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Cerclage Cervical
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1. Cervical cerclage in the prevention of preterm birth.
Match Strength: 22.578

Cervical cerclage has been used in the management of cervical insufficiency for several decades, yet the indications are uncertain and benefits marginal. It remains a controversial intervention. The diagnosis of cervical insufficiency is traditionally based on a history of recurrent second trimester miscarriages, or very preterm delivery whereby the cervix is unable to retain the pregnancy until term. Cervical cerclage has been the subject of many observational and randomised controlled trials. This article reviews the literature regarding the effectiveness of elective or emergency ... Read More »
» Published in Best Pract Res Clin Obstet Gynaecol. 2007 May 8;

2. Contemporary use of cervical cerclage.
Match Strength: 21.041

Although it was devised over 50 years ago, only recently controlled randomized trials have evaluated the efficacy of cervical cerclage. Cerclage was originally devised for women with both prior preterm birth (PTB) and cervical changes in the current pregnancy. Evidence suggests that transvaginal cerclage probably prevents second trimester loss/PTB in women with >or=3 PTB/second trimester loss (history-indicated cerclage best placed at 12 to 14 wk); and in women with a prior PTB 16 to 36 weeks and transvaginal ultrasound cervical length<25 mm in the current pregnancy (ultrasound-indicated ... Read More »
» Published in Clin Obstet Gynecol. 2007 Jun;50(2):468-77.

3. Cervical cerclage: a review.
Match Strength: 20.593

Cervical cerclage is a common prophylactic intervention that has been used in the management of second trimester loss for several decades, yet it remains one of the more controversial surgical interventions in obstetrics. The diagnosis of cervical insufficiency is notoriously difficult to make, and is usually a retrospective one based on a history of recurrent second trimester loss (or early preterm delivery) following painless cervical dilatation in the absence of contractions, bleeding, or other causes of recurrent pregnancy loss. This article reviews the current literature regarding the ... Read More »
» Published in Int J Surg. 2007 Jun;5(3):205-9. Epub 2006 Jun 16.

4. Cervical cerclage and evidence-based medicine: if, how and when.
Match Strength: 19.720

Cervical cerclage has always been the main treatment option in cases of so-called cervical insufficiency, a condition that is notoriously associated with a high risk of second trimester abortion and/or preterm delivery. We can distinguish between a prophylactic cerclage, to be performed electively, usually at 13-16 weeks gestation, only when the woman has a history extremely suggestive for cervical incompetence (3 or more mid-trimester abortions or preterm deliveries) and a therapeutic cerclage. This last cerclage is recommended either for women who have ultrasonographic changes consistent ... Read More »
» Published in Minerva Ginecol. 2007 Apr;59(2):191-8.

5. Clinical aspects of cervical insufficiency.
Match Strength: 19.332

ABSTRACT : Fetal loss is a painful experience. A history of second or early third trimester fetal loss, after painless dilatation of the cervix, prolapse or rupture of the membranes, and expulsion of a live fetus despite minimal uterine activity, is characteristic for cervical insufficiency. In such cases the risk of recurrence is high, and a policy of prophylactic cerclage may be safer than one of serial cervical length measurements followed by cerclage, tocolysis and bed rest in case of cervical shortening or dilatation. In low risk cases, however, prophylactic cerclage is not useful. There ... Read More »
» Published in BMC Pregnancy Childbirth. 2007 Jun 1;7 Suppl 1:S17.

6. Outcome after transabdominal cervicoisthmic cerclage.
Match Strength: 18.983

OBJECTIVE: To estimate benefits and risks of transabdominal cervicoisthmic cerclage in women with cervical insufficiency in whom transvaginal cerclage is considered surgically unfeasible. METHODS: This was an observational cohort study with historical controls of 101 pregnancies after transabdominal cervicoisthmic cerclage in 101 women with a classic history of cervical insufficiency and severe cervical defects precluding transvaginal cerclage. RESULTS: Median gestational age at elective transabdominal cerclage (n = 95) was 14 (range 12-16) weeks and at emergency cerclage (n = 6) was 18 (range ... Read More »
» Published in Obstet Gynecol. 2006 Apr;107(4):779-84.

