Association of open fetal MMC repair post-operative cervical length and gestational age at delivery

Introduction. Although nonabsorbable woven tape has been widely used for cervical cerclage, technical difficulties that can occur with an effaced cervix because of the thickness of the tape, and the risks of local infection are two major concerns. This study investigated perinatal outcomes of pregnancies involving an emergency cervical cerclage using absorbable monofilament polydioxanone sutures, which is a narrow thread and protects against bacterial infection. Materials and Methods. We performed a chart review of patients who underwent emergency McDonald cerclage with polydioxanone sutures at our institution between 2007 and 2015. Gestational age at delivery, duration between cerclage and delivery, and neonatal prognosis were evaluated as primary outcomes. Results. Among the 23 patients (18 singleton and five twin pregnancies) evaluated, ultrasound-indicated (progressive cervical length shortening) were eight (35%) and physical examination-indicated (fetal membranes that prolapsed into the vagina or dilated cervix) were 15 patients (65%). The median gestational age at cerclage was 22+3 weeks (range, 17+5 to 25+3 weeks). Postoperative spontaneous abortion occurred in only one patient. The median gestational age at delivery was 32+5 weeks (range, 20+5 to 40+6 weeks). Extremely preterm delivery before 28 weeks of gestation occurred in four (17%) cases. Full-term delivery was achieved in 10 (42%) cases. The duration between cerclage and delivery ranged from 5 to 136 days (median, 77 days). Except for one case of spontaneous abortion, all newborns survived till hospital discharge. Conclusions. Although our series included some patients at high risk for spontaneous abortion and preterm delivery, satisfactory prolongation and favorable neonatal outcomes were achieved for most patients by using absorbable monofilament sutures, thus suggesting the efficacy of this type of suture for emergency cervical cerclage.

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Cerclage Location and Gestational Age at Delivery

American Journal of Perinatology Reports ◽

10.1055/s-0039-1688778 ◽

2019 ◽

Vol 09 (02) ◽

pp. e195-e199

Author(s):

Fatima Estrada ◽

Scarlett Karakash ◽

Terry SeeToe ◽

Jeremy Weedon ◽

Howard Minkoff

Keyword(s):

Logistic Regression ◽

Cohort Study ◽

Gestational Age ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Medical Center ◽

Statistical Significance ◽

General Linear Model ◽

Cervical Length ◽

Gestational Age At Delivery

Objective Multiple authors have suggested cerclage position is a determinant of “success.” We assessed the interaction between cervical length (CL), cerclage height (cerH), proximal residual length (PRL), gestational age at delivery, and rate of delivery ≤ 34 weeks, in this study. Study Design Present study is a retrospective cohort study of all cerclages placed at Maimonides Medical Center from 2006 to 2016. Outcomes: gestational age at delivery and delivery before 34 weeks; predictors: PRL, cerH, CL; and indications for cerclage: history (Hx), physical exam (PE), and ultrasound (US) indicated cerclage. A general linear model was used to predict power-transformed age at delivery from cerH, CL, and indication for cerclage. Subanalyses by indication were conducted. Logistic regression was used for delivery ≤ 34 weeks. Results The cerH by indication did not reach statistical significance (p = 0.090). When stratified by indications, the effect of cerH on age at delivery was apparent for Hx (adjusted R 2 = 0.18, p < 0.001) and PE (adjusted R 2 = 0.43, p = 0.004) cerclages but not for US cerclages (adjusted R 2 = 0.08, p = 0.206). Logistic regression predicting delivery ≤ 34 weeks (n = 29) produced similar results. Conclusions For Hx and PE indicated cerclages, the location of the stitch may influence the timing of delivery. Specifically, the higher the cerclage, the more advanced the gestational age at delivery.

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Measurement of the uterocervical angle for the prediction of preterm birth in symptomatic women

Archives of Gynecology and Obstetrics ◽

10.1007/s00404-021-06002-0 ◽

2021 ◽

Author(s):

Philipp Wagner ◽

Jana Schlechtendahl ◽

Markus Hoopmann ◽

Natalia Prodan ◽

Harald Abele ◽

...

