Cervical cerclage for short cervix on transvaginal ultrasound: Review of effectiveness in preventing preterm birth

One of the biggest obstetric challenges is the diagnosis and management of a short cervix as cervical length has an inverse relationship with risk of preterm birth. A cervical cerclage is a surgical procedure to reduce the risk of preterm birth and can be placed in an elective or emergency setting. This is a retrospective review of cervical cerclages inserted at an outer metropolitan hospital from February 2014 to May 2017. Since the introduction of the service, a total of 43 patients were identified as requiring a cervical cerclage. Four of these patients were transferred to tertiary hospitals. Of the 39 cerclages inserted, 26 were elective and 13 were emergency, placed at a mean gestation of 15.6 and 19.6 weeks. In total, there were 35 live births, 2 stillbirths, and 2 neonatal deaths. The maternal demographics (age, gravidity, parity, and preterm risk factors) were not statistically significant between the two groups. The mean pregnancy prolongation and birthweight was greater in the elective than the emergency group (21.4 versus 14.1 weeks; 3148.2 versus 2447.2 grams). There was no obvious pattern with which patients received antibiotics pre-, intra-, or postoperatively or received a vaginal swab. This audit identified the need for improvements to guidelines to standardise the use of antibiotics and progesterone in women with a cervical cerclage.

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173: A comparison of cervical cerclage and vaginal pessaries in the prevention of spontaneous preterm birth in women with a short cervix

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2014.10.219 ◽

2015 ◽

Vol 212 (1) ◽

pp. S101 ◽

Cited By ~ 2

Author(s):

Katherine Scolari Childress ◽

Amy Flick ◽

Erin Dickert ◽

Jeffrey Gavard ◽

Ricardo Bolanos ◽

...

Keyword(s):

Preterm Birth ◽

Spontaneous Preterm Birth ◽

Cervical Cerclage ◽

Short Cervix

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The Length of the Cervix and the Risk of Spontaneous Preterm Delivery

50 Studies Every Obstetrician-Gynecologist Should Know ◽

10.1093/med/9780190947088.003.0006 ◽

2021 ◽

pp. 32-37

Author(s):

Julie Stone ◽

Michael House

Keyword(s):

Preterm Birth ◽

Inverse Relationship ◽

Clinical Case ◽

Transvaginal Ultrasound ◽

Cervical Length ◽

Central Component ◽

Current Clinical Practice ◽

Short Cervix ◽

Spontaneous Preterm Delivery ◽

Increased Risk

Measurement of the cervical length has become a central component of prenatal care. Mid-trimester cervical shortening is associated with preterm birth. This article summarizes a key study that established a strong correlation between cervical shortening and an increased risk of preterm birth. Transvaginal ultrasound was used to measure cervical length at 22 to 24 weeks’ gestation. The study showed that a short cervix was associated with an increased risk of preterm birth before 35 weeks. In addition, the shortest cervix conferred the highest risk, suggesting an inverse relationship. This article concludes by summarizing how cervical length is incorporated into current clinical practice. Also, a clinical case is presented.

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Vaginal progesterone in risk reduction of preterm birth in women with short cervix

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20193027 ◽

2019 ◽

Vol 8 (7) ◽

pp. 2695

Author(s):

Shubhi Srivastava ◽

D. Borgohain

Keyword(s):

Preterm Birth ◽

Transvaginal Ultrasound ◽

Perinatal Outcomes ◽

Cervical Length ◽

Singleton Pregnancy ◽

Short Cervix ◽

Mortality And Morbidity ◽

Medical College ◽

Vaginal Progesterone ◽

Adverse Neonatal Outcomes

Background: Preterm birth is a global health problem affecting the neonate, family and country in general. It is the leading cause of perinatal mortality and morbidity. Short cervical length detected on transvaginal ultrasound is the most practical risk factor for prediction of preterm birth. The aim of this study was to determine the efficacy and safety of vaginal progesterone in reducing the rate of preterm birth in women with a short cervix and to determine its effect on neonatal mortality and morbidity.Methods: The study was carried out in the Department of Obstetrics and Gynaecology at Assam Medical College, Dibrugarh for a period of one year. It included 128 asymptomatic women with a singleton pregnancy and a sonographic short cervix. Women were randomly divided into two groups, one of which was given placebo and the other was given vaginal progesterone and a comparative study was conducted.Results: It was observed that delivery before 37 weeks of gestation was less frequent in the progesterone group than in the placebo group (60.94% vs. 90.63%). Vaginal progesterone was also associated with a significant reduction in adverse neonatal outcomes like the rate of sepsis (6.25% vs. 18.75%), requirement of ventilator (12.5% vs. 26.56%), admission to NICU (10.94% vs. 26.56%) and birth weight ≤1.5kg (7.81% vs. 21.88%).Conclusions: Vaginal progesterone reduces the risk of preterm birth and adverse perinatal outcomes in pregnant women without any deleterious effects on the foetus or mother.

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A randomized controlled trial on the use of pessary plus progesterone to prevent preterm birth in women with short cervical length (P5 trial)

BMC Pregnancy and Childbirth ◽

10.1186/s12884-019-2513-2 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Rodolfo C. Pacagnella ◽

◽

Ben W. Mol ◽

Anderson Borovac-Pinheiro ◽

Renato Passini ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Preterm Birth ◽

Controlled Trial ◽

Transvaginal Ultrasound ◽

Cervical Length ◽

Categorical Variables ◽

Continuous Variables ◽

Short Cervix ◽

Randomized Controlled ◽

Vaginal Progesterone

Abstract Background Preterm birth is the leading cause of mortality and disability in newborn and infants. Having a short cervix increases the risk of preterm birth, which can be accessed by a transvaginal ultrasound scan during the second trimester. In women with a short cervix, vaginal progesterone and pessary can both reduce this risk, which progesterone more established than cervical pessary. The aim of this study is to compare the use of vaginal progesterone alone versus the association of progesterone plus pessary to prevent preterm birth in women with a short cervix. Methods This is a pragmatic open-label randomized controlled trial that will take place in 17 health facilities in Brazil. Pregnant women will be screened for a short cervix with a transvaginal ultrasound between 18 0/7 until 22 6/7 weeks of gestational age. Women with a cervical length below or equal to 30 mm will be randomized to the combination of progesterone (200 mg) and pessary or progesterone (200 mg) alone until 36 + 0 weeks. The primary outcome will be a composite of neonatal adverse events, to be collected at 10 weeks after birth. The analysis will be by intention to treat. The sample size is 936 women, and a prespecified subgroup analysis is planned for cervical length (= < or > 25 mm). Categorical variables will be expressed as a percentage and continuous variables as mean with standard deviation. Time to delivery will be assessed with Kaplan-Meier analysis and Cox proportional hazard analysis. Discussion In clinical practice, the combination of progesterone and pessary is common however, few studies have studied this association. The combination of treatment might act in both the biochemical and mechanical routes related to the onset of preterm birth. Trial registration Brazilian Clinical Trial Registry (ReBec) RBR-3t8prz, UTN: U1111–1164-2636, 2014/11/18.

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