7. Evaluation of effectiveness of prophylactic cerclage of a short cervix according to interleukin-8 in cervical mucus.
Match Strength: 18.768

OBJECTIVE: This study was undertaken to compare rates of preterm delivery according to cervical mucus interleukin-8 (IL-8) among women who underwent cerclage because of a short cervix. STUDY DESIGN: This retrospective study included 16,508 patients whose cervical length and cervical mucus IL-8 concentrations were measured between 20 and 24 weeks. A short cervix was defined by a length of 25 mm or less, whereas IL-8 concentrations exceeding 360 ng/mL were considered high. Whether to perform cerclage was decided by clinicians without consideration of IL-8 concentrations. RESULTS: Among all ... Read More »
» Published in Am J Obstet Gynecol. 2006 Jan;194(1):14-9. Comment in: Am J Obstet Gynecol. 2006 Jan;194(1):1-9.

8. The Role of Cervical Cerclage in Obstetric Practice: Can the Patient Who Could Benefit from This Procedure Be Identified?
Match Strength: 17.922

This editorial critically examines the definition of "cervical insufficiency." The definition, the clinical ascertainment, efforts to develop an objective method of diagnosis, as well as the nature of cervical disease leading to spontaneous mid-trimester spontaneous abortion and preterm delivery are reviewed. The value and limitations of cervical sonography as a risk assessment tool for spontaneous preterm delivery are appraised. The main focus is on the role of cervical cerclage to prevent an adverse pregnancy outcome. The value of assessing the presence or absence of endocervical ... Read More »
» Published in Am J Obstet Gynecol. 2006 Jan;194(1):1-9. Comment On: Am J Obstet Gynecol. 2006 Jan;194(1):14-9.

9. Use of the cervical cerclage: comparison of a community and university hospital setting.
Match Strength: 17.311

OBJECTIVE: To compare the use of cervical cerclage between a community hospital and a university teaching hospital to estimate if the rate of cervical cerclage placement differs and if indications selected for cervical cerclage placement vary by institution type. METHODS: A review of medical records from January 1, 2000, through December 31, 2004, of women undergoing cervical cerclage was performed at a community hospital and a university teaching hospital. The rate of cerclage and indications for placement were estimated. A multivariate logistic regression model examined the likelihood that ... Read More »
» Published in Obstet Gynecol. 2007 Feb;109(2 Pt 1):320-5.

10. A novel method for laparoscopic abdominal cerclage utilizing minimally invasive hydrodissection: a case report.
Match Strength: 17.220

BACKGROUND: Cervical incompetence can lead to the inability to sustain an intrauterine pregnancy and may account for a substantial portion of second-trimester losses. Placement of a transvaginal cerclage has been shown to decrease morbidity in a substantial number of such cases. In patients lacking sufficient cervical tissue, a cerclage may be placed by a transabdominal approach. This procedure carries risks of significant morbidity to the maternal-fetal unit if done by laparotomy. CASE: A 22-year-old gravida at 13 weeks' gestation with a past history significant for cervical incompetence and ... Read More »
» Published in J Reprod Med. 2007 May;52(5):428-30.

11. Vesicovaginal fistula formation after cervical cerclage mimicking premature rupture of membranes.
Match Strength: 16.933

BACKGROUND: Women with a history of pregnancy loss in the second trimester are often diagnosed with cervical insufficiency and are treated with cervical cerclage. We present an unusual complication of this procedure that mimicked preterm rupture of membranes. CASE: A 38-year-old woman with a history of cervical conization, loss of a triplet pregnancy at 22 weeks, and one early spontaneous abortion underwent cervical cerclage placement during her third pregnancy. She developed an intermittent vesicovaginal fistula 2 weeks after the procedure that mimicked preterm premature rupture of membranes. ... Read More »
» Published in Obstet Gynecol. 2007 Feb;109(2 Pt2):493-4.

12. Cerclage for short cervix on ultrasonography: meta-analysis of trials using individual patient-level data.
Match Strength: 16.695

OBJECTIVE: Preterm birth is the main cause of perinatal morbidity and mortality. A short cervical length on transvaginal ultrasonography predicts preterm birth. Our aim was to estimate by meta-analysis of randomized trials whether cerclage prevents preterm birth in women with a short cervical length. DATA SOURCES: MEDLINE, PubMed, EMBASE, and the Cochrane Library were searched with the terms "cerclage," "cervical cerclage," "short cervix," "ultrasound," and "randomized trial." We included randomized trials involving the use of cerclage in women with short cervical length on transvaginal ... Read More »
» Published in Obstet Gynecol. 2005 Jul;106(1):181-9.

