheng Wang
- Department of Obstetrics and Gynecology; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Ling Feng
- Department of Obstetrics and Gynecology; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
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Steenhaut P, Hubinont C, Bernard P, Debiève F. Retrospective comparison of perinatal outcomes following emergency cervical cerclage with or without prolapsed membranes. Int J Gynaecol Obstet 2017; 137:260-264. [DOI: 10.1002/ijgo.12144] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 01/24/2017] [Accepted: 03/06/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Patricia Steenhaut
- Department of Obstetrics; Saint Luc University Hospital; Université Catholique de Louvain; Brussels Belgium
| | - Corinne Hubinont
- Department of Obstetrics; Saint Luc University Hospital; Université Catholique de Louvain; Brussels Belgium
| | - Pierre Bernard
- Department of Obstetrics; Saint Luc University Hospital; Université Catholique de Louvain; Brussels Belgium
| | - Frédéric Debiève
- Department of Obstetrics; Saint Luc University Hospital; Université Catholique de Louvain; Brussels Belgium
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Bayrak M, Gul A, Goynumer G. Rescue cerclage when foetal membranes prolapse into the vagina. J OBSTET GYNAECOL 2017; 37:471-475. [DOI: 10.1080/01443615.2016.1268574] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Mehmet Bayrak
- Istanbul Medeniyet University Goztepe Education and Research Hospital, Istanbul, Turkey
| | - Ahmet Gul
- Istanbul Prenatal Center, Istanbul, Turkey
| | - Gokhan Goynumer
- Istanbul Medeniyet University Goztepe Education and Research Hospital, Istanbul, Turkey
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Hatakeyama Y, Miura H, Sato A, Onodera Y, Sato N, Shimizu D, Kumazawa Y, Sanada H, Hirano H, Terada Y. Neutrophil elastase in amniotic fluid as a predictor of preterm birth after emergent cervical cerclage. Acta Obstet Gynecol Scand 2016; 95:1136-42. [PMID: 27216361 PMCID: PMC5094512 DOI: 10.1111/aogs.12928] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 05/19/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The aim of this study was to investigate neutrophil elastase (NE) in amniotic fluid as a potential marker for predicting pregnancy continuation. MATERIAL AND METHODS We enrolled 34 pregnant women with bulging fetal membrane during the second trimester who underwent emergent cerclage after confirming the absence of intrauterine infection (amniotic fluid glucose ≥15 mg/dL). Amniotic fluid NE levels were compared between women who completed and did not complete 30, 34, and 36 weeks of gestation, and the optimal cut-off value for predicting pregnancy continuation was estimated. Moreover, the differences in the duration of continued pregnancy were compared between women with NE levels above and below the optimal cut-off value. RESULTS The optimal cut-off value for NE in amniotic fluid that predicted pregnancy continuation beyond 30, 34, and 36 weeks of gestation was 180 ng/mL; this cut-off value had a sensitivity, specificity, positive predictive value, and negative predictive value of 84.0, 77.8, 91.3, and 63.7% beyond 30 weeks of gestation; 87.5, 80.0, 91.5, and 72.3% beyond 34 weeks of gestation; and 85.0, 71.4, 80.9, and 76.9% beyond 36 weeks of gestation, respectively. The duration of continued pregnancy from emergent cerclage to delivery was significantly longer in women with amniotic fluid NE <180 ng/mL (95.1 ± 5.4 days) than in women with amniotic fluid NE ≥180 ng/mL (44.8 ± 14.3 days). CONCLUSION The NE levels in amniotic fluid may serve as a useful marker for predicting the duration of continued pregnancy after cervical cerclage.
