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Song W, Wang W, Wang F, He X, Li X, Feng L, Cui W, Guo Q. Risk factors for high-stage histological chorioamnionitis among pregnancies with cervical incompetence. J Obstet Gynaecol Res 2024; 50:572-579. [PMID: 38196295 DOI: 10.1111/jog.15880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 12/28/2023] [Indexed: 01/11/2024]
Abstract
AIM The study aimed to identify predictive risk factor to identify high-stage histological chorioamnionitis (HCA) in pregnancies with cervical incompetence (CIC). METHODS A retrospective cohort study was conducted by including 116 pregnant women with cervical incompetence that required prophylactical and therapeutical cerclage. The histopathology examination on placenta was conducted with informed patient consent. All the cases included in this study were divided based on the severity degree of HCA. The demographic characteristic and the parameters related to maternal and fetal outcome were all analyzed. Besides, perioperative parameters of cerclage, including cervical length, cervical morphology, and laboratory indexes were also compared between two groups. Univariate and multivariate logistic regression analysis were used to determine the risk factor of severe chorioamnionitis. RESULTS Severe HCA was significantly associated with cervical morphology, cerclage indication, cerclage type, and cervical length measured via ultrasound and vaginal examination. After adjusted for confounders, V-type funneling and short cervix was indicated as independent risk factors of severe HCA by multivariate logistic regression analysis, respectively. CONCLUSIONS V-type funneling and short cervix may indicate the elevated risk of high-stage HCA. Due to the negative outcomes related with high-stage HCA, appropriate prenatal treatment would improve the pregnancy outcomes in cerclaged population. To facilitate postpartum treatment, placental histological examination should be routinely recommended to identify the high-stage HCA, especially in high risk pregnancies.
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Affiliation(s)
- Wenhui Song
- The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, PR China
| | - Wei Wang
- Hebei Medical University First Affiliated Hospital, Shijiazhuang, Hebei, PR China
| | - Fengjiao Wang
- The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, PR China
| | - Xueqing He
- The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, PR China
| | - Xia Li
- The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, PR China
| | - Li Feng
- The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, PR China
| | - Wenhua Cui
- The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, PR China
| | - Qing Guo
- The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, PR China
- Hebei Key Laboratory of Maternal and Fetal Medicine, Shijiazhuang, Hebei, PR China
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Abdulrahman N, Burger NB, Hehenkamp WJK, Maghsoudlou P, Einarsson JI, Huirne JAF. Favorable surgical and obstetrical outcomes in pre- and postconceptional laparoscopic abdominal cerclage: a large multicenter cohort study. Am J Obstet Gynecol MFM 2024; 6:101227. [PMID: 37984689 DOI: 10.1016/j.ajogmf.2023.101227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 11/04/2023] [Accepted: 11/15/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Cervical incompetence is an important cause of extremely preterm delivery. Without specialized treatment, cervical incompetence has a 30% chance of recurrence in a subsequent pregnancy. Recently, the first randomized controlled trial showed significant superiority of abdominal cerclage compared with both high and low vaginal cerclage in preventing preterm delivery at <32 weeks of gestation and fetal loss in patients with a previous failed vaginal cerclage. OBJECTIVE This study aimed to assess surgical and obstetrical outcomes in patients with pre- and postconceptional laparoscopic abdominal cerclage placement. Furthermore, it also aimed to perform subgroup analysis based on the indication for cerclage placement in order to identify patients who benefit the most from an abdominal cerclage. STUDY DESIGN A retrospective multicenter cohort study with consecutive inclusion of all eligible patients from 1997 onward in the Dutch cohort (104 patients) and from 2007 onward in the Boston cohort (169 patients) was conducted. Eligible patients had at least 1 second- or third-trimester fetal loss due to cervical incompetence and/or a short or absent cervix after cervical surgery. This includes loop electrosurgical excision procedure, conization, or trachelectomy. Patients were divided into the following subgroups based on the indication for cerclage placement: (1) previous failed vaginal cerclage, (2) previous cervical surgery, and (3) other indications. The third group consisted of patients with a history of multiple second- or early third-trimester fetal losses due to cervical incompetence (without a failed vaginal cerclage) and/or multiple dilation and curettage procedures. The primary outcome measure was delivery at ≥34 weeks of gestation with neonatal survival at hospital discharge. Secondary outcome measures included surgical and obstetrical outcomes, such as pregnancy rates after preconceptional surgery, obstetrical complications, and fetal survival rates. RESULTS A total of 273 patients were included (250 in the preconceptional and 23 in the postconceptional cohort). Surgical outcomes of 273 patients were favorable, with 6 minor complications (2.2%). In the postconceptional cohort, 1 patient (0.4%) had hemorrhage of 650 mL, resulting in conversion to laparotomy. After preconceptional laparoscopic abdominal cerclage (n=250), the pregnancy rate was 74.1% (n=137) with a minimal follow-up of 12 months. Delivery at ³34 weeks of gestation occurred in 90.5% of all ongoing pregnancies. Four patients (3.3%) had a second-trimester fetal loss. The indication for cerclage in all 4 patients was a previous failed vaginal cerclage. The other subgroups showed fetal survival rates of 100% in ongoing pregnancies, with a total fetal survival rate of 96%. After postconceptional placement, 94.1% of all patients with an ongoing pregnancy delivered at ³34 weeks of gestation, with a total fetal survival rate of 100%. Thus, second-trimester fetal losses did not occur in this group. CONCLUSION Pre- and postconceptional laparoscopic abdominal cerclage is a safe procedure with favorable obstetrical outcomes in patients with increased risk of cervical incompetence. All subgroups showed high fetal survival rates. Second-trimester fetal loss only occurred in the group of patients with a cerclage placed for the indication of previous failed vaginal cerclage, but was nevertheless rare even in this group.
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Affiliation(s)
- Nour Abdulrahman
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Drs Abdulrahman, Burger, Hehenkamp, and Huirne, Ms Maghsoudlou); Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands (Drs Abdulrahman, Burger, Hehenkamp, and Huirne).
