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Noninvasive cerclage for the management of cervical incompetence: a prospective study

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Abstract

Objective: The aim of this study was to evaluate the efficacy and safety of a noninvasive cerclage pessary in the management of cervical incompetence. Methods: This is a prospective cohort study of all pregnant women treated for cervical incompetence during a 4-year period. Women with known risk factors for preterm delivery had transvaginal ultrasonography every 2–3 weeks after 17–19 weeks of gestation. Those with progressive shortening of cervix diagnosed before 30 weeks were treated with a cerclage pessary when the cervical length was ≤25 mm. The pessary was electively removed at 34–36 weeks. The course and outcome of pregnancy were recorded. Results: Thirty-two women were treated with a cerclage pessary. There were nine twin and two triplet pregnancies. Fifteen (47%) had two or more risk factors for preterm delivery. The mean gestational age at cerclage was 23 (17–29) weeks, cervical length 17 (5–25) mm. Two women required delivery before the onset of labor due to severe intrauterine growth restriction and one due to HELLP syndrome. These were excluded from further analysis. In the remaining 29 women, the interval between cerclage and delivery was 10.4 (2–19) weeks, mean gestational age at delivery 34 (22–42) weeks, and birth weight 2,255 (410–4,045) g. Thirteen (45%) women delivered before 34 weeks. There were a total of 35 live-born infants and four intrapartum fetal deaths (all between 22 and 25 weeks gestation). All women complained of increased vaginal discharge, but no other significant complications were observed that could be attributed to the use of pessary. Conclusion : Cerclage pessary may be useful in the management of cervical incompetence. Whether it can be a noninvasive alternative to surgical cerclage merits further investigation.

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References

  1. Harger JH (2002) Cerclage and cervical insufficiency: an evidence-based analysis. Obstet Gynecol 100:1313–1327

    Article  PubMed  Google Scholar 

  2. Iams JD, Goldenberg RL, Meis PJ, Mercer BM, Moawad A, Das A et al (1996) The length of the cervix and the risk of spontaneous premature delivery. N Engl J Med 334:567–572

    Article  PubMed  CAS  Google Scholar 

  3. Heath VC, Southall TR, Souka AP, Elisseou A, Nicolaides KH (1998) Cervical length at 23 weeks of gestation: prediction of spontaneous preterm delivery. Ultrasound Obstet Gynecol 12:312–317

    Article  PubMed  CAS  Google Scholar 

  4. Taipale P, Hiilesmaa V (1998) Sonographic measurement of uterine cervix at 18–22 weeks’ gestation and the risk of preterm delivery. Obstet Gynecol 92:902–907

    Article  PubMed  CAS  Google Scholar 

  5. Guzman ER, Mellon C, Vintzileos AM, Ananth CV, Walters C, Gipson K (1998) Longitudinal assessment of endocervical canal length between 15 and 24 weeks gestation in women at risk for pregnancy loss or preterm birth. Obstet Gynecol 92:31–37

    Article  PubMed  CAS  Google Scholar 

  6. Hassan SS, Romero R, Berry SM, Dang K, Blackwell SC, Treadwell MC et al (2000) Patients with an ultrasonographic cervical length ≤15 mm have nearly 50% risk of early spontaneous preterm delivery. Am J Obstet Gynecol 182:1458–1467

    Article  PubMed  CAS  Google Scholar 

  7. Althuisius SM, Dekker GA, Hummel P, Bekedam DJ, van Geijn HP (2001) Final results of the cervical incompetence prevention randomized cerclage trial (CIPRACT): therapeutic cerclage with bed rest versus bed rest alone. Am J Obstet Gynecol 185:1106–1112

    Article  PubMed  CAS  Google Scholar 

  8. To MS, Palaniappan V, Skentou C, Gibb D, Nicolaides HK (2002) Elective cerclage vs. ultrasound-indicated cerclage in high-risk pregnancies. Ultrasound Obstet Gynecol 19:475–477

    Article  PubMed  CAS  Google Scholar 

  9. Groom KM, Bennett PR, Golara M, Thalon A, Shennan AH (2004) Elective cervical cerclage versus serial ultrasound surveillance of cervical length in a population at high risk for preterm delivery. Eur J Obstet Gynecol Reprod Biol 112:158–161

    Article  PubMed  Google Scholar 

  10. Lazar P, Gueguen S, Dreyfus J, Reynaud R, Pontonnier G, Papiernik E (1984) Multicentred controlled trial of cervical cerclage in women at moderate risk of preterm delivery. Br J Obstet Gynaecol 91:724–730

    PubMed  Google Scholar 

  11. Rush RW, Isaacs S, McPherson K, Jones L, Chalmers I, Grant A (1984) A randomized controlled trial of cervical cerclage in women at high risk of spontaneous preterm delivery. Br J Obstet Gynaecol 91:731–735

    PubMed  Google Scholar 

  12. Rust OA, Atlas RO, Jones KJ, Benham BN, Balducci J (2000) A randomized trial of cerclage versus no cerclage among patients with ultrasonographically detected second-trimester preterm dilatation of the internal os. Am J Obstet Gynecol 183:830–835

