| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
REVIEWS |
From the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson University, Philadelphia; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania; St. Thomas’s and Guy’s Hospital, London, United Kingdom; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lehigh Valley Hospital and Health Network, Allentown, Pennsylvania; and Department of Obstetrics and Gynecology, Leeds General Infirmary, Belmont Grove, United Kingdom.
Objective: Preterm birth is the main cause of perinatal morbidity and mortality. A short cervical length on transvaginal ultrasonography predicts preterm birth. Our aim was to estimate by meta-analysis of randomized trials whether cerclage prevents preterm birth in women with a short cervical length.
Data Sources: MEDLINE, PubMed, EMBASE, and the Cochrane Library were searched with the terms "cerclage," "cervical cerclage," "short cervix," "ultrasound," and "randomized trial." We included randomized trials involving the use of cerclage in women with short cervical length on transvaginal ultrasonography using patient-level data.
Tabulation, Integration, and Results: Four properly conducted trials were identified. In the total population, preterm birth at less than 35 weeks of gestation occurred in 29.2% (89/305) of the cerclage group, compared with 34.8% (105/302) of the no-cerclage groups (relative risk [RR] 0.84, 95% confidence interval [CI] 0.67–1.06). There was no significant heterogeneity in the overall analysis (P = .29). There was a significant reduction in preterm birth at less than 35 weeks in the cerclage group compared with the no-cerclage groups in singleton gestations (RR 0.74, 95% CI 0.57–0.96), singleton gestations with prior preterm birth (RR 0.61, 95% CI 0.40–0.92), and singleton gestations with prior second-trimester loss (RR 0.57, 95% CI 0.33–0.99). There was a significant increase in preterm birth at less than 35 weeks in twin gestations (RR 2.15, 95% CI 1.15–4.01).
Conclusion: Cerclage does not prevent preterm birth in all women with short cervical length on transvaginal ultrasonography. In the subgroup analysis of singleton gestations with short cervical length, especially those with a prior preterm birth, cerclage may reduce preterm birth, and a well-powered trial should be carried out in this group of patients. In contrast, in twins, cerclage was associated with a significantly higher incidence of preterm birth.
This article has been cited by other articles:
|
|
 |
|
  S L Rodriguez-Zas, Y Ko, H A Adams, and B R Southey Advancing the understanding of the embryo transcriptome co-regulation using meta-, functional, and gene network analysis tools Reproduction, February 1, 2008; 135(2): 213 - 224. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Berghella, A. Roman, C. Daskalakis, A. Ness, and J. K. Baxter Gestational Age at Cervical Length Measurement and Incidence of Preterm Birth Obstet. Gynecol., August 1, 2007; 110(2): 311 - 317. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Y. Spong Prediction and Prevention of Recurrent Spontaneous Preterm Birth Obstet. Gynecol., August 1, 2007; 110(2): 405 - 415. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Chatterjee, J. Gullam, M. Vatish, and S. Thornton The management of preterm labour Arch. Dis. Child. Fetal Neonatal Ed., March 1, 2007; 92(2): F88 - F93. [Full Text] [PDF]
|
|
|
|
|
|
M. A. Turrentine, D. J. Stewart, and M. M. Ramirez Use of the Cervical Cerclage: Comparison of a Community and University Hospital Setting Obstet. Gynecol., February 1, 2007; 109(2): 320 - 325. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Other articles noted Evid. Based Med., February 1, 2006; 11(1): 31 - 32. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