| | - Nicole B Burger
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Drs Abdulrahman, Burger, Hehenkamp, and Huirne, Ms Maghsoudlou); Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands (Drs Abdulrahman, Burger, Hehenkamp, and Huirne)
| | - Wouter J K Hehenkamp
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Drs Abdulrahman, Burger, Hehenkamp, and Huirne, Ms Maghsoudlou); Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands (Drs Abdulrahman, Burger, Hehenkamp, and Huirne)
| | - Parmida Maghsoudlou
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Drs Abdulrahman, Burger, Hehenkamp, and Huirne, Ms Maghsoudlou); Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA (Ms Maghsoudlou and Dr Einarsson)
| | - Jon I Einarsson
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA (Ms Maghsoudlou and Dr Einarsson)
| | - Judith A F Huirne
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Drs Abdulrahman, Burger, Hehenkamp, and Huirne, Ms Maghsoudlou); Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands (Drs Abdulrahman, Burger, Hehenkamp, and Huirne)
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Yang L, Ni T, Huang Y, Yan Y, Xia M, Zhou W, Zhang Q, Yan J. Impact of a previous late miscarriage on subsequent pregnancy outcomes: A retrospective cohort study over 10 years. Int J Gynaecol Obstet 2023; 163:610-617. [PMID: 37208989 DOI: 10.1002/ijgo.14862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 04/05/2023] [Accepted: 05/04/2023] [Indexed: 05/21/2023]
Abstract
OBJECTIVE To explore the prognostic impact of a previous late miscarriage (LM) on the subsequent pregnancy outcomes of women with infertility. METHOD This retrospective cohort study included couples who had experienced LM following their first embryo transfer during an in vitro fertilization (IVF) cycle from January 2008 to December 2020. Subgroup analysis and binary logistic regression were performed to evaluate the associations between LM due to different causes and subsequent pregnancy outcomes. RESULTS A total of 1072 women who had experienced LM were included in this study, comprising 458, 146, 412, and 56 women with LM due to unexplained factors (unLM), fetal factors (feLM), cervical factors (ceLM; i.e. cervical incompetence), and trauma factors (trLM), respectively. Compared with the general IVF (gIVF) population, the early miscarriage rate was significantly higher in the unLM group (8.28% vs. 13.47%, adjusted odds ratio [OR] 1.60, 95% confidence interval [95% CI] 1.12-2.28; P = 0.01). Furthermore, women in the unLM and ceLM groups had a dramatically increased risk of recurrent LM (unLM: 4.24% vs. 9.43%, aOR 1.91, 95% CI 1.24-2.94; P = 0.003; ceLM: 4.24% vs.15.53%, aOR 2.68, 95% CI 1.82-3.95; P < 0.001) and consequently a reduced frequency of live birth (unLM: 49.96% vs. 43.01%, aOR 0.75, 95% CI 0.61-0.91; P = 0.004; ceLM: 49.96% vs. 38.59%, aOR 0.61, 95% CI 0.49-0.77; P < 0.001) compared with the gIVF population. CONCLUSION A previous LM due to an unexplained factor or cervical incompetence was significantly associated with a higher risk of miscarriage and a lower live birth rate after subsequent embryo transfer.
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Affiliation(s)
- Linlin Yang
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, China
| | - Tianxiang Ni
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, China
| | - Yumei Huang
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, China
| | - Yueyue Yan
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, China
| | - Mingdi Xia
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, China
| | - Wei Zhou
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, China
| | - Qian Zhang
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, China
| | - Junhao Yan
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, China
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Saroyo YB, Madjid OA, Santawi VPA, Scovani L, Purbadi S. Cerclage in complete placenta previa preventing preterm labor: A rare case report. SAGE Open Med Case Rep 2023; 11:2050313X231200121. [PMID: 37791065 PMCID: PMC10542318 DOI: 10.1177/2050313x231200121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 08/22/2023] [Indexed: 10/05/2023] Open
Abstract
Placenta previa often leads to antepartum hemorrhage, which warrants the patient for emergency room admission. The bleeding occurs mainly due to cervical dilation, which could be caused by cervical incompetence. Cervical cerclage has been considered as the primary treatment for cervical incompetence. However, evidence is lacking for its application in placenta previa. Here, we present a case of a 30-year-old pregnant woman diagnosed with complete placenta previa where a good obstetrical outcome could be achieved. The patient had antepartum hemorrhage during the 21st week of gestational age due to cervical dilation in a complete placenta previa case. An emergency cerclage using McDonald's technique was then performed, which prolonged the pregnancy to the 34th week of gestation. The patient had cesarean section and delivered a healthy baby girl weighing 2190 g. The mother and the baby had an uneventful recovery and were discharged after 2 days of hospitalization.
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Affiliation(s)
- Yudianto Budi Saroyo
- Fetomaternal Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National Hospital, Jakarta, DKI Jakarta, Indonesia
| | - Omo Abdul Madjid
- Social Obstetrics and Gynecology Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National Hospital, Jakarta, DKI Jakarta, Indonesia
| | - Victor Prana Andika Santawi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National Hospital, Jakarta, DKI Jakarta, Indonesia
| | - Laurensia Scovani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National Hospital, Jakarta, DKI Jakarta, Indonesia
| | - Sigit Purbadi
- Gynecology-Oncology Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National Hospital, Jakarta, DKI Jakarta, Indonesia
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Cheung KW, Seto MTY, Wang W, Mok YK, Cheung VYT. Clinical presentation, investigation, underlying causes, and subsequent pregnancy outcomes among different phenotypes of second trimester miscarriage. J Obstet Gynaecol Res 2023; 49:539-547. [PMID: 36455921 DOI: 10.1111/jog.15514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/31/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022]
Abstract
AIM To evaluate the causes of miscarriage and subsequent pregnancy outcomes among different phenotypes of second trimester miscarriage. METHODS Retrospective analysis of 170 consecutive second trimester miscarriages between 14 + 0 and 23 + 6 weeks recorded in the Clinical Data Analysis and Reporting System from 2012 to 2021. Cases were excluded if miscarriages occurred before 14 + 0 weeks of gestation, data were incomplete, or passage of the fetus happened before the clinical assessment. Cases were classified with a stepwise approach into three phenotypic groups including silent miscarriages (ST-SM), rupture of membranes (ST-ROM), and inevitable miscarriages (ST-IM) depending on the fetal heart pulsation and leakage of liquor at presentation. Clinical investigation of the underlying causes and the outcome of the subsequent pregnancy was then reviewed. RESULTS There were 97 cases of ST-SM, 21 cases of ST-ROM, and 52 cases of ST-IM. Placental histology and karyotype examination were more likely to yield significant results in the cases of ST-ROM and ST-SM (p < 0.05). The phenotypic examination identified different underlying causes including fetal anomaly, suspected cervical insufficiency, diabetes mellitus, and unknown causes (p < 0.001). Sixty-four cases achieved a subsequent pregnancy. Although women with history of ST-ROM and ST-IM received more cervical length monitoring and cervical cerclage than those with ST-SM (66.7% vs. 44.4% vs. 7.5%, p = 0.0002; and 16.7% vs. 22.2% vs. 2.5%, p = 0.031, respectively), the risk of recurrent second trimester miscarriage was higher in ST-ROM and ST-IM than in ST-SM (16.7% vs. 0%, p = 0.018). CONCLUSION The classification can differentiate different second trimester miscarriage phenotypes, which offers essential information to guide investigation panels of the underlying cause of miscarriages, and the prognosis and management of subsequent pregnancy. Future researches focused on second trimester miscarriage should report their findings according to different phenotypes.
