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By Chad Klauser Maternal Fetal Medicine physician in NYC
Nicola Vousden, Natasha Hezelgrave, Jenny Carter, Paul T Seed, Andrew H Shennan
OBJECTIVE: To determine the subsequent need for cerclage and pregnancy outcome, in women with a prior ultrasound-indicated cerclage. STUDY DESIGN: Analysis of a prospectively collected database from November 2010 to July 2014 from 15 Preterm Surveillance clinics across the UK was performed. Women with an index and previous singleton pregnancy with an ultrasound-indicated cerclage were eligible for inclusion (n=55). Previous ultrasound-indicated cerclage was defined as cerclage inserted prior to 24 weeks' for cervical length <25 mm as detected by transvaginal ultrasound...
May 2015: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Gabriele Saccone, Orion Rust, Sietske Althuisius, Amanda Roman, Vincenzo Berghella
OBJECTIVE: To evaluate the efficacy of cerclage for preventing preterm birth in twin pregnancies with a short cervical length. DESIGN: We performed an individual patient data meta-analysis. Searches were performed in electronic databases. SETTING: Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA. POPULATION: Twin pregnancies in mothers with short cervical length. METHODS: We performed an individual patient data meta-analysis of randomized trials of twin pregnancies screened by transvaginal ultrasound in second trimester and where mothers had a short cervical length <25 mm before 24 weeks...
April 2015: Acta Obstetricia et Gynecologica Scandinavica
Timothy J Rafael, Vincenzo Berghella, Zarko Alfirevic
BACKGROUND: Cervical cerclage is a surgical intervention involving placing a stitch around the uterine cervix. The suture material aims to prevent cervical shortening and opening, thereby reducing the risk of preterm birth. The effectiveness and safety of this procedure in multiple gestations remains controversial. OBJECTIVES: To assess whether the use of a cervical cerclage in multiple gestations, either at high risk of pregnancy loss based on just the multiple gestation (history-indicated cerclage), the ultrasound findings of 'short cervix' (ultrasound-indicated cerclage), or the physical exam changes in the cervix (physical exam-indicated cerclage), improves obstetrical and perinatal outcomes...
September 10, 2014: Cochrane Database of Systematic Reviews
Vincenzo Berghella, Amanda Roman
No abstract text is available yet for this article.
July 2014: American Journal of Obstetrics and Gynecology
Anju Suhag, Vincenzo Berghella
Cervical cerclage is an obstetric procedure performed for prevention of prematurity. Cerclage was first introduced by Drs Shirodkar and McDonald in the mid-1950s for women with repeated second trimester losses and cervical changes in current pregnancy. Currently, cerclage placement is based on 3 common indications in singleton gestations, including history-indicated (prior multiple early preterm births or second trimester losses), ultrasound-indicated (cervical length <25 mm before 24-wk gestational age in women with prior spontaneous preterm birth) and physical examination-indicated (cervical dilation on manual or physical examination before 24 wk)...
September 2014: Clinical Obstetrics and Gynecology
Matthew D Laskin, Yoav Yinon, Wendy L Whittle
OBJECTIVE: To determine whether preterm premature rupture of membranes (PPROM) in the presence of a cerclage is associated with an increased incidence of intrauterine infection and/or adverse neonatal outcome compared to PPROM in the absence of cerclage. STUDY DESIGN: Patients diagnosed with PPROM with a cerclage (cases) between 24-34 weeks were matched (1:2.6) for gestational age at PPROM, gestational number, and chorionicity with patients diagnosed with PPROM without a cerclage (controls)...
April 2012: Journal of Maternal-fetal & Neonatal Medicine
Vincenzo Berghella, Timothy J Rafael, Jeff M Szychowski, Orion A Rust, John Owen
OBJECTIVE: To estimate if cerclage prevents preterm birth and perinatal mortality and morbidity in women with previous preterm birth, singleton gestation, and short cervical length in a meta-analysis of randomized trials. DATA SOURCES: MEDLINE, PUBMED, EMBASE, and the Cochrane Library were searched using the terms "cerclage," "short cervix," "ultrasound," and "randomized trial." METHODS OF STUDY SELECTION: We included randomized trials of cerclage in women with short cervical length on transvaginal ultrasonography, limiting the analysis to women with previous spontaneous preterm birth and singleton gestation...
March 2011: Obstetrics and Gynecology
Vincenzo Berghella, A Dhanya Mackeen
OBJECTIVE: To compare pregnancy outcomes in singleton gestations with prior preterm birth that were managed either by cervical length screening with cerclage for short cervical length or history-indicated cerclage. DATA SOURCES AND METHODS OF STUDY SELECTION: Medline, Scopus, and the Cochrane Central Register of Controlled Trials were searched for the terms "cerclage," "randomized trial," and "clinical trial" from 1966 until January 2011. No restrictions for language were applied...
