Cervical Cerclage: Does the Location of the Suture Placement Make a Difference?

Introduction: The aim of cervical cerclage is to prevent or treat cervical insufficiency. The goal of the study was to investigate the correlation between the location of the cerclage suture within the cervix and its efficacy in preventing preterm birth. Materials and methods: Sixty-seven images of the cervix performed within two weeks of cerclage placement were extracted from the sonographic database and collected. The location of cerclage was divided into three categories: within the vicinity of the internal os, in the middle portion of the cervix, and in the vicinity of the external os. Gestational age at delivery was analyzed in the groups. Results: In 26 patients, the suture was identified in the vicinity of the internal os. Most of these patients delivered between 34 and 41 weeks of pregnancy. In 29 patients, the suture was located in the middle portion of the cervix. Most of these patients delivered between 33 and 40 weeks of pregnancy. The third group consisted of 12 patients, in whom cervical cerclages were detected in the lower third of the cervix in the vicinity of external os. Five of the 12 patients delivered prior to 30 weeks of pregnancy; the rest delivered between 30 and 34 weeks. Conclusion: Our experience links the sonographically detected cerclage location with pregnancy outcome.

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Cerclage outcomes in singleton pregnancies at risk for preterm birth following assisted reproductive treatments

Aegean Journal of Obstetrics and Gynecology ◽

10.46328/aejog.v3i3.108 ◽

2021 ◽

Vol 3 (3) ◽

pp. 78-82

Author(s):

Gülnaz Şahin ◽

Ferruh Acet ◽

Ege Nazan Tavmergen Goker ◽

Erol Tavmergen

Keyword(s):

At Risk ◽

Preterm Birth ◽

Gestational Age ◽

Cervical Insufficiency ◽

Special Group ◽

Cervical Cerclage ◽

Unicornuate Uterus ◽

Gestational Age At Delivery ◽

History Of ◽

Singleton Pregnancies

Objective: We aimed to evaluate the obstetric and neonatal outcomes of singleton pregnancies at risk for preterm birth (PTB) following assisted reproductive treatments and underwent cervical cerclage placement. Material and methods: A total of 42 women with singleton pregnancies following ART who underwent cerclage between 2009-2021 were included in this retrospective study. Indications of the cerclage procedure, gestational age at cerclage placement and delivery, neonatal birthweight, and requirement for admission to the neonatal unit of newborns were evaluated. Results: Of those cerclage placement performed in women with a history of second-trimester loss (19%), women with suspected cervical insufficiency according to pre-pregnancy evaluation (52.4%), women with the unicornuate uterus (4.8%), women with cervical shortening/or suspicious changes on ultrasonography (11.9%), and women with detection of cervical dilatation/shortening beyond 20 weeks of gestation (11.9%). Of the total group, 7.1% resulted in late miscarriages, while the remaining 92.9% ended with a live birth with mean gestational age at delivery of 37.0±2.5 weeks. Of those live births, 92.3% (36/39) delivered at >34 weeks and %74.4 (29/39) delivered at term. Except one neonatal death due to extremely PTB at 26th weeks, all infants were discharged from the hospital with well condition. Conclusion: ART pregnancies are evaluated as a special group as having a higher PTB risk at baseline. Cerclage may be considered in broader indications for suspected cervical insufficiency in these pregnancies. There is need for further studies on the effectiveness of cerclage in these ART pregnancies with suspected cervical insufficiency based on different criterions used.

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Funisitis is more common in cervical insufficiency than in preterm labor and preterm premature rupture of membranes

Journal of Perinatal Medicine ◽

10.1515/jpm-2015-0123 ◽

2016 ◽

Vol 44 (5) ◽

Cited By ~ 4

Author(s):

Joohee Choi ◽

Jeong Woo Park ◽

Byoung Jae Kim ◽

Ye-Jin Choi ◽

Jong Hee Hwang ◽

...