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Affiliation(s)
- Ka Wang Cheung
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Mimi Tin Yan Seto
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Weilan Wang
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Yin Kwan Mok
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Vincent Y T Cheung
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
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Xiao Y, Huang S, Yu W, Ni Y, Lu D, Wu Q, Leng Q, Yang T, Ni M, Xie J, Zhang X. Effects of emergency/nonemergency cervical cerclage on the vaginal microbiome of pregnant women with cervical incompetence. Front Cell Infect Microbiol 2023; 13:1072960. [PMID: 36968117 PMCID: PMC10034410 DOI: 10.3389/fcimb.2023.1072960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/21/2023] [Indexed: 03/29/2023] Open
Abstract
Background Evaluation of the therapeutic effects of cerclage on preterm birth (PTB) caused by cervical incompetence remains challenging. The vaginal microbiome is associated with preterm births. Thus, this study aimed to analyse the vaginal microbiota of patients with cervical incompetence, explore the relationship between the composition of the vaginal microbiota before cervical cerclage and at term delivery, and assess the effect of cervical cerclage on the vaginal microbiota. Methods Patients (n = 30) underwent cerclage performed by the same surgical team. Vaginal swabs were obtained pre-surgery and seven days post-surgery. A gestational age-matched cohort of healthy pregnant women (n = 20) (no particular abnormality during pregnancy, delivery at term) was used as the control group and sampled during a comparable pregnancy. All collected vaginal swabs were analysed by 16S rRNA gene sequencing. Results When comparing the healthy control and cervical cerclage groups, the enriched microorganism in the healthy controls was G. Scardovia, and the enriched microorganism of the cerclage was G. Streptococcus. α diversity was significantly increased in patients who received cerclage with preterm delivery compared with those with full-term delivery, and the enriched microorganism was F. Enterococcus. A comparison before and after nonemergency cerclage suggested that the enriched microorganisms were G. Lactobacillus and F. Lactobacillaceae before surgery. After nonemergency cerclage, the enriched microorganisms were F. Enterobacteriaceae and C. Gammaproteobacteria. Vaginal microbiota diversity significantly increased, and the proportion of women with Lactobacillus spp.-depleted microbiomes increased after emergency cerclage. Significant differences in β diversity were found between the groups. Before the emergency cerclage, the enriched microorganisms were G. Lactobacillus, O. Alteromonadales, and P. Firmicutes. After emergency cerclage, the enriched microorganisms were P. Actinobacteria, C. Actinobacteria, P. Proteobacteria, F. Bifidobacteriaceae, O. Bifidobacteriales, G. Gardnerella, and G. Veillonella. Conclusion Cerclage (particularly emergency cerclage) may alter the vaginal microbiota by increasing microbiota diversity, decreasing vaginal Lactobacillus abundance, and increasing the abundance of pathogenic bacteria that are not conducive to pregnancy maintenance, thereby affecting surgical efficacy. Therefore, the role of the vaginal microbiome should be considered when developing treatment strategies for pregnant women with cervical incompetence. Clinical trial registration https://www.chictr.org.cn, identifier ChiCTR2100046305.
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Affiliation(s)
- Yunshan Xiao
- Department of Obstetrics, Women and Children’s Hospital, School of Medicine, Xiamen University, Xiamen, China
- Xiamen Key Laboratory of Basic and Clinical Research on Major Obstetrical Diseases, Xiamen, China
- Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, China
| | - Shiting Huang
- Department of Obstetrics, Women and Children’s Hospital, School of Medicine, Xiamen University, Xiamen, China
- Xiamen Key Laboratory of Basic and Clinical Research on Major Obstetrical Diseases, Xiamen, China
| | - Weiwei Yu
- Department of Obstetrics, Women and Children’s Hospital, School of Medicine, Xiamen University, Xiamen, China
- Xiamen Key Laboratory of Basic and Clinical Research on Major Obstetrical Diseases, Xiamen, China
| | - Yan Ni
- Department of Obstetrics, Women and Children’s Hospital, School of Medicine, Xiamen University, Xiamen, China
- Xiamen Key Laboratory of Basic and Clinical Research on Major Obstetrical Diseases, Xiamen, China
| | - Danni Lu
- Department of Obstetrics, Women and Children’s Hospital, School of Medicine, Xiamen University, Xiamen, China
- Xiamen Key Laboratory of Basic and Clinical Research on Major Obstetrical Diseases, Xiamen, China
| | - Quanfeng Wu
- Department of Obstetrics, Women and Children’s Hospital, School of Medicine, Xiamen University, Xiamen, China
- Xiamen Key Laboratory of Basic and Clinical Research on Major Obstetrical Diseases, Xiamen, China
| | - Qin Leng
- Department of Obstetrics, Women and Children’s Hospital, School of Medicine, Xiamen University, Xiamen, China
- Xiamen Key Laboratory of Basic and Clinical Research on Major Obstetrical Diseases, Xiamen, China
| | - Ting Yang
- Department of Obstetrics, Women and Children’s Hospital, School of Medicine, Xiamen University, Xiamen, China
- Xiamen Key Laboratory of Basic and Clinical Research on Major Obstetrical Diseases, Xiamen, China
| | - Meilan Ni
- Department of Obstetrics, Women and Children’s Hospital, School of Medicine, Xiamen University, Xiamen, China
- Xiamen Key Laboratory of Basic and Clinical Research on Major Obstetrical Diseases, Xiamen, China
| | - Jingxian Xie
- Department of Obstetrics, Women and Children’s Hospital, School of Medicine, Xiamen University, Xiamen, China
- Xiamen Key Laboratory of Basic and Clinical Research on Major Obstetrical Diseases, Xiamen, China
| | - Xueqin Zhang
- Department of Obstetrics, Women and Children’s Hospital, School of Medicine, Xiamen University, Xiamen, China
- Xiamen Key Laboratory of Basic and Clinical Research on Major Obstetrical Diseases, Xiamen, China
- Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, China
- *Correspondence: Xueqin Zhang,
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Gómez-Castellano M, Sabonet-Morente L, González-Mesa E, Jiménez-López JS. A Three-Step Procedure for Emergency Cerclage: Gestational and Neonatal Outcomes. Int J Environ Res Public Health 2022; 19:ijerph19052636. [PMID: 35270320 PMCID: PMC8909863 DOI: 10.3390/ijerph19052636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 02/01/2023]
Abstract
(1) Background: The objective of our prospective observational study was to evaluate a new technique for emergency cerclage, which was performed on a cohort of patients with cervical incompetence in the second trimester. (2) Methods: 26 pregnant women presented at 15 to 24 weeks of gestation with cervical dilatation and bursa prolapse. A new emergency cerclage was performed using a technique consisting of the first cerclage in a tobacco bag and a second occlusive cerclage located inferiorly to the first. The technique is concluded with the performance of a cervical cleisis when vaginal bag prolapse is present, and this overall procedure is called the three-step procedure for emergency cerclage (TSEC). (3) Results: To assess its effectiveness, we measured the latency from procedure to delivery, pregnancy duration, infant birth weight, and rate of premature amniorrhexis. The mean latency from procedure to delivery was 14 weeks + 6 days, the mean weight of newborns was 2550 g and the mean gestational age at delivery was 35 weeks. The neonatal survival rate was 95.8%. The rate of premature amniorrhexis (<34 weeks gestational age) was 8.3% (two cases) with successful perinatal outcomes. There were significant differences (p < 0.05) between groups. A multivariate regression model showed that the best variables for predicting the latency to delivery were the cervical dilatation at diagnosis, use of the three-step cerclage, cervical length after the procedure, and gestational age at diagnosis. (4) Conclusions: The excellent results obtained with the TSEC procedure in terms of the latency from the procedure to delivery, gestational age at delivery, birth weight, and having few reported complications highlight the importance of collecting new data on this promising novel procedure.
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Affiliation(s)
- Manuel Gómez-Castellano
- Obstetrics and Gynecology, Materno-Infantil Hospital Regional Universitary Málaga, Avd Arroyo de los Angeles S/N, 29011 Malaga, Spain; (M.G.-C.); (E.G.-M.); (J.S.J.-L.)
| | - Lorena Sabonet-Morente
- Obstetrics and Gynecology, Materno-Infantil Hospital Regional Universitary Málaga, Avd Arroyo de los Angeles S/N, 29011 Malaga, Spain; (M.G.-C.); (E.G.-M.); (J.S.J.-L.)
- Correspondence:
| | - Ernesto González-Mesa
- Obstetrics and Gynecology, Materno-Infantil Hospital Regional Universitary Málaga, Avd Arroyo de los Angeles S/N, 29011 Malaga, Spain; (M.G.-C.); (E.G.-M.); (J.S.J.-L.)