Keyword(s):

Preterm Birth ◽

Gestational Age ◽

Cervical Length ◽

University Hospital ◽

Second Line ◽

Uterine Contractions ◽

Gestational Age At Delivery ◽

The University ◽

Time Of Presentation ◽

Singleton Pregnancies

Abstract Purpose To examine if the uterocervical angle (UCA) can be used to predict preterm delivery in women with painful and regular uterine contractions and a cervical length of 25 mm or less. Methods Retrospective study at the perinatal unit of the University Hospital of Tuebingen, Germany. Women with singleton gestation and preterm contractions between 24 + 0 and 33 + 6 weeks’ gestation were included. For the UCA measurement, a line is placed from the internal os to the external os irrespective of whether the cervix is straight or curved. A second line is drawn to delineate the lower uterine segment. The angle between the two lines is the UCA measurement. The measurements were taken on stored images from our database. Results The study consisted of 213 singleton pregnancies. At the time of UCA measurement, median maternal and gestational age was 31.4 years and 29.7 weeks’ gestation. Median gestational age at delivery was 35.3 weeks and the corresponding birth weight 2480 g, respectively. The UCA measurement in women who delivered within 2 days, between 3–7 days and after 7 days was not helpful to distinguish between these three groups [median UCA measurements: 108.5°, 108.0° and 107.3° (Kruskal–Wallis test p = 0.576)]. Uni- and multivariate logistic multiple regression analysis demonstrated that the delivery within 2 days was only dependent on the gestational age and the cervical length at the time of presentation. Conclusion The measurement of UCA is not useful in predicting preterm birth in the subsequent 7 days after an episode of preterm contractions.

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628 Gestational age at delivery of triplet pregnancies as a function of cervical length throughout gestation

American Journal of Obstetrics and Gynecology ◽

10.1016/s0002-9378(01)80661-x ◽

2001 ◽

Vol 185 (6) ◽

pp. S250

Author(s):

Thomas McElrath ◽

Anjali Kaimal ◽

Carol Benson ◽

Steve Ringer ◽

Linda Heffner ◽

...

Keyword(s):

Gestational Age ◽

Cervical Length ◽

Gestational Age At Delivery

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148: Post-cerclage ultrasound monitoring of cervical length for predicting gestational age at delivery

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2009.10.163 ◽

2009 ◽

Vol 201 (6) ◽

pp. S69

Author(s):

Alison Cape ◽

Carol Benson ◽

Thomas McElrath

Keyword(s):

Gestational Age ◽

Cervical Length ◽

Ultrasound Monitoring ◽

Gestational Age At Delivery

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The Effect of Intramuscular 17α-Hydroxyprogesterone in Women Screened for Shortened Cervical Length

American Journal of Perinatology ◽

10.1055/s-0039-3400448 ◽

2019 ◽

Vol 37 (07) ◽

pp. 659-665

Author(s):

S. Lindsay Wood ◽

Bria N. Williams ◽

Jeff M. Szychowski ◽

John Owen

Keyword(s):

Gestational Age ◽

Preterm Labor ◽

Secondary Analysis ◽

Cervical Length ◽

Spontaneous Preterm Birth ◽

Short Cervix ◽

Hydroxyprogesterone Caproate ◽

Gestational Age At Delivery ◽

Risk Patients ◽

Multivariable Regression

Abstract Objective This article assesses the effect of weekly intramuscular 17α-hydroxyprogesterone caproate (17P) on midtrimester cervical length (CL) in patients with prior spontaneous preterm birth. Study Design Retrospective cohort study of all singletons that underwent CL screening at a single institution from 2011 to 2016. The timing of 17P exposure was assessed. The primary outcome was shortest midtrimester CL. Secondary outcomes included gestational age at delivery, rate of short cervix, cerclage, preterm labor admission, and preterm premature rupture of the membranes (PROM). Multivariable regression analysis was used to model the relationship between 17P exposure and shortest CL, controlling for selected covariates. Results Of 409 women who underwent screening, 211 received and 198 did not receive 17P prior to the last CL. Rates of short cervix and cerclage were similar between groups. After adjusting for covariates, the shortest CL was significantly shorter in the 17P group. In a secondary analysis, those who received any 17P (n = 293) versus those who did not (n = 116) had higher rates of preterm PROM, preterm labor admission, and cerclage. After controlling for covariates, gestational age at delivery was significantly lower in those receiving 17P. Conclusion In high-risk patients undergoing CL screening for ultrasound-indicated cerclage, 17P did not prevent midtrimester cervical shortening or prolong gestation.

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