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

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.

Therapeutic Effect of Cervical Cerclage on Cervical Insufficiency during Pregnancy Analyzed by Magnetic Resonance Image under Neural Network Algorithm

Objective. This research was developed to investigate the effect of magnetic resonance imaging (MRI) analysis based on neural network algorithm for cervical ligation in the treatment of cervical insufficiency. Methods. 44 patients who were suspected to be pregnant with cervical insufficiency and needed cervical ligation were selected. MR imaging analysis was performed before cervical ligation. MR images were analyzed based on the back propagation neural network (BPNN) algorithm, and patients were randomly divided into experimental group and control group. Preoperative MRI analysis was performed in the experimental group, while simple transvaginal ultrasonography was used to diagnose cervical insufficiency in the control group. Then, postoperative fetal preservation time, vaginal bleeding rate, and infection rate within one week after surgery were compared between the two groups. Results. Based on experience and experimental testing, the relevant parameters were set as follows. The number of particles n = 50, the inertia weight ω = 0.9, and c1 = c2 = 2. The weight range of the output layer of the neural network was [−1, 1], the target error e = 10−5, and the maximum number of iteration steps was 3,000. Compared with the control group, the experimental group’s postoperative bleeding rate and infection probability were substantially reduced, while the normal delivery rate was substantially increased ( P < 0.05 ). Conclusion. MR image analysis based on neural network algorithm played an important role in cervical cerclage surgery. The image map showed the local anatomy clearly, increasing the success rate of the operation and improving the prognosis of the patient.

Screening vs no screening for preterm delivery in low risk singleton pregnancies

Introduction: To compare the effect of a policy of screening for spontaneous preterm delivery (SPD) by transvaginal cervical length (CL) measurement versus a no screening policy in the prevention of severe prematurity. Methods: Retrospective study on low risk singleton pregnancies examined at 20-24 weeks. Two cohorts one with SPD screening and the other without screening were matched using propensity analysis to create the study groups. Women with short CL were treated with vaginal progesterone and/or cervical cerclage/pessary. The outcomes examined were SPD<32 weeks (SPD 32) and SPD between 20 and 32 weeks (SPD 20-32). Results: Screening for SPD was associated with a significant reduction in the rate of SPD at less than 32 weeks (0.3% vs 0.8%, p=0.001 in the screened and no screened pregnancies respectively) and in the rate of SPD 20-32 (0.3% vs 0.9%, p=0.005 in the screened and no screened pregnancies respectively). After adjusting for maternal age, parity, body mass index, smoking and mode of conception, the screening group had significantly lower hazard for SPD 20-32 (HR=0.36, 95% CI: 0.18-0.75, p=0.006) and SPD32 (HR=0.39, 95% CI: 0.19-0.82, p=0.013). Conclusion: Screening for SPD by transvaginal CL measurement in mid pregnancy may reduce the incidence of severe prematurity in low risk singleton pregnancies.

Eradication of Cervical Canal Colonization In Treatment Associated With Prophylactic Cervical Cerclage: The LOOK FURTHER Study

BACKGROUND: The perioperative management of the cervical cerclage procedure is not unified. Controlling microbiome cervical status does not affect obstetric outcomes in general population, but it can be beneficial in cervical insufficiency. Eliminating cervical pathogens in those patients may increase the effectiveness, resulting in prevention of miscarriage or preterm labor and delivery of a baby capable of normal development.METHODS: Thirty five patients undergoing cervical cerclage at the 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, were included in the study. The procedure was performed only after receiving a negative culture from the cervical canal.RESULTS: Thirty one (88.5%) patients delivered after the 34th and 28 (80%) after the 37th week of gestation. The colonization of genital tract was found in 31% of patients prior to the procedure, 42% in the subsequent course of pregnancy and 48% before delivery. Eighty five percent of patients who had miscarriage or delivered prematurely had abnormal cervical cultures. In patients with normal cervical cultures 91.67% women delivered at term. There were no abnormalities in children’s development.CONCLUSIONS: Controlling microbiological status of the cervical canal results in better or similar outcomes to those reported by other authors in terms of obstetric and neonatal outcomes. Active eradication of the reproductive tract colonization potentially increases the effectiveness of the cervical cerclage placement.