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Affiliation(s)
- Yuko Hatakeyama
- Division of Obstetrics and Gynecology, Department of Reproductive and Developmental Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiroshi Miura
- Division of Obstetrics and Gynecology, Department of Reproductive and Developmental Medicine, Akita University Graduate School of Medicine, Akita, Japan.
| | - Akira Sato
- Division of Obstetrics and Gynecology, Department of Reproductive and Developmental Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Yohei Onodera
- Division of Obstetrics and Gynecology, Department of Reproductive and Developmental Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Naoki Sato
- Division of Obstetrics and Gynecology, Department of Reproductive and Developmental Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Dai Shimizu
- Division of Obstetrics and Gynecology, Department of Reproductive and Developmental Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Yukiyo Kumazawa
- Division of Obstetrics and Gynecology, Department of Reproductive and Developmental Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiroyuki Sanada
- Division of Obstetrics and Gynecology, Akita Red Cross Hospital, Akita, Japan
| | - Hideto Hirano
- Division of Obstetrics and Gynecology, Akita Red Cross Hospital, Akita, Japan
| | - Yukihiro Terada
- Division of Obstetrics and Gynecology, Department of Reproductive and Developmental Medicine, Akita University Graduate School of Medicine, Akita, Japan
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22
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Jung EY, Oh KJ, Hong JS, Han BR, Joo JK. Addition of adjuvant progesterone to physical-exam-indicated cervical cerclage to prevent preterm birth. J Obstet Gynaecol Res 2016; 42:1666-1672. [PMID: 27641755 DOI: 10.1111/jog.13128] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 07/10/2016] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to assess the effect of vaginal progesterone as an adjuvant therapy to physical-exam-indicated cervical cerclage (PEICC). METHODS This retrospective cohort study included 53 consecutive singleton women who underwent PEICC because of acute cervical insufficiency at 17-24 gestational weeks. The study population was divided into two groups: the adjuvant progesterone group (n = 18) and the non-adjuvant group (n = 35). A 200-mg dose of vaginal micronized natural progesterone was administered after cerclage in the adjuvant progesterone group. Primary outcome measure was spontaneous preterm birth (SPTB) at <36 weeks. RESULTS The SPTB rate at <36 weeks in the adjuvant group was significantly lower than in the non-adjuvant group (17% vs 51%, P < 0.05). Adjuvant progesterone therapy was significantly associated with a reduction in SPTB at <36 weeks (adjusted odds ratio, 0.12; 95% confidence interval, 0.02-0.69, P < 0.05) even after adjusting for known covariates, including a visible membrane size of ≥4 cm, gestational age, prior SPTB, and use of amnioreduction. The frequency of SPTB at <32 weeks, birthweight < 2500 g, and neonatal intensive care unit admission was significantly lower in the adjuvant progesterone group than in the non-adjuvant group (P < 0.05 for all). CONCLUSION Adjuvant vaginal progesterone therapy with PEICC was associated with reductions in SPTB, low birthweight, and neonatal intensive care unit admission.
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Affiliation(s)
- Eun Young Jung
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnamsi, Republic of Korea
| | - Kyung Joon Oh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnamsi, Republic of Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joon-Seok Hong
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnamsi, Republic of Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Bo Ryoung Han
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnamsi, Republic of Korea
| | - Jung Kyung Joo
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnamsi, Republic of Korea
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23
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Gluck O, Mizrachi Y, Ginath S, Bar J, Sagiv R. Obstetrical outcomes of emergency compared with elective cervical cerclage. J Matern Fetal Neonatal Med 2016; 30:1650-1654. [DOI: 10.1080/14767058.2016.1220529] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ohad Gluck
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel and
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Mizrachi
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel and
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shimon Ginath
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel and
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel and
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Sagiv
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel and
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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24
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Ragab A, Mesbah Y. To do or not to do emergency cervical cerclage (a rescue stitch) at 24-28 weeks gestation in addition to progesterone for patients coming early in labor? A prospective randomized trial for efficacy and safety. Arch Gynecol Obstet 2015; 292:1255-60. [PMID: 26041325 DOI: 10.1007/s00404-015-3772-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 05/27/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE To measure the outcome of emergency cervical cerclage (ECC) combined with progesterone vs. progesterone alone in pregnancy prolongation for preterm labor at 24-28 weeks. METHODS One hundred patients in early labor were allocated randomly into two equal groups. Group A were treated by ECC and progesterone, and group B were on the same progesterone dose only treatment. RESULTS No significant differences were observed in both groups as regard demographic data, fetal gestational age or cervical state on admission. However, a significant pregnancy prolongation was observed in group A (28.44 ± 12.73 days vs. 9.96 ± 3.27 in group B, p < 0.001) with subsequent increase in fetal gestational age (32.04 ± 3.2 vs. 27.86 ± 3.213, p < 0.001), heavier weight, higher Apgar score at 1 and 5 min, and lower rate of cesarean delivery (1033.1 ± 170.83 vs. 715.1 ± 138.73, p < 0.001) (2.68 ± 1.132 vs. 2.14 ± 0.93, p < 0.001), (5.48 ± 2.6 vs. 2.38 ± 1.59, p = 0.01) and (16 vs. 62 %, p = 0.01), respectively. Also neonatal outcomes in terms of early neonatal deaths were lower in this group (18 vs. 46 %, p = 0.049). CONCLUSIONS ECC is effective in pregnancy prolongation when judiciously used in combination with progesterone compared to progesterone alone.