- Biochemistry and Immunology Department, Malaga Biomedical Research Institute—IBIMA, University of Málaga, Surgical Specialties, 29010 Malaga, Spain
| | - Jesús S. Jiménez-López
- Obstetrics and Gynecology, Materno-Infantil Hospital Regional Universitary Málaga, Avd Arroyo de los Angeles S/N, 29011 Malaga, Spain; (M.G.-C.); (E.G.-M.); (J.S.J.-L.)
- Biochemistry and Immunology Department, Malaga Biomedical Research Institute—IBIMA, University of Málaga, Surgical Specialties, 29010 Malaga, Spain
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Delić R. Pregnancy in a Unicornuate Uterus with Non-Communicating Rudimentary Horn: Diagnostic and Therapeutic Challenges. Acta Med Litu 2020; 27:84-89. [PMID: 34113213 PMCID: PMC7968949 DOI: 10.15388/amed.2020.27.2.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/17/2020] [Indexed: 11/22/2022] Open
Abstract
Unicornuate uterus with non-communicating rudimentary horn is a type of congenital uterine abnormality that occurs as a consequence of the arrested development of one of the two Müllerian ducts. Patients with unicornuate uterus have increased incidence of obstetric and gynaecological complications. We present a report of a clinical case of a 28-years-old female, who was referred to the hospital for evaluation of her infertility. The patient reported primary infertility and inability to conceive after 3-year period of regular unprotected intercourse. Transvaginal ultrasound, along with the preoperative evaluation were completed; however, no anomalies or irregularities were reported. Combined diagnostic simultaneous laparoscopy and hysteroscopy were performed to establish the diagnosis of unicornuate uterus with non-communicating rudimentary horn. The patient conceived spontaneously after diagnostic laparoscopy and hysteroscopy. During and after pregnancy, our patient and her child experienced numerous complications (cervical incompetence, acute chorioamnionitis, acute fetal distress, pneumonia, septic shock) and procedures (cervical cerclage, urgent cesarean section, intensive care unit treatment) without significant fetal or maternal compromise.
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Affiliation(s)
- Ratko Delić
- Department of Obstetrics and Gynecology, General and Teaching Hospital Celje, Slovenia
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9
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Abstract
Many papers and reviews have described the changes of the cervix during pregnancy, cervical cancer, sexually transmitted infections, and cervicovaginal microbiota. In this Views and Reviews, we focus on some specific topics in relation to the uterine cervix and infertility: early cervical cancer and fertility sparing surgery, cesarean scar defect, cervical incompetence, and cervical müllerian anomalies.
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10
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Ndubuisi VA, Ezugwu EC, Iyoke C. A ten year review of time interval between elective cervical cerclage removal at term and spontaneous onset of labour in Enugu, South-East Nigeria. J OBSTET GYNAECOL 2020; 41:552-556. [PMID: 32500771 DOI: 10.1080/01443615.2020.1755627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Cervical insufficiency is a recognised cause of third trimester miscarriage and spontaneous preterm births. It is one of the leading causes of neonatal morbidity and mortality. Miscarriage and preterm deliveries due to cervical insufficiency can be prevented by cervical cerclage insertion. The study aimed to determine the time interval between elective cervical cerclage removal at term and spontaneous onset of labour in Enugu, south-east Nigeria. A ten year retrospective review of all women who had cervical cerclage inserted for suspected cervical insufficiency at the two tertiary health institutions in Enugu state was done. Their case files were retrieved and relevant data extracted. The mean time interval from cerclage removal at term to spontaneous onset of labour was 12 days. The majority of patients (45.6%) had spontaneous onset of labour at the 2nd week of cerclage removal. There was no significant difference in the mean time interval from cerclage removal to spontaneous onset of labour between ultrasound indicated group and history indicated group. These findings hopefully may assist in proper counselling and management of women who had cervical cerclage removed at term.Impact StatementWhat is already known on this subject? Cervical insufficiency is a known cause of mid trimester pregnancy loss and preterm delivery. Preterm babies are at risk of several complications, with high neonatal morbidity and mortality especially in developing world. Cervical cerclage insertion is a recognised surgical treatment for cervical incompetence aimed at preventing preterm births.What do the results of this study add? The study shows that removal of cervical cerclage at term does not result in immediate onset of spontaneous labour in women diagnosed to have cervical insufficiency. Notably, a majority of the women had spontaneous onset of labour at the 2nd weeks of cerclage removal. Only 5.3% of them had spontaneous onset of labour within 48 hours of cerclage removal. This is contrary to the general belief in the region that once cervical cerclage is removed, spontaneous onset of labour results.What are the implications of these findings for clinical practice and/or further research? This finding suggests that there is no compelling need for admission into hospital after removal of cerclage as very few of them will have spontaneous onset of labour within 48 hours of cervical cerclage removal.
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Affiliation(s)
- Vivian Adaeze Ndubuisi
- Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Euzebus Chinonye Ezugwu
- Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.,Department of Obstetrics and Gynecology, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
| | - Chukwuemeka Iyoke
- Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.,Department of Obstetrics and Gynecology, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
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11
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Lee KN, Ham HJ, Whang EJ, Eun-Ji J, Seung-Hye C, Lee KY. Successful heterotopic pregnancy with prior radical trachelectomy after transabdominal cervico isthimic cerclage with methotrexate treatment. J Obstet Gynaecol Res 2020; 46:663-667. [PMID: 32028544 DOI: 10.1111/jog.14196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 12/30/2019] [Indexed: 11/30/2022]
Abstract
Heterotopic pregnancy with cervical incompetence is very uncommon. And yet there is no definite treatment for cervical incompetence occurring after radical trachelectomy. We are reporting a rare and novel case of a following in vitro fertilization combined intrauterine pregnancy and interstitial pregnancy which was successfully treated with maintenance of the pregnancy to term.