Keyword(s):

Preterm Birth ◽

Gestational Age ◽

Preterm Labor ◽

Cervical Insufficiency ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Preterm Premature Rupture ◽

Histologic Chorioamnionitis ◽

Gestational Age At Delivery ◽

The Difference

AbstractTo compare the frequency of histologic chorioamnionitis and funisitis among women experiencing preterm labor, preterm premature rupture of membranes (PROM) and cervical insufficiency.This retrospective cohort study included singleton pregnant women who delivered at ≤36 weeks of gestation. The patients with preterm birth were subdivided into preterm labor (n=117), preterm PROM (n=153), and cervical insufficiency (n=20). All placentas were examined for pathology, according to the criteria of1) Histologic chorioamnionitis was diagnosed in 48.7% (57/117) of cases with preterm labor, 47.4% (73/153) with preterm PROM, and 75.0% (15/20) with cervical insufficiency. Funisitis was detected in 11.1% (13/117) of cases with preterm labor, 15.7% (24/153) with preterm PROM, and 40.0% (8/20) with cervical insufficiency. 2) Frequency of histologic chorioamnionitis was higher in cases with cervical insufficiency compared to preterm PROM. Frequency of funisitis was higher in cases with cervical insufficiency compared to both preterm labor and preterm PROM (P<0.05). The difference in frequency of funisitis remained significant after adjustment for gestational age at delivery and cervical dilatation at diagnosis. 3) Frequency of grade 2 funisitis was higher in cases with cervical insufficiency (35.0%, 7/20) compared to both preterm labor (6.8%, 8/117) and preterm PROM (9.8%, 15/153) (P=0.001). And the difference remained significant after adjustment for gestational age at delivery and cervical dilatation at diagnosis.: The highest frequency of funisitis was observed in cervical insufficiency among cases with spontaneous preterm birth.

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Endocrine disrupting chemical-associated hair product use during pregnancy and gestational age at delivery: a pilot study

Environmental Health ◽

10.1186/s12940-021-00772-5 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Emma V. Preston ◽

Victoria Fruh ◽

Marlee R. Quinn ◽

Michele R. Hacker ◽

Blair J. Wylie ◽

...

Keyword(s):

Preterm Birth ◽

Black Women ◽

Pilot Study ◽

Gestational Age ◽

Endocrine Disrupting Chemical ◽

Product Use ◽

Frequent Use ◽

Increased Risk ◽

Endocrine Disrupting ◽

Gestational Age At Delivery

Abstract Background Prenatal endocrine disrupting chemical (EDC) exposure has been associated with increased risk of preterm birth. Non-Hispanic Black women have higher incidence of preterm birth compared to other racial/ethnic groups and may be disproportionately exposed to EDCs through EDC-containing hair products. However, research on the use of EDC-associated hair products during pregnancy and risk of preterm birth is lacking. Therefore, the objective of this pilot study was to estimate associations of prenatal hair product use with gestational age at delivery in a Boston, Massachusetts area pregnancy cohort. Methods The study population consisted of a subset of participants enrolled in the Environmental Reproductive and Glucose Outcomes (ERGO) Study between 2018 and 2020. We collected self-reported data on demographics and hair product use using a previously validated questionnaire at four prenatal visits (median: 12, 19, 26, 36 weeks’ gestation) and abstracted gestational age at delivery from medical records. We compared gestational age and hair product use by race/ethnicity and used linear regression to estimate covariate-adjusted associations of product use and frequency of use at each study visit with gestational age at delivery. Primary models were adjusted for maternal age at enrollment and delivery method. Results Of the 154 study participants, 7% delivered preterm. Non-Hispanic Black participants had lower mean gestational age at delivery compared to non-Hispanic White participants (38.2 vs. 39.2 weeks) and were more likely to report ever and more frequent use of hair products. In regression models, participants reporting daily use of hair oils at visit 4 had lower mean gestational age at delivery compared to non-users (β: -8.3 days; 95% confidence interval: -14.9, -1.6). We did not find evidence of associations at earlier visits or with other products. Conclusions Frequent use of hair oils during late pregnancy may be associated with shorter gestational duration. As hair oils are more commonly used by non-Hispanic Black women and represent potentially modifiable EDC exposure sources, this may have important implications for the known racial disparity in preterm birth.