13. Treatment of early cervical pregnancy with cerclage, carboprost, curettage, and balloon tamponade.
Match Strength: 16.651

BACKGROUND: Cervical pregnancy, an uncommon variety of ectopic gestation is associated with high morbidity and adverse consequences for future fertility. Currently there are no specific recommendations for the best treatment of this entity. CASE: A 35-year-old nullipara presented with 8 weeks of amenorrhea and painless brown discharge. The patient was diagnosed with cervical pregnancy with embryonic cardiac activity. A conservative surgical treatment under general anesthesia involved intracervical infiltration of carboprost, cerclage, suction curettage of cervix, and Foley balloon tamponade ... Read More »
» Published in Obstet Gynecol. 2007 Feb;109(2 Pt2):505-7.

14. Transvaginal cervicoisthmic cerclage as an alternative to the transabdominal technique.
Match Strength: 16.641

OBJECTIVES: To analyse the foetal outcome after transvaginal cervicoisthmic cerclage, to determine whether it is a valid alternative to the reference transabdominal technique. STUDY DESIGN: Description of the vaginal operative technique, retrospective review of 20 cervicoisthmic cerclage patients from 1990 to 2000. RESULTS: In the curative group of women with a history of late pregnancy losses or premature deliveries and usually previous failed classical cervical cerclage, the foetal survival rate improved from 18% before cerclage to 79% after cerclage. No operative complications were reported ... Read More »
» Published in Eur J Obstet Gynecol Reprod Biol. 2001 Dec 10;100(1):16-21.

15. Emergency cerclage. A successful challenge despite advanced second trimester cervical dilatation.
Match Strength: 16.581

A 22-year-old, primigravida +/- 20 weeks of gestation presented with abdominal pain. She was diagnosed as a case of advanced cervical incompetence. We carried out an emergency cerclage after 24 hours from her admission, while the cervix was fully dilated with bulging of the membranes and prolapse of both lower limbs in the middle of the vagina. She delivered normally at 38 weeks of gestation with favorable outcomes. We believe that even if miscarriage is inevitable, the so called emergency cerclage might be considered. Publication Types: Case ... Read More »
» Published in Saudi Med J. 2006 Apr;27(4):544-6.

16. Infectious Complications of Cervical Cerclage
Match Strength: 16.228

A study of 115 gravid patients who required cervical cerclage indicated that the optimum time to perform the surgical procedure was between the fourteenth and eighteenth weeks. If the operation is delayed until later in the second trimester, the incidence of chorioamnionitis is increased 2.6-fold, and premature rupture of the membranes prior to the thirty-second week of gestation is trebled. Amniocentesis performed in nine patients with chorioamnionitis and intact membranes after cerclage demonstrated the polymicrobial nature of the amniotic fluid infection. The isolation of such organisms at ... Read More »
» Published in Am J Obstet Gynecol. 1981 Dec 15;141(8):1065-71.

17. Final results of the Cervical Incompetence Prevention Randomized Cerclage Trial (CIPRACT): therapeutic cerclage with bed rest versus bed rest alone.
Match Strength: 16.121

OBJECTIVE: To compare preterm delivery rates (before 34 weeks of gestation) and neonatal morbidity and mortality in patients with risk factors or symptoms of cervical incompetence managed with therapeutic McDonald cerclage and bed rest versus bed rest alone. STUDY DESIGN: Cervical length was measured in patients with risk factors or symptoms of cervical incompetence. Risk factors for cervical incompetence included previous preterm delivery before 34 weeks of gestation that met clinical criteria for the diagnosis of cervical incompetence, previous preterm premature rupture of membranes before ... Read More »
» Published in Am J Obstet Gynecol. 2001 Nov;185(5):1106-12. Comment in: Am J Obstet Gynecol. 2002 Aug;187(2):514; author reply 514-5., Am J Obstet Gynecol. 2002 Nov;187(5):1426-7; author reply 1427-8.