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Affiliation(s)
- Kyong-No Lee
- Department of Obstetrics and Gynecology, Kangnam Sacred Heart Hospital of Hallym University, Seoul, Korea
| | - Hee-Jin Ham
- Department of Obstetrics and Gynecology, Kangnam Sacred Heart Hospital of Hallym University, Seoul, Korea
| | - Eun-Jee Whang
- Department of Obstetrics and Gynecology, Kangnam Sacred Heart Hospital of Hallym University, Seoul, Korea
| | - Jo Eun-Ji
- Department of Obstetrics and Gynecology, Kangnam Sacred Heart Hospital of Hallym University, Seoul, Korea
| | - Choi Seung-Hye
- Department of Obstetrics and Gynecology, Kangnam Sacred Heart Hospital of Hallym University, Seoul, Korea
| | - Keun-Young Lee
- Department of Obstetrics and Gynecology, Kangnam Sacred Heart Hospital of Hallym University, Seoul, Korea
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12
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Mönckeberg M, Valdés R, Kusanovic JP, Schepeler M, Nien JK, Pertossi E, Silva P, Silva K, Venegas P, Guajardo U, Romero R, Illanes SE. Patients with acute cervical insufficiency without intra-amniotic infection/inflammation treated with cerclage have a good prognosis. J Perinat Med 2019; 47:500-509. [PMID: 30849048 PMCID: PMC6606339 DOI: 10.1515/jpm-2018-0388] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 12/16/2018] [Indexed: 01/30/2023]
Abstract
Background The frequency of intra-amniotic infection/inflammation (IAI/I) in patients with midtrimester cervical insufficiency is up to 50%. Our purpose was to determine the perinatal outcomes of cervical cerclage in patients with acute cervical insufficiency with bulging membranes, and to compare the admission-to-delivery interval and pregnancy outcomes according to the results of amniotic fluid (AF) analysis and cerclage placement. Methods This was a retrospective cohort study including singleton pregnancies with cervical insufficiency between 15 and 26.9 weeks in two tertiary health centers. IAI/I was defined when at least one of the following criteria was present in AF: (a) a white blood cell (WBC) count >50 cells/mm3; (b) glucose concentration <14 mg/dL; and/or (c) a Gram stain positive for bacteria. Three different groups were compared: (1) absence of IAI/I with placement of a cerclage; (2) amniocentesis not performed with placement of a cerclage; and (3) IAI/I with or without a cerclage. Results Seventy patients underwent an amniocentesis to rule out IAI/I. The prevalence of IAI/I was 19%. Forty-seven patients underwent a cerclage. Patients with a cerclage had a longer median admission-to-delivery interval (33 vs. 2 days; P < 0.001) and delivered at a higher median gestational age (27.4 vs. 22.6 weeks; P = 0.001) than those without a cerclage. The neonatal survival rate in the cerclage group was 62% vs. 23% in those without a cerclage (P = 0.01). Patients without IAI/I who underwent a cerclage had a longer median admission-to-delivery interval (43 vs. 1 day; P < 0.001), delivered at a higher median gestational age (28 vs. 22.1 weeks; P = 0.001) and had a higher neonatal survival rate (67% vs. 8%; P < 0.001) than those with IAI/I. Conclusion The pregnancy outcomes of patients with midtrimester cervical insufficiency and bulging membranes are poor as they have a high prevalence of IAI/I. Therefore, a pre-operative amniocentesis is key to identify the best candidates for the subsequent placement of a cerclage.
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Affiliation(s)
- Max Mönckeberg
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universidad de los Andes, Santiago, Chile,Department of Public Health and Epidemiology, Faculty of Medicine, Universidad de los Andes, Santiago, Chile
| | - Rafael Valdés
- Center for Research and Innovation in Maternal-Fetal Medicine (CIMAF), Hospital Sótero del Río, Santiago, Chile
| | - Juan P. Kusanovic
- Center for Research and Innovation in Maternal-Fetal Medicine (CIMAF), Hospital Sótero del Río, Santiago, Chile,Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile,Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD and Detroit, MI, USA
| | - Manuel Schepeler
- Department of Obstetrics and Gynecology, Clínica Dávila, Santiago, Chile
| | - Jyh K. Nien
- Department of Obstetrics and Gynecology, Clínica Dávila, Santiago, Chile
| | - Emiliano Pertossi
- Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Silva
- Center for Research and Innovation in Maternal-Fetal Medicine (CIMAF), Hospital Sótero del Río, Santiago, Chile,Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Karla Silva
- Center for Research and Innovation in Maternal-Fetal Medicine (CIMAF), Hospital Sótero del Río, Santiago, Chile
| | - Pía Venegas
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universidad de los Andes, Santiago, Chile
| | - Ulises Guajardo
- Faculty of Medicine, Universidad de los Andes, Santiago, Chile
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD and Detroit, MI, USA,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA,Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA,Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA
| | - Sebastián E. Illanes
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universidad de los Andes, Santiago, Chile,Department of Obstetrics and Gynecology, Clínica Dávila, Santiago, Chile
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13
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Başbuğ A, Doğan O. A comparison of emergency and therapeutic modified Shirodkar cerclage: an analysis of 38 consecutive cases. Turk J Obstet Gynecol 2019; 16:1-6. [PMID: 31019833 PMCID: PMC6463426 DOI: 10.4274/tjod.galenos.2018.33410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 11/06/2018] [Indexed: 12/01/2022] Open
Abstract
Objective: To compare the maternal and neonatal outcomes of patients with emergency versus therapeutic cerclage. Materials and Methods: The study included 38 female patients who underwent cervical cerclage using the modified Shirodkar method in the Obstetrics and Gynecology Clinics of Düzce University Medical Faculty Hospital and Düzce Atatürk State Hospital. Results: The operating time for the emergency cerclage group was significantly longer than that of the therapeutic group (30.40 minutes vs 19.85 minutes, p=0.001). Following the cerclage procedure, the cervical length was longer in the therapeutic cerclage group [29.90 millimeters (mm) vs. 22.45 mm, p=0.001]. The cerclage to birth interval was also longer in the therapeutic group (91 vs. 138 days). Conclusion: In comparison with therapeutic cerclage, the total duration of pregnancy after emergency cerclage is shorter, and newborns have a greater need for intensive care. Both methods, however, protect against advanced prematurity, which causes neonatal loss.
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Affiliation(s)
- Alper Başbuğ
- Düzce University Faculty of Medicine Hospital, Clinic of Obstetrics and Gynecology, Düzce, Turkey
| | - Ozan Doğan
- University of Health Sciences, İstanbul Şisli Hamidiye Etfal Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
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14
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Abstract
Laparoscopic transabdominal cerclage (LTAC) is a well documented procedure for cervical incompetence. In this article we have done a detailed stepwise description of LTAC by broadligament window technique. This technique makes the procedure simpler, safer and easy to reproduce.
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Affiliation(s)
- B Ramesh
- Department of Advanced Laparoscopic Surgeries in Gynecology, Altius Hospital, Bengaluru, Karnataka, India
| | - T M Chaithra
- Department of Advanced Laparoscopic Surgeries in Gynecology, Altius Hospital, Bengaluru, Karnataka, India
| | - G Prasanna
- Department of Advanced Laparoscopic Surgeries in Gynecology, Altius Hospital, Bengaluru, Karnataka, India
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15
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Samson FD, Merriman AL, Tate DL, Apostolakis-Kyrus K, Gomez LM. Adjuvant administration of 17-α-hydroxy-progesterone caproate in women with three or more second trimester pregnancy losses undergoing cervical cerclage is no more effective than cerclage alone. J Perinat Med 2018; 46:155-161. [PMID: 28753545 DOI: 10.1515/jpm-2017-0074] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 06/12/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the role of adjuvant 17-α-hydroxy-progesterone caproate (17OHP-C) in reducing the risk of preterm delivery <34 weeks and adverse perinatal outcomes in women with ≥3 second trimester pregnancy losses attributed to cervical insufficiency undergoing prophylactic cerclage. MATERIAL AND METHODS Retrospective cohort study of women with prophylactic cerclage placed between 2006 and 2014 divided into a cohort of (i) those receiving adjuvant 17OHP-C (n=43), and (ii) controls with cerclage alone (n=59). RESULTS Demographic characteristics were comparable in both groups. There was no significant difference in gestational age at delivery between the cerclage-17OHP-C group (33.4±5.6 weeks) and the cerclage-alone group (34.4±4.6 weeks); P=0.33. We noted a non-significant increase for deliveries <34 weeks in the cerclage-17OHP-C group (44.2%) compared to controls (28.8%) which remained non-significant after adjusting for confounders; P=0.46. There was no statistically significant difference in the rate of delivery <37, 32, 28 and 24 weeks. Adverse neonatal outcomes were comparable in both groups (cerclage-17OHP-C 48.8% vs. cerclage-alone 39%); P=0.43. CONCLUSION Intramuscular 17OHP-C in combination with prophylactic cerclage in women with cervical insufficiency and ≥3 second trimester pregnancy losses had no synergistic effect in reducing the rate of recurrent preterm birth or improving perinatal outcomes.