    Article  PubMed  CAS  Google Scholar 

  13. MRC/RCOG Working Party on Cervical Cerclage (1993) Final report of the Medical Research Council/Royal College of Obstetricians and Gynaecologists Multicentre Randomised trial of cervical cerclage. Br J Obstet Gynaecol 100:516–23

    Google Scholar 

  14. Hassan SS, Romero R, Maymon E, Berry SM, Blackwell SC, Treadwell MC et al (2001) Does cervical cerclage prevent preterm delivery in patients with a short cervix? Am J Obstet Gynecol 184:1325–1331

    Article  PubMed  CAS  Google Scholar 

  15. Drakeley AJ, Roberts D, Alfirevic Z (2003) Cervical cerclage for prevention of preterm delivery: meta-analysis of randomized trials. Obstet Gynecol 102:621–627

    Article  PubMed  Google Scholar 

  16. Owen J, Iams JD, Hauth JC (2003) Vaginal sonography and cervical incompetence. Am J Obstet Gynecol 188:586–96

    Article  PubMed  Google Scholar 

  17. To MS, Alfirevic Z, Heath VCF, Cicero S, Cacho AM, Williamson PR, Nicolaides KH (2004) Cervical cerclage for prevention of preterm delivery in women with short cervix: randomized controlled trial. Lancet 363:1849–1853

    Article  PubMed  Google Scholar 

  18. Berghella V, Odibo AO, Tolosa JE (2004) Cerclage for prevention of preterm birth in women with short cervix found on transvaginal ultrasound examination: a randomized trial. Am J Obstet Gynecol 191:1311–1317

    Article  PubMed  Google Scholar 

  19. Roman AS, Rebarber A, Pereira L, Sfakianaki AK, Mulholland J, Berghella V (2005) The efficacy of sonographically indicated cerclage in multiple gestations. J Ultrasound Med 24:763–768

    PubMed  Google Scholar 

  20. Cross RG (1959) Treatment of habitual abortion due to cervical incompetence. Lancet 2:127

    Article  Google Scholar 

  21. Oster S, Javert CT (1966) Treatment of the incompetent cervix with Hodge pessary. Obstet Gynecol 28:206–208

    PubMed  CAS  Google Scholar 

  22. Vitsky M (1968) Pessary treatment of the incompetent cervical os. Obstet Gynecol 31:732–733

    Article  PubMed  CAS  Google Scholar 

  23. Seyffarth K (1978) Noninvasive cerclage using support pessaries for prevention and therapy of premature birth. Zentralbl Gynäkol 100:1566–1570

    PubMed  CAS  Google Scholar 

  24. Quaas L, Hillemanns HG, du Bois A, Schillinger H (1990) The Arabin cerclage pessary-alternative to surgery. Geburtshilfe Frauenheilk 50:429–433

    Article  CAS  Google Scholar 

  25. Arabin B, Halbesma JR, Vork F, Hubener M, van Eyck J (2003) Is treatment with vaginal pessaries an option in patients with a sonographically detected short cervix? J Perinat Med 31:122–133

    Article  PubMed  Google Scholar 

  26. Förster VF, During R, Schwarzlos G (1998) Treatment of cervix incompetence—cerclage versus pessary. Zentralbl Gynäkol 108:230–237

    Google Scholar 

  27. Newcomer J (2000) Pessaries for the treatment of incompetent cervix and premature delivery. Obstet Gynecol Surv 55:443–448

    Article  PubMed  CAS  Google Scholar 

  28. Hibbard JU, Tart M, Moawd AH (2000) Cervical length at 16–22 weeks’ gestation and risk for preterm delivery. Obstet Gynecol 96:972–978

    Article  PubMed  CAS  Google Scholar 

  29. Guzman ER, Forster JK, Vintzileos AM, Ananth CV, Walters C, Gipson P (1998) Pregnancy outcomes in women treated with elective versus ultrasound-indicated cervical cerclage. Ultrasound Obstet Gynecol 12:323–327

    Article  PubMed  CAS  Google Scholar 

  30. Iams JD (2004) Abnormal cervical competence. In: Creasy RK, Resnik R, Iams JD (eds). Maternal-fetal medicine: principles and practice (fifth edition). Saunders, Elsevier Inc., USA, pp 603–622

    Google Scholar 

  31. Berghella V, Odibo AO, To MS, Rust OA, Althuisius SM (2005) Cerclage for short cervix on ultrasonography: meta-analysis of trials using individual patient-level data. Obstet Gynecol 106:181–189

    PubMed  Google Scholar 

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Correspondence to Ganesh Acharya.

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Acharya, G., Eschler, B., Grønberg, M. et al. Noninvasive cerclage for the management of cervical incompetence: a prospective study. Arch Gynecol Obstet 273, 283–287 (2006). https://doi.org/10.1007/s00404-005-0082-2

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