18. Good Pregnancy Outcome with Emergent Cerclage Placed in the Presence of Intra-Amniotic Microbial Invasion.
Match Strength: 16.070

Cervical insufficiency with dilation can be associated with amniotic fluid microbial invasion. Cerclage placement in the presence of infection is contraindicated because it is associated with poor fetal and maternal outcome. A 30-year-old gravida 4 para 0 with cervical insufficiency had emergent cervical suture placement at 19 weeks. The patient underwent amniocentesis to screen for infection. After the screen for infection using amniotic fluid glucose and white blood cells had indicated negative results, the patient had cerclage placed. Post cerclage placement, amniotic culture results were ... Read More »
» Published in Am J Perinatol. 2007 Jun 27;

19. The short and funneling cervix: when to use cerclage?
Match Strength: 16.060

PURPOSE OF REVIEW: The diagnosis of cervical incompetence remains extremely difficult because there is no diagnostic test available prior to, during or after pregnancy. This review will summarize the latest publications on the use of transvaginal ultrasonography to identify women at high risk of preterm delivery and the use of cervical cerclage in these women. RECENT FINDINGS: Cervical length is not only inversely related to the risk of preterm delivery but also inversely related to the risk of intrauterine infection in women with preterm labor. Furthermore, previous history of preterm ... Read More »
» Published in Curr Opin Obstet Gynecol. 2005 Dec;17(6):574-8.

20. Cervical cerclage for prevention of preterm birth in women with twin pregnancy.
Match Strength: 15.836

OBJECTIVE: To compare the effect of elective cervical cerclage in women with twin pregnancy on gestational age at time of delivery. METHOD: In a pragmatic fashion women in Abha Maternity Hospital, Saudi Arabia with twin gestations were allocated to receive either an elective cerclage (group I) or no cerclage (group II). Elective cerclage was performed at 12 to 14 weeks of gestation after sonographic examination of the fetus to confirm gestational age and exclude major congenital anomalies. In all cases, follow up of the pregnancy was continued until delivery. RESULTS: Of the 176 twin ... Read More »
» Published in Int J Gynaecol Obstet. 2007 Jul 3;

21. Tightening McDonald cerclage suture under sonographic guidance.
Match Strength: 15.745

OBJECTIVE: The technical factors contributing to failure of cerclage are not fully understood. The aims of this study were to assess the possibility of tightening the McDonald cerclage under ultrasound guidance and to examine the width and shape of the cervical canal before and after tightening the suture. METHODS: A prospective study was performed. The sole indication for cerclage placement was clinical history of cervical insufficiency. Cervical length and canal width were measured by transvaginal ultrasound, at 12-14 weeks' gestation, with the patient's bladder empty, after which the ... Read More »
» Published in Ultrasound Obstet Gynecol. 2008 Feb;31(2):194-7.

22. Effect of 2 stitches vs 1 stitch on the prevention of preterm birth in women with singleton pregnancies who undergo cervical cerclage.
Match Strength: 15.677

OBJECTIVE: This study investigates whether 2 cerclage stitches are more effective than 1 stitch in the prevention of preterm birth. STUDY DESIGN: This is a retrospective cohort study of 150 singleton pregnancies that underwent cervical cerclage. Gestational age at delivery and clinical characteristics were compared. RESULTS: One hundred twelve patients (74.7%) received 1 stitch, and 38 patients (25.3%) received 2 stitches. There were no baseline differences between the groups. Analysis showed no significant difference in gestational age at delivery between the 1 vs 2 cerclage groups overall ... Read More »
» Published in Am J Obstet Gynecol. 2008 Jan 4

23. The management of an early-missed abortion after radical trachelectomy--a case report and a review of the literature.
Match Strength: 15.668

Radical trachelectomy (RT) has been reported for almost 20 years. This case report describes and addresses the issue of the clinical management of early-missed abortion in a patient after RT with a cerclage. CASE: A 35-year-old woman who had a RT 2 years ago due to cervical carcinoma stage IB1 presented with a missed abortion of an 8-week gestational age. At the end of the RT, a cerclage suture was inserted in the remaining internal oss of the cervix. The patient went through a cervical dilatation followed by suction curettage guided by ultrasonography without compromising the cerclage. This ... Read More »
» Published in Int J Gynecol Cancer. 2006 Jul-Aug;16(4):1688-90.

24. Is routine prophylactic cervical cerclage associated with significant prolongation of triplet gestation?
Match Strength: 15.321

OBJECTIVE: The purpose of this study was to determine if routine prophylactic cervical cerclage was associated with a significant prolongation of triplet pregnancy. STUDY DESIGN: A retrospective study of all women carrying triplet pregnancies at a single institution during a four-year period was carried out. Selected maternal characteristics and obstetric outcome measures in women who received prophylactic cerclage (PC) were compared to women who did not receive PC (no cerclage placed and emergency cerclage). Statistical comparison was done using the Mann-Whitney test for continuous variables ... Read More »
» Published in J Matern Fetal Neonatal Med. 2006 Sep;19(9):575-8.