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Affiliation(s)
- Ahmed Ragab
- Department of Obstetrics and Gynecology, Mansoura College of Medicine, Mansoura University, Mansoura, Egypt.
| | - Yasser Mesbah
- Department of Obstetrics and Gynecology, Mansoura College of Medicine, Mansoura University, Mansoura, Egypt
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25
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Ehsanipoor RM, Seligman NS, Saccone G, Szymanski LM, Wissinger C, Werner EF, Berghella V. Physical Examination-Indicated Cerclage: A Systematic Review and Meta-analysis. Obstet Gynecol 2015; 126:125-35. [PMID: 26241265 DOI: 10.1097/aog.0000000000000850] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate the effectiveness of physical examination-indicated cerclage in the setting of second-trimester cervical dilatation by systematic review and meta-analysis of published studies. DATA SOURCES We searched MEDLINE, EMBASE, Scopus, ClinicalTrials.gov, Web of Science, and the Cochrane Library for studies published between 1966 and 2014 that evaluated cervical cerclage for the treatment of cervical insufficiency. METHODS OF STUDY SELECTION The search yielded 6,314 citations. We included cohort studies and randomized controlled trials comparing cerclage placement with expectant management of women with cervical dilatation between 14 and 27 weeks of gestation. Two investigators independently reviewed each citation for inclusion or exclusion and discordant decisions were arbitrated by a third reviewer. Summary estimates were reported as the mean difference and 95% confidence interval (CI) for continuous variables or relative risk and with 95% CI for dichotomous outcomes. Fixed- and random-effects meta-analysis was used, depending on heterogeneity. TABULATION, INTEGRATION, AND RESULTS Ten studies met inclusion criteria and were included in the final analysis. One was a randomized controlled trial, two were prospective cohort studies, and the remaining seven were retrospective cohort studies. Of the 757 women, 485 (64%) underwent physical examination-indicated cerclage placement and 272 (36%) were expectantly managed. Cerclage was associated with increased neonatal survival (71% compared with 43%; relative risk 1.65, 95% CI 1.19-2.28) and prolongation of pregnancy (mean difference 33.98 days, 95% CI 17.88-50.08). CONCLUSION Physical examination-indicated cerclage is associated with a significant increase in neonatal survival and prolongation of pregnancy of approximately 1 month when compared with no such cerclage. The strength of this conclusion is limited by the potential for bias in the included studies.