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Affiliation(s)
- Fernand D Samson
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Amanda L Merriman
- Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Danielle L Tate
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Katherine Apostolakis-Kyrus
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Luis M Gomez
- Perinatal Associates of Northern Virginia, Inova Health System, Maternal Fetal Medicine, 3300 Gallows Road, Falls Church, VA, 22042, USA, Tel.: +1 (703) 776-2745, Fax: +1 (703) 776-6443
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16
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Monsanto SP, Daher S, Ono E, Pendeloski KPT, Trainá É, Mattar R, Tayade C. Cervical cerclage placement decreases local levels of proinflammatory cytokines in patients with cervical insufficiency. Am J Obstet Gynecol 2017; 217:455.e1-455.e8. [PMID: 28673792 DOI: 10.1016/j.ajog.2017.06.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 05/29/2017] [Accepted: 06/21/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cervical insufficiency is characterized by premature, progressive dilation and shortening of the cervix during pregnancy. If left unattended, this can lead to the prolapse and rupture of the amniotic membrane, which usually results in midtrimester pregnancy loss or preterm birth. Previous studies have shown that proinflammatory cytokines such as interleukin-1β, interleukin-6, interleukin-8, and tumor necrosis factor alpha are up-regulated in normal parturition but are also associated with preterm birth. Studies evaluating such markers in patients with cervical insufficiency have evaluated only their diagnostic potential. Even fewer studies have studied them within the context of cerclage surgery. OBJECTIVES(S) The objective of the study was to evaluate the impact of local and systemic inflammatory markers on the pathogenesis of cervical insufficiency and the effect of cerclage surgery on the local immune microenvironment of women with cervical insufficiency. STUDY DESIGN We recruited 28 pregnant women (12-20 weeks' gestation) diagnosed with insufficiency and referred for cerclage surgery and 19 gestational age-matched normal pregnant women as controls. Serum and cervicovaginal fluid samples were collected before and after cerclage surgery and during a routine checkup for normal women and analyzed using a targeted 13-plex proinflammatory cytokine assay. RESULTS Before surgery, patients with cervical insufficiency had higher levels of interleukin-1β, interleukin-6, interleukin-12, monocyte chemoattractant protein-1 and tumor necrosis factor alpha in cervicovaginal fluid compared to controls, but after surgery, these differences disappeared. No differences were found in serum of insufficiency versus control women. In patients with insufficiency, the levels of interleukin-1β, interleukin-6, interleukin-8, monocyte chemoattractant protein-1, and interferon gamma in cervicovaginal fluid declined significantly after cerclage compared with before intervention, but these changes were not detected in serum. CONCLUSION Compared with normal women, patients with cervical insufficiency have elevated levels of proinflammatory cytokines in cervicovaginal fluid but not in serum, suggesting a dysregulation of the local immune environment. Cerclage intervention led to a significant decline in these proinflammatory cytokines, suggesting that cerclage may help reduce local inflammation in cervical insufficiency.
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17
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Deanna J, Abuzied O, Islam F, Vettriano I, Rocha F, Abuzeid M. The place for prophylactic cerclage in the infertile patient with established cervical incompetence who conceived twins after septum reduction. Facts Views Vis Obgyn 2017; 9:71-77. [PMID: 29209482 PMCID: PMC5707775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION It is well known that cervical incompetence and associated preterm birth confers greater morbidity and mortality on birth outcomes, with an additional increased risk of cervical incompetence in higher order gestations. While the pathophysiology of cervical incompetence has yet to be elucidated, research has identified risk factors and assessed outcomes of numerous interventions. Cervical cerclage has been shown, in certain situations involving singleton pregnancies, to improve outcomes. Conversely, rescue cerclage increases the risk of preterm birth in twin gestations. However, these studies did not consider the unique situation of infertile patients, with known cervical incompetence, who have utilized assisted reproductive technologies to attain pregnancy. This study aims to describe the outcomes of infertile patients with known cervical incompetence, carrying twin gestation, who have undergone cervical cerclage. METHODS This case series includes eight infertile patients who have cervical incompetence resulting in fetal loss between 20-24 weeks after in vitro fertilization embryo transfer (IVF-ET). These patients continued with IVF treatments and subsequently conceived twins. All patients underwent prophylactic cervical cerclage placement before 12 weeks. The outcomes of these pregnancies are reviewed. RESULTS All pregnancies resulted in the delivery of viable twins. Six of the eight pregnancies (75%) were carried beyond 34 weeks. One pregnancy delivered at 31 weeks and one pregnancy delivered at 25 weeks after placental abruption. CONCLUSIONS This data suggest that 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.
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Affiliation(s)
- Jennifer Deanna
- Department of Obstetrics and Gyneacology, Genesys Regional Medical Center, Michigan State University Statewide Campus System, Grand Blanc, MI
| | - Omar Abuzied
- Department of Obstetrics and Gyneacology, Hurley Medical Center, MSU College of Human Medicine (Flint Campus), Flint, MI
| | - Fahmi Islam
- Department of Obstetrics and Gyneacology, Hurley Medical Center, MSU College of Human Medicine (Flint Campus), Flint, MI
| | - Ivana Vettriano
- Division of Maternal Fetal Medicine, St. John Providence Hospital/ Michigan State University, South eld, MI, USA
| | - Frederico Rocha
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gyneacology, Hurley Medical Center, MSU College of Human Medicine (Flint Campus), Flint, MI
| | - Mostafa Abuzeid
- Division of Repro- ductive Endocrinology and Infertility, Department of Obstetrics and Gyneacology, Hurley Medical Center, MSU College of Human Medicine (Flint Campus), Flint, MI
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18
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Sundtoft I, Langhoff-Roos J, Sandager P, Sommer S, Uldbjerg N. Cervical collagen is reduced in non-pregnant women with a history of cervical insufficiency and a short cervix. Acta Obstet Gynecol Scand 2017; 96:984-990. [PMID: 28374904 DOI: 10.1111/aogs.13143] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 03/29/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Preterm cervical shortening and cervical insufficiency may be caused by a constitutional weakness of the cervix. The aim of this study was to assess the cervical collagen concentration in non-pregnant women with a history of cervical insufficiency or of a short cervix in the second trimester of pregnancy. MATERIAL AND METHODS In this case-control study we included non-pregnant women one year or more after pregnancy: 55 controls with a history of normal delivery; 27 women with a history of cervical insufficiency; and 10 women with a history of a short cervix (<5th percentile) and 10 women with a history of a long cervix (>95th percentile) at gestational weeks 18-20. We obtained biopsies (3 × 3-4 mm) from the ectocervix and determined the collagen concentration by measuring the hydroxyproline concentration. RESULTS Women with cervical insufficiency had lower collagen concentrations (63.5 ± 5.1%; mean ± SD) compared with controls (68.2 ± 5.4%; p = 0.0004); area under the ROC curve 0.73 (95% CI 0.62-0.84). A cut-off value at 67.6% collagen resulted in a positive likelihood ratio of 3.2, a sensitivity of 60%, and a specificity of 81%. Also, women with a short cervix in the second trimester had lower collagen concentrations in a non-pregnant state (62.1% ± 4.9%) compared with women with a long cervix (67.8% ± 5.0%; p = 0.02). CONCLUSIONS Both cervical insufficiency and a short cervix in the second trimester of pregnancy are associated with low cervical collagen concentrations in a non-pregnant state more than one year after pregnancy.