25. Laparoscopic abdominal cerclage during pregnancy: A case report and a review of the described operative techniques.
Match Strength: 15.250

A case report and systematic review of the literature. We report on a 26-year-old patient, gravida 2, para 0, at 12 weeks gestation with the diagnosis of cervical incompetence, in whom transvaginal cerclage was not technically possible and laparoscopic transcervical abdominal cerclage was performed. The operation lasted 100 minutes and was completed successfully. The patient was discharged the next day and the remainder of her pregnancy was uneventful. A healthy infant weighing 3010 g was delivered at 38.4 weeks by cesarean section. Laparoscopic transcervical abdominal cerclage approach is ... Read More »
» Published in J Minim Invasive Gynecol. 2006 Jul-Aug;13(4):337-41.

26. Perspectives on the management of the short cervix identified by transvaginal ultrasound during pregnancy: an update for canadian obstetrical caregivers.
Match Strength: 14.928

A shortened cervix is often considered to be equivalent to cervical insufficiency, and a cerclage may be offered as an intervention to prolong pregnancy; however, we may not be differentiating between true cervical insufficiency and intrauterine causes of cervical shortening. A recent meta-analysis found no significant reduction in preterm birth < 35 weeks' gestation in women with cerclage compared with no cerclage in the total population of women studied. However, there was a potentially significant reduction in preterm birth < 35 weeks among women with a singleton pregnancy (relative ... Read More »
» Published in J Obstet Gynaecol Can. 2006 Mar;28(3):203-5.

27. Emergency cervical cerclage: A review of 15 cases.
Match Strength: 14.921

Background: This report describes our experience with 15 consecutive emergency cervical cerclages performed at Al Yamamah Hospital. Patients and Methods: Between February 1994 and February 1997, 15 women with singleton pregnancies between 18 and 26 weeksa gestation, with a cervical dilatation between 3 and 10 cm and with membrane prolapse, underwent emergency cerclage after excluding labor, placental abruption and intrauterine infection. The membranes were replaced using the technique of overfilling the urinary bladder and then performing McDonaldas cerclage. All the patients received ... Read More »
» Published in Ann Saudi Med. 1999 Jan-Feb;19(1):23-6.

28. Cervical occlusion in women with cervical insufficiency: protocol for a randomised, controlled trial with cerclage, with and without cervical occlusion.
Match Strength: 14.875

OBJECTIVE: To evaluate the effect of double cerclage compared with a single cerclage. DESIGN: Randomised, controlled multicentre trial. SETTING: Ten different countries are participating with both secondary and tertiary centres. The countries participating are Denmark, Sweden, Germany, United Kingdom, Spain, South Africa, Australia and India. This gives both a broad spectrum of diversity global and local. We expect a total of 242 women enrolled per year. POPULATION: Prophylactic study: 1. History of cervical incompetence/insufficiency. (Delivery 15 to <36 weeks.) 2. Congenital short cervix ... Read More »
» Published in BJOG. 2007 May;114(5):649, e1-6.

29. Could a cervical occlusion suture be effective at improving perinatal outcome?
Match Strength: 14.861

Cervical weakness and infection have long been regarded as major causes of preterm birth. Cervical cerclage has been used extensively to reduce the risk of preterm birth arising as a result of cervical weakness, but increasing evidence suggests that the cervix plays more than just a mechanical role. Immunological function of the cervix and mucus plug is thought to be important in minimising the ingress of microbes, which can lead to chorioamnionitis and rupture of the amniotic membranes. In this review, we examine the background of traditional cervical cerclage and introduce the concept of the ... Read More »
» Published in BJOG. 2007 May;114(5):532-6.