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Affiliation(s)
- Robert M Ehsanipoor
- Departments of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland, University of Rochester, Rochester, New York, and Warren Alpert Medical School of Brown University, Providence, Rhode Island; the Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy; and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
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26
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Ciavattini A, Delli Carpini G, Boscarato V, Febi T, Di Giuseppe J, Landi B. Effectiveness of emergency cerclage in cervical insufficiency. J Matern Fetal Neonatal Med 2015; 29:2088-92. [DOI: 10.3109/14767058.2015.1075202] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Andrea Ciavattini
- Clinica Ostetrica E Ginecologica, Presidio Ospedaliero Di Alta Specializzazione “G. Salesi”, Az. Ospedaliero-Universitaria Ospedali Riuniti Di Ancona, Università Politecnica Delle Marche, Ancona, Italy
| | - Giovanni Delli Carpini
- Clinica Ostetrica E Ginecologica, Presidio Ospedaliero Di Alta Specializzazione “G. Salesi”, Az. Ospedaliero-Universitaria Ospedali Riuniti Di Ancona, Università Politecnica Delle Marche, Ancona, Italy
| | - Virginia Boscarato
- Clinica Ostetrica E Ginecologica, Presidio Ospedaliero Di Alta Specializzazione “G. Salesi”, Az. Ospedaliero-Universitaria Ospedali Riuniti Di Ancona, Università Politecnica Delle Marche, Ancona, Italy
| | - Tamara Febi
- Clinica Ostetrica E Ginecologica, Presidio Ospedaliero Di Alta Specializzazione “G. Salesi”, Az. Ospedaliero-Universitaria Ospedali Riuniti Di Ancona, Università Politecnica Delle Marche, Ancona, Italy
| | - Jacopo Di Giuseppe
- Clinica Ostetrica E Ginecologica, Presidio Ospedaliero Di Alta Specializzazione “G. Salesi”, Az. Ospedaliero-Universitaria Ospedali Riuniti Di Ancona, Università Politecnica Delle Marche, Ancona, Italy
| | - Beatrice Landi
- Clinica Ostetrica E Ginecologica, Presidio Ospedaliero Di Alta Specializzazione “G. Salesi”, Az. Ospedaliero-Universitaria Ospedali Riuniti Di Ancona, Università Politecnica Delle Marche, Ancona, Italy
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27
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Zhu LQ, Chen H, Chen LB, Liu YL, Tian JP, Wang YH, Zhang R, Zhang JP. Effects of emergency cervical cerclage on pregnancy outcome: a retrospective study of 158 cases. Med Sci Monit 2015; 21:1395-401. [PMID: 25975832 PMCID: PMC4444177 DOI: 10.12659/msm.893244] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to evaluate the effectiveness and safety of emergency cervical cerclage in women with advanced cervical dilatation and bulging of fetal membranes. The study included 158 women who underwent emergency cervical cerclage because of cervix dilatation and protruding membranes in mid-trimester at Sun Yat-sen Memorial Hospital of Sun Yat-sen University. Pregnancy outcomes and pregnancy outcome related to clinical features were analyzed retrospectively. Analysis revealed that the placement of emergency cerclage led to the delivery of live infants with a success rate of 82.28%. The mean interval between cerclage and delivery was 52.16.±26.62 days, with a mean gestation at delivery of 30.3±4.7 weeks and a mean birth weight of 1934.69±570.37 g. No severe maternal complications such as maternal death, hematosepsis, and hysterorrhexis occurred after the operation. Two women (1.25%) had laceration of the cervix, 1 woman (0.61%) suffered pulmonary edema, and 2 women (1.25%) developed deep vein thrombosis (DVT). There were significant correlations between the pregnancy outcome and risk factors, including any presenting symptoms, cervical dilatation, postoperative white blood cell count, and C-reactive protein (CRP) value. No significant difference was found in women with good vs. poor outcome in terms of maternal age and obstetric histories. Emergency cervical cerclage is effective in prolonging pregnancy and improving neonatal outcome in women with cervical incompetence. It should be considered a viable option for women with a dilated cervix in mid-trimester.
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Affiliation(s)
- Li-Qiong Zhu
- Department of Obstetrics and Gynecology, un Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Hui Chen
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Li-Bin Chen
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Ying-Lin Liu
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Jian-Ping Tian
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Yun-Hui Wang
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Rui Zhang
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Jian-Ping Zhang
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
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