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Pregnancy Outcome during the First COVID 19 Lockdown in Vienna, Austria

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18073782 ◽

2021 ◽

Vol 18 (7) ◽

pp. 3782

Author(s):

Sylvia Kirchengast ◽

Beda Hartmann

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Pregnancy Outcome ◽

Gestational Age ◽

Very Low Birth Weight ◽

Extremely Low Birth Weight ◽

Negative Effects ◽

Gestational Length ◽

Live Births

The COVID 19 pandemic represents a major stress factor for non-infected pregnant women. Although maternal stress during pregnancy increases the risk of preterm birth and intrauterine growth restriction, an increasing number of studies yielded no negative effects of COVID 19 lockdowns on pregnancy outcome. The present study focused on pregnancy outcome during the first COVID 19 lockdown phase in Austria. In particular, it was hypothesized that the national lockdown had no negative effects on birth weight, low birth weight rate and preterm birth rate. In a retrospective medical record-based single center study, the outcome of 669 singleton live births in Vienna Austria during the lockdown phase between March and July 2020 was compared with the pregnancy outcome of 277 live births at the same hospital during the pre-lockdown months of January and February 2020 and, in addition, with the outcome of 28,807 live births between 2005 and 2019. The rate of very low gestational age was significantly lower during the lockdown phase than during the pre-lockdown phase. The rate of low gestational age, however, was slightly higher during the lockdown phase. Mean birth weight was significantly higher during the lockdown phase; the rates of low birth weight, very low birth weight and extremely low birth weight were significantly lower during the lockdown phase. In contrast, maternal gestational weight gain was significantly higher during the lockdown phase. The stressful lockdown phase in Austria seems to have no negative affect on gestational length and newborn weight among non-infected mothers.

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Pregnancy Outcome after Cerclage for Cervical Incompetence at a Private Hospital of Dhaka

Faridpur Medical College Journal ◽

10.3329/fmcj.v12i2.34234 ◽

2017 ◽

Vol 12 (2) ◽

pp. 78-81

Author(s):

Shafeya Khanam ◽

Maliha Rashid ◽

Ayesha Siddika Purobi ◽

Zebunnessa Parvin ◽

Sanjoy Kumar Das ◽

...

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Fetal Loss ◽

Cervical Dilatation ◽

Cervical Insufficiency ◽

Miscarriage Rate ◽

Cervical Cerclage ◽

Cervical Incompetence ◽

Obstetric Population

Miscarriage, particularly recurrent mid-trimester miscarriage is a distressful condition. This form of miscarriage and preterm birth appear to have some etiologies. An important etiology is cervical incompetence that describes a disorder in which painless cervical dilatation leads to recurrent second trimester pregnancy losses. Every year more than 10 million preterm birth occurs and more than 1 million baby die from this common complication of pregnancy. The incidence of true cervical insufficiency is estimated at less than 1% of the obstetric population. In the index pregnancy, findings indicative of possible cervical insufficiency include cervical funneling, cervical shortening, and overt cervical dilatation. The main objective of the study was to explore the benefit from cervical cerclage in pregnant women with cervical incompetence. This is a retrospective observational study conducted over a period of twelve months. All cases delivered in Central Hospital were assisted by consultant obstetricians, in which 16(61.5%) out of 26 cases were delivered by caesarean section. Miscarriage rate was 11.53%. Out of the caesarean deliveries 2(12.5%) were at term and 14(87.5%) were at preterm. In this study 3(21.42%) babies born at 32nd and 33rd weeks, 6(42.85%) at 34th week and 2(14.28%) were at 35th week. There was no fetal loss. Extreme low birth weight was only one, 7(43.75%) of the babies had normal body weight for the area of study, 8 babies (50%) had low birth weight. The cervical cerclage procedure therefore should be available more widely to benefit those patients with proven or strongly suspected cervical incompetence.Faridpur Med. Coll. J. Jul 2017;12(2): 78-81