July 2011: Obstetrics and Gynecology
Emily S Miller, William A Grobman, Linda Fonseca, Barrett K Robinson
OBJECTIVE: To evaluate whether perioperative indomethacin and antibiotic administration at the time of examination-indicated cerclage placement prolongs gestation. METHODS: This is a randomized controlled trial performed at a single tertiary care hospital between March 2010 and November 2012. Women older than 18 years of age with a singleton pregnancy between 16 0/7 and 23 6/7 weeks of gestation undergoing an examination-indicated cerclage were eligible. Women were randomly assigned to receive either perioperative indomethacin and antibiotics or no perioperative prophylactic medications...
June 2014: Obstetrics and Gynecology
Anju Suhag, Laura Sanapo, Sushma Potti, Vincenzo Berghella
INTRODUCTION: To evaluate pregnancy outcomes of women with a history of ultrasound-indicated cerclage for a short cervix who in subsequent pregnancy either were followed by transvaginal ultrasound cervical length screening or received a history-indicated cerclage. METHODS: Retrospective cohort study was performed from 1993 to 2012 involving women with an index singleton pregnancy and history of ultrasound-indicated cerclage. Prior ultrasound-indicated cerclage was defined as cerclage placed for cervical length less than 25 mm before 24 weeks of gestation in women at high risk for preterm birth...
May 2014: Obstetrics and Gynecology
(no author information available yet)
The inability of the uterine cervix to retain a pregnancy in the second trimester is referred to as cervical insufficiency. Controversy exists in the medical literature pertaining to issues of pathophysiology, screening, diagnosis, and management of cervical insufficiency. The purpose of this document is to provide a review of current evidence of cervical insufficiency, including screening of asymptomatic at-risk women, and to offer guidelines on the use of cerclage for management. The diagnosis and management of other cervical issues during pregnancy, such as short cervical length, are discussed more in-depth in other publications of the American College of Obstetricians and Gynecologists...
February 2014: Obstetrics and Gynecology
Vincenzo Berghella, Jack Ludmir, Giuliana Simonazzi, John Owen
The objective was to review the evidence supporting various perioperative technical and management strategies for transvaginal cervical cerclage. We performed MEDLINE, PubMed, EMBASE, and COCHRANE searches with the terms, cerclage, cervical cerclage, cervical insufficiency, and randomized trials, plus each technical aspect (eg, suture, amniocentesis, etc) considered. The search spanned 1966 through September 2012 and was not restricted by language. Each retrieved manuscript was carefully evaluated, and any pertinent references from the reports were also obtained and reviewed...
September 2013: American Journal of Obstetrics and Gynecology
Vasileios Pergialiotis, Dimitrios G Vlachos, Anastasia Prodromidou, Despina Perrea, Eleana Gkioka, Georgios D Vlachos
OBJECTIVE: To evaluate the effectiveness double cervical cerclage in reducing antenatal complications and improve perinatal outcomes. METHODS: We searched Medline, Scopus,, The Cochrane Central Register of Controlled Trials and Google Scholar search engines. RESULTS: Six studies were included that involved 880 women. Double cerclage was significantly superior to single cerclage in reducing preterm births <34 weeks (734 cases, OR 0...
March 2015: Journal of Maternal-fetal & Neonatal Medicine
Anna Galyean, Thomas J Garite, Kimberly Maurel, Diana Abril, Charles D Adair, Paul Browne, C Andrew Combs, Helen How, Brian K Iriye, Michelle Kominiarek, George Lu, David Luthy, Hugh Miller, Michael Nageotte, Tulin Ozcan, Manuel Porto, Mildred Ramirez, Shirley Sawai, Yoram Sorokin
OBJECTIVE: The decision of whether to retain or remove a previously placed cervical cerclage in women who subsequently rupture fetal membranes in a premature gestation is controversial and all studies to date are retrospective. We performed a multicenter randomized controlled trial of removal vs retention of cerclage in these patients to determine whether leaving the cerclage in place prolonged gestation and/or increased the risk of maternal or fetal infection. STUDY DESIGN: A prospective randomized multicenter trial of 27 hospitals was performed...
October 2014: American Journal of Obstetrics and Gynecology
Emily S Miller, Priya V Rajan, William A Grobman
OBJECTIVE: To compare outcomes of physical examination-indicated cerclage in women with twin gestations to those with singleton gestations and to identify whether risk factors for extremely preterm birth (before 28 weeks) differ between these 2 groups. STUDY DESIGN: This is a single institution retrospective cohort study of women who underwent a physical examination-indicated cerclage between Jan. 1, 1980, and Aug. 15, 2012. Differences in characteristics and outcomes were compared between women with twin and singleton gestations...
July 2014: American Journal of Obstetrics and Gynecology
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