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Affiliation(s)
- Iben Sundtoft
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Langhoff-Roos
- Clinic of Obstetrics and Gynecology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Puk Sandager
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Steffen Sommer
- Department of Obstetrics and Gynecology, The Regional Hospital Horsens, Horsens, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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19
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Sneider K, Christiansen OB, Sundtoft IB, Langhoff-Roos J. Recurrence of second trimester miscarriage and extreme preterm delivery at 16-27 weeks of gestation with a focus on cervical insufficiency and prophylactic cerclage. Acta Obstet Gynecol Scand 2017; 95:1383-1390. [PMID: 27663202 DOI: 10.1111/aogs.13027] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 09/19/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The objective of this study was to describe recurrence rates of second trimester miscarriage and extreme preterm delivery by phenotype and use of prophylactic cerclage in a register-based cohort. MATERIAL AND METHODS We included women with a first second trimester miscarriage or extreme preterm delivery (16+0 to 27+6 gestational weeks) in Denmark in 1997-2012 (n = 9602) by combined use of the Danish Medical Birth Register and the Danish National Patient Register. Eight phenotypes were identified by ICD-10 codes in a hierarchy with the following sequence: major fetal anomaly, multiple gestation, uterine anomaly, placental insufficiency, antepartum bleeding, cervical insufficiency, preterm premature rupture of membranes, and intrauterine fetal death. Recurrence rate after a second trimester miscarriage/spontaneous delivery in the period was calculated based on the register data. In cervical insufficiency outcome was stratified by prophylactic cerclage applied <16 weeks of gestation. RESULTS Overall recurrence rate was 7.3% (n = 452), a rate that differed by phenotype from <5% (fetal anomaly, multiple gestations, intrauterine fetal death) to 21% (cervical insufficiency). In women with cervical insufficiency the recurrence rate was 28% without cerclage; vaginal cerclage was associated with a significant reduction [adjusted odds ratio (OR) 0.47; 95% CI 0.29-0.76] and abdominal cerclage with an even greater reduction (adjusted OR 0.14; 95% CI 0.03-0.61). CONCLUSIONS The overall recurrence rate of second trimester miscarriage or extreme preterm delivery was 7%, but it differed significantly by phenotype. The highest rate, 28%, was found in cervical insufficiency, and prophylactic cerclage was associated with a significant reduction in recurrence.
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Affiliation(s)
- Kirstine Sneider
- Department of Clinical Research, Vendsyssel Hospital, Hjørring, Denmark
| | - Ole B Christiansen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark.,The Fertility Clinic, University Hospital Copenhagen, Copenhagen, Denmark
| | - Iben B Sundtoft
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Langhoff-Roos
- Department of Obstetrics, Rigshospitalet University Hospital, University of Copenhagen, Copenhagen, Denmark
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20
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Brown R, Gagnon R, Delisle MF. Insuffisance cervicale et cerclage cervical. J Obstet Gynaecol Can 2017; 38:S376-S390. [PMID: 28063549 DOI: 10.1016/j.jogc.2016.09.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIF La présente directive clinique a pour but de fournir un cadre de référence que les cliniciens pourront utiliser pour identifier les femmes qui sont exposées aux plus grands risques de connaître une insuffisance cervicale, ainsi que pour déterminer les circonstances en présence desquelles la mise en place d'un cerclage pourrait s'avérer souhaitable. RéSULTATS: La littérature publiée a été récupérée par l'intermédiaire de recherches menées dans PubMed ou MEDLINE, CINAHL et The Cochrane Library en 2012 au moyen d'un vocabulaire contrôlé (p. ex. « uterine cervical incompetence ») et de mots clés appropriés (p. ex. « cervical insufficiency », « cerclage », « Shirodkar », « cerclage », « MacDonald », « cerclage », « abdominal », « cervical length », « mid-trimester pregnancy loss »). Les résultats ont été restreints aux analyses systématiques, aux essais comparatifs randomisés / essais cliniques comparatifs et aux études observationnelles. Aucune restriction n'a été appliquée en matière de date ou de langue. Les recherches ont été mises à jour de façon régulière et intégrées à la directive clinique jusqu'en janvier 2011. La littérature grise (non publiée) a été identifiée par l'intermédiaire de recherches menées dans les sites Web d'organismes s'intéressant à l'évaluation des technologies dans le domaine de la santé et d'organismes connexes, dans des collections de directives cliniques, dans des registres d'essais cliniques et auprès de sociétés de spécialité médicale nationales et internationales. VALEURS La qualité des résultats est évaluée au moyen des critères décrits dans le rapport du Groupe d'étude canadien sur les soins de santé préventifs (Tableau). RECOMMANDATIONS.
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Barinov SV, Shamina IV, Lazareva OV, Tirskaya YI, Ralko VV, Shkabarnya LL, Dikke GB, Kochev DM, Klementyeva LL. Comparative assessment of arabin pessary, cervical cerclage and medical management for preterm birth prevention in high-risk pregnancies. J Matern Fetal Neonatal Med 2016; 30:1841-1846. [PMID: 27550418 DOI: 10.1080/14767058.2016.1228054] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study aimed to compare the efficacy of combined use of Arabin pessary, cervical cerclage and progesterone with progesterone-only management of pregnant women at high risk of preterm birth. MATERIALS AND METHODS The study included 203 pregnant women at high risk of preterm birth who were randomised to receive Arabin pessary (Group 1, n = 82) and progesterone, circular cervical cerclage and progesterone (Group 2, n = 121) or progesterone treatment only (Group3, controls, n = 50). Patients in the pessary and cerclage group also received progesterone. RESULTS The use of Arabin pessary combined with progesterone resulted in a 2.5-fold decrease in the rate of vaginal dysbiosis in pregnancy (p = 0.015) and almost three-fold reduction in in the postpartum period (p = 0.037), combined with circular cervical cerclage and progesterone. Suture eruption was observed in 4.3% of women. In patients with abnormal placental location, placental migration was observed in 62.1% of patients in Group I, 52.1% in Group II and a significantly lower proportion of patients (14.0%) in Group III (p = 0.001). Bleeding during pregnancy was observed significantly more often in both comparison groups (p = 0.005). Incidence of intrapartum bleeding was 17.4% (p = 0.011) in Group II and 24.5% in Group III (p = 0.002). Intrapartum chorioamnionitis was observed in 4.3% of patients in Group II and 2.04% of patients in Group III. CONCLUSIONS The use of Arabin pessary compbined with progesterone reduces the rate of infectious complications and bleeding during pregnancy and the postpartum period.