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Randomised trial of cervical cerclage, with and without occlusion, for the prevention of preterm birth in women suspected for cervical insufficiency

BJOG An International Journal of Obstetrics & Gynaecology ◽

10.1111/1471-0528.12119 ◽

2013 ◽

Vol 120 (5) ◽

pp. 613-620 ◽

Cited By ~ 19

Author(s):

N Brix ◽

NJ Secher ◽

CD McCormack ◽

RB Helmig ◽

M Hein ◽

...

Keyword(s):

Preterm Birth ◽

Randomised Trial ◽

Cervical Insufficiency ◽

Cervical Cerclage

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Placental malperfusion as a possible mechanism of preterm birth in patients with Müllerian anomalies

Journal of Perinatal Medicine ◽

10.1515/jpm-2016-0075 ◽

2017 ◽

Vol 45 (1) ◽

Cited By ~ 6

Author(s):

Jovana Lekovich ◽

Joshua Stewart ◽

Sarah Anderson ◽

Erin Niemasik ◽

Nigel Pereira ◽

...

Keyword(s):

Preterm Birth ◽

Gestational Age ◽

Placenta Previa ◽

Preterm Births ◽

Mullerian Anomalies ◽

Müllerian Anomalies ◽

Increased Risk ◽

Uterine Anomalies ◽

Gestational Age At Delivery ◽

Term Births

AbstractObjective:Müllerian anomalies are associated with increased risk of miscarriage, intrauterine growth restriction (IUGR) and preterm birth. While a commonly implicated cause is restricted expansion of endometrial cavity, alternatively it could be due to abnormal placentation. We sought to examine clinical and histopathologic factors associated with preterm delivery in women with Müllerian anomalies.Study design:One hundred and eleven singleton pregnancies in 85 women were analyzed retrospectively. There were 42 pregnancies with bicornaute, 24 with unicornuate, 24 with septate, 19 with didelphys and one each with arcuate and T-shaped uterus. Primary outcomes included gestational age at delivery, placental histopathology, placenta previa and accreta.Results:Twenty-eight (25.2%) of pregnancies were delivered prior to term. Of those, only 14 (50%) were due to preterm labor or preterm premature rupture of membranes (PPROM). Histological evidence of placental malperfusion was present in 22% of all pregnancies and those delivered at an earlier median gestational age [34 (IQR 31–37) vs. 37 weeks (IQR 34–39); P=0.001]. Malperfusion was more common in preterm than in full term births (46% vs. 14%; P=0.04). Conversely, inflammation was not more common in preterm compared to term deliveries (17.9% vs. 16.9%; P=0.89). Five pregnancies had placenta previa, three of which were complicated by accreta.Conclusion:Placental malperfusion, rather than inflammation, was more commonly associated with preterm births in women with uterine anomalies.

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Maternal obesity classes, preterm and post-term birth: a retrospective analysis of 479,864 births in England

BMC Pregnancy and Childbirth ◽

10.1186/s12884-019-2585-z ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 4

Author(s):

Emma Slack ◽

Kate E. Best ◽

Judith Rankin ◽

Nicola Heslehurst

Keyword(s):