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Affiliation(s)
- Sergey V Barinov
- a Russian Ministry of Healthcare, State Budget Educational Institution of Higher Professional Education "Omsk State Medical Academy" , Omsk , Russia
| | - Irina V Shamina
- a Russian Ministry of Healthcare, State Budget Educational Institution of Higher Professional Education "Omsk State Medical Academy" , Omsk , Russia
| | - Oksana V Lazareva
- a Russian Ministry of Healthcare, State Budget Educational Institution of Higher Professional Education "Omsk State Medical Academy" , Omsk , Russia
| | - Yuliya I Tirskaya
- a Russian Ministry of Healthcare, State Budget Educational Institution of Higher Professional Education "Omsk State Medical Academy" , Omsk , Russia
| | - Vyacheslav V Ralko
- b Perinatal Centre, Budget Healthcare Omsk Region Institution "Regional Clinical Hospital" , Omsk , Russia
| | - Lyudmila L Shkabarnya
- b Perinatal Centre, Budget Healthcare Omsk Region Institution "Regional Clinical Hospital" , Omsk , Russia
| | - Galina B Dikke
- c Federal State Autonomous Educational Institution "Peoples' Friendship University of Russia" , Moscow , Russia
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Nohuz E, Albaut M, Brunel A, Champel N, Pellizzaro J, Gallot D, Lemery D, Vendittelli F. [Management of preterm labor on cervical-uterine incompetence using a pessary cerclage obstetrical]. Pan Afr Med J 2015; 20:284. [PMID: 26161207 PMCID: PMC4483363 DOI: 10.11604/pamj.2015.20.284.5847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 03/18/2015] [Indexed: 11/29/2022] Open
Abstract
Nous rapportons le recours efficace à un pessaire dans la prise en charge d'une menace d'accouchement prématuré. Une patiente de 28 ans, G2P1, ayant présenté une fausse-couche tardive à 20 semaines d'aménorrhée (SA) un an auparavant, bénéficiait d'un cerclage cervical à 15 SA. L’échographie endovaginale réalisée à 24 SA (sensation de pesanteur pelvienne) révélait un funnelling majeur et une longueur cervicale à 7 mm. Un pessaire obstétrical permettait la poursuite de la grossesse jusqu'au terme de 36 SA. Ce dispositif semble intéressant chez des patientes présentant une béance cervico-isthmique et chez qui un cerclage cervical s'est révélé inefficace.
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Affiliation(s)
- Erdogan Nohuz
- Service de Gynécologie-Obstétrique, Centre Hospitalier de Thiers, Route du Fau, 63300 Thiers, France ; Service de Gynécologie-Obstétrique et Biologie de la Reproduction, CHU Estaing, 1, Place Lucie Aubrac, 63001 Clermont-Ferrand
| | - Maël Albaut
- Service de Gynécologie-Obstétrique, Centre Hospitalier de Thiers, Route du Fau, 63300 Thiers, France
| | - Angélique Brunel
- Service de Pédiatrie, Centre Hospitalier de Thiers, Route du Fau, 63300 Thiers, France
| | - Nadine Champel
- Service de Gynécologie-Obstétrique, Centre Hospitalier de Thiers, Route du Fau, 63300 Thiers, France
| | - Julie Pellizzaro
- Service de Pharmacie, Centre Hospitalier de Thiers, Route du Fau, 63300 Thiers, France
| | - Denis Gallot
- Service de Gynécologie-Obstétrique et Biologie de la Reproduction, CHU Estaing, 1, Place Lucie Aubrac, 63001 Clermont-Ferrand
| | - Didier Lemery
- Service de Gynécologie-Obstétrique et Biologie de la Reproduction, CHU Estaing, 1, Place Lucie Aubrac, 63001 Clermont-Ferrand
| | - Françoise Vendittelli
- Service de Gynécologie-Obstétrique et Biologie de la Reproduction, CHU Estaing, 1, Place Lucie Aubrac, 63001 Clermont-Ferrand
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Zolghadri J, Younesi M, Asadi N, Khosravi D, Behdin S, Tavana Z, Ghaffarpasand F. Double versus single cervical cerclage for patients with recurrent pregnancy loss: a randomized clinical trial. J Obstet Gynaecol Res 2013; 40:375-80. [PMID: 24147660 DOI: 10.1111/jog.12201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 06/05/2013] [Indexed: 11/27/2022]
Abstract
AIM To compare the effectiveness of the double cervical cerclage method versus the single method in women with recurrent second-trimester delivery. METHOD In this randomized clinical trial, we included 33 singleton pregnancies suffering from recurrent second-trimester pregnancy loss (≥2 consecutive fetal loss during second-trimester or with a history of unsuccessful procedures utilizing the McDonald method), due to cervical incompetence. Patients were randomly assigned to undergo either the classic McDonald method (n = 14) or the double cerclage method (n = 19). The successful pregnancy rate and gestational age at delivery was also compared between the two groups. RESULTS The two study groups were comparable regarding their baseline characteristics. The successful pregnancy rate did not differ significantly between those who underwent the double cerclage method or the classic McDonald cerclage method (100% vs 85.7%; P = 0.172). In the same way, the preterm delivery rate (<34 weeks of gestation) was comparable between the two study groups (10.5% vs 35.7%; P = 0.106). Those undergoing the double cerclage method had longer gestational duration (37.2 ± 2.6 vs 34.3 ± 3.8 weeks; P = 0.016). CONCLUSION The double cervical cerclage method seems to provide better cervical support, as compared with the classic McDonald cerclage method, in those suffering from recurrent pregnancy loss, due to cervical incompetence.
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Affiliation(s)
- Jaleh Zolghadri
- Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Scholten BL, Page-Christiaens GCML, Franx A, Hukkelhoven CWPM, Koster MPH. The influence of pregnancy termination on the outcome of subsequent pregnancies: a retrospective cohort study. BMJ Open 2013; 3:bmjopen-2013-002803. [PMID: 23793655 PMCID: PMC3669713 DOI: 10.1136/bmjopen-2013-002803] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare the incidences of preterm delivery, cervical incompetence treated by cerclage, placental implantation or retention problems (ie, placenta praevia, placental abruption and retained placenta) and postpartum haemorrhage between women with and without a history of pregnancy termination. DESIGN A retrospective cohort study using aggregated data from a national perinatal registry. SETTING All midwifery practices and hospitals in the Netherlands. PARTICIPANTS All pregnant women with a singleton pregnancy without congenital malformations and a gestational age of ≥20 weeks who delivered between January 2000 and December 2007. MAIN OUTCOME MEASURES Preterm delivery, cervical incompetence treated by cerclage, placenta praevia, placental abruption, retained placenta and postpartum haemorrhage. RESULTS A previous pregnancy termination was reported in 16 000 (1.2%) deliveries. The vast majority of these (90-95%) were performed by surgical methods. The incidence of all outcome measures was significantly higher in women with a history of pregnancy termination. Adjusted ORs (95% CI) for cervical incompetence treated by cerclage, preterm delivery, placental implantation or retention problems and postpartum haemorrhage were 4.6 (2.9 to 7.2), 1.11 (1.02 to 1.20), 1.42 (1.29 to 1.55) and 1.16 (1.08 to 1.25), respectively. Associated numbers needed to harm were 1000, 167, 111 and 111, respectively. For any listed adverse outcome, the number needed to harm was 63. CONCLUSIONS In this large nationwide cohort study, we found a positive association between surgical termination of pregnancy and subsequent preterm delivery, cervical incompetence treated by cerclage, placental implantation or retention problems and postpartum haemorrhage in a subsequent pregnancy. Absolute risks for these outcomes, however, remain small. Medicinal termination might be considered first whenever there is a choice between both methods.
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Affiliation(s)
- Brenda L Scholten
- Department of Obstetrics, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Arie Franx
- Department of Obstetrics, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Maria P H Koster
- Department of Obstetrics, University Medical Center Utrecht, Utrecht, The Netherlands
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