Preterm Birth ◽

Retrospective Analysis ◽

Gestational Age ◽

Maternal Obesity ◽

Absolute Risk ◽

Full Term ◽

Effect Sizes ◽

Term Birth ◽

Gestational Age At Delivery ◽

Maternal Bmi

Abstract Background Preterm (< 37 weeks gestation) and post–term birth (≥42 weeks gestation) are associated with increased morbidity and mortality for mother and infant. Obesity (body mass index (BMI) ≥30 kg/m2) is increasing in women of reproductive age. Maternal obesity has been associated with adverse pregnancy outcomes including preterm and post–term birth. However, the effect sizes vary according to the subgroups of both maternal BMI and gestational age considered. The aim of this retrospective analysis was to determine the association between maternal obesity classes and gestational age at delivery. Methods A secondary data analysis of 13 maternity units in England with information on 479,864 singleton live births between 1990 and 2007. BMI categories were: underweight (< 18.5 kg/m2), recommended weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2) and obesity classes I (30.0–34.9 kg/m2), II (35.0–39.9 kg/m2), IIIa (40–49.9 kg/m2) and IIIb (≥50 kg/m2). Gestational age at delivery categories were: Gestational age at delivery (weeks): extreme preterm (20–27), very preterm (28–31), moderately preterm (32–36), early term (37, 38), full term (39–40), late term (41) and post–term (≥42). The adjusted odds of births in each gestational age category (compared to full-term birth), according to maternal BMI categories were estimated using multinomial logistic regression. Missing data were estimated using multiple imputation with chained equations. Results There was a J-shaped association between the absolute risk of extreme, very and moderate preterm birth and BMI category, with the greatest effect size for extreme preterm. The absolute risk of post-term birth increased monotonically as BMI category increased. The largest effect sizes were observed for class IIIb obesity and extreme preterm birth (adjusted OR 2.80, 95% CI 1.31–5.98). Conclusion Women with class IIIb obesity have the greatest risks for inadequate gestational age. Combining obesity classes does not accurately represent risks for many women as it overestimates the risk of all preterm and post-term categories for women with class I obesity, and underestimates the risk for women in all other obesity classes.

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Antenatal Azithromycin to Prevent Preterm Birth in Pregnant women with Vaginal Cerclage. A Randomized Controlled Trial

QJM ◽

10.1093/qjmed/hcab115.037 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Rania Hassan Mostafa ◽

Sherif Ahmed Ashoush ◽

Hassan Awwad Bayoumy ◽

Wessam Kamal Lotfy Gabr

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Antenatal Care ◽

Gestational Age ◽

Mode Of Delivery ◽

Perinatal Morbidity ◽

Randomized Controlled ◽

Significant Difference ◽

Gestational Age At Delivery

Abstract Background Preterm birth with its complications is one of the leading causes of perinatal morbidity and mortality, as well as maternal morbidity, especially in low and middle-income countries. Cervical cerclage is a well-established preventive tool in women at high risk of preterm birth; however, subclinical maternal infection might still cause failure of this method. Thus, adding prophylactic antibiotics, namely macrolides, could prevent preterm birth. Patients and methods This was a randomized controlled clinical trial involving two groups of women who underwent vaginal cerclage at Ain Shams University Maternity Hospital. One group received azithromycin 500mg one tablet orally once daily for 3 days every month from 14th week to 34th week gestation, in addition to routine antenatal care; while the other group received usual antenatal care without antibiotic prophylaxis after cerclage. Follow-up was done and we compared the outcomes in each group: gestational age at delivery, birth weight, mode of delivery, maternal complications, and perinatal complications. ClinicalTrials.gov Identifier NCT04278937. Results Gestational age at delivery was significantly higher in the azithromycin group (36.8weeks vs 34.1weeks; P = 0.017), with significant prolongation of gestation in the azithromycin group (23.7weeks vs 21.1weeks; P = 0.005). As regards birth weight, it was significantly higher in the azithromycin group (2932.6gm vs 2401.8gm; P = 0.006); however babies with low birth weight (birth weight <2500gm) were non-significantly less frequent in the azithromycin group (3cases vs 7cases; P = 0.165). There was no significant difference between the two groups as regards other outcomes (miscarriage, stillbirth, neonatal intensive care unit admission, antepartum hemorrhage, postpartum pyrexia, need for blood transfusion). Conclusion Adding azithromycin as antenatal prophylaxis in women undergoing vaginal cerclage prolongs pregnancy and reduces risk of PTB, with slight increase in birth weight. However, there was no clear effect on incidence of low birth weight, or perinatal morbidity/mortality.

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