30. Management of cervical weakness based on the measurement of cervical resistance index.
Match Strength: 14.816

OBJECTIVE: To assess the value of measuring cervical resistance index (CRI) as an aid to selecting patients with a history of spontaneous mid-trimester miscarriage for cervical cerclage in subsequent pregnancies. STUDY DESIGN: An observational study of 175 patients with a history of one or more spontaneous mid-trimester losses and 123 non-pregnant women who had CRI measurements performed while undergoing routine gynaecological surgery. Those women whose CRI indicated an incompetent cervix were recommended for cervical cerclage in future pregnancies while women with a normal CRI were ... Read More »
» Published in Eur J Obstet Gynecol Reprod Biol. 2006 Nov 21;

31. Cervical lacerations: some surprising facts.
Match Strength: 14.360

OBJECTIVE: Our aim was to calculate the incidence of cervical lacerations after vaginal delivery and to study its associated risk factors. STUDY DESIGN: A retrospective chart review of all patients with a cervical laceration after vaginal delivery during a 5 year period was performed. Their risk factors were studied. A chi2 test and Bonferroni's correction were applied. The relative risk, P values, and confidence intervals were calculated. RESULTS: Thirty-two patients of 16,931 vaginal deliveries had a cervical laceration for an incidence of 0.2%. Cervical cerclage was associated with an 11.5 ... Read More »
» Published in Am J Obstet Gynecol. 2007 May;196(5):e17-8.

32. Indomethacin administration at the time of ultrasound-indicated cerclage: is there an association with a reduction in spontaneous preterm birth?
Match Strength: 14.250

OBJECTIVE: The purpose of this study was to estimate the effect of indomethacin on the prevention of preterm birth (PTB) in women with an ultrasound-indicated cerclage. STUDY DESIGN: We performed a retrospective cohort study from 1995-2006. Asymptomatic women with a cerclage for a short cervical length (CL), which was defined as <25 mm, between 14-23 weeks 6 days of gestation were included. Women who received indomethacin therapy at the time of ultrasound-indicated cerclage for a short CL were compared with those women who did not. Our primary outcome was spontaneous PTB at <35 weeks of ... Read More »
» Published in Am J Obstet Gynecol. 2008 Jan 24

33. Interleukin-6, But Not Relaxin, Predicts Outcome of Rescue Cerclage in Women With Cervical Incompetence
Match Strength: 14.159

OBJECTIVE: We investigated the potential roles of relaxin and subclinical intra-amniotic inflammation by quantitating amniotic fluid relaxin and interleukin-6 concentrations for the prediction of outcome of rescue cerclage in women with cervical incompetence. STUDY DESIGN: Cervical incompetence was diagnosed when cervical dilatation exceeded 2 cm with intact but bulging membranes and no detectable uterine activity. Each woman underwent amniocentesis to facilitate the performance of a rescue cerclage between 15 and 27 weeks of gestation (n=40 women). Forty-five additional women who underwent ... Read More »
» Published in Am J Obstet Gynecol. 2004 Sep;191(3):784-9.

34. Cervical incompetence: the use of transvaginal sonography to provide an objective diagnosis.
Match Strength: 14.114

OBJECTIVE: To investigate the use of transvaginal sonography in monitoring the cervix in women at high risk of a preterm delivery. STUDY DESIGN: One hundred and six women at high risk of preterm labor had regular cervical monitoring by transvaginal ultrasound throughout pregnancy from the second trimester to delivery. The study was designed to be observational, but intervention was considered if the cervical length fell below 10 mm. RESULTS: Eleven women demonstrated opening of the cervical canal at rest or with fundal pressure before 24 weeks' gestation. Between 2 and 17 days later all 11 ... Read More »
» Published in Ultrasound Obstet Gynecol. 2001 Sep;18(3):211-6. Comment in: Ultrasound Obstet Gynecol. 2001 Sep;18(3):195-9.

35. Revisiting the short cervix detected by transvaginal ultrasound in the second trimester: why cerclage therapy may not help.
Match Strength: 14.021

OBJECTIVE: The purpose of this study was to identify the risk factors that are associated with increased neonatal morbidity in patients who were treated for sonographic evidence of internal os dilation and distal cervical shortening during the second trimester. STUDY DESIGN: From May 1998 to June 2000 patients between 16 and 24 weeks of gestation with the following sonographic criteria were randomly assigned to McDonald cerclage or no cerclage: internal os dilation and either membrane prolapse into the endocervical canal at least 25% of the total cervical length but not beyond the external os ... Read More »
» Published in Am J Obstet Gynecol. 2001 Nov;185(5):1098-105. Comment in: Am J Obstet Gynecol. 2002 Aug;187(2):514; author reply 514-5.

36. Is there still a role for emergency cerclage in the developed world? An experience from a London district hospital.
Match Strength: 13.993

INTRODUCTION: Cervical incompetence appears to have a greater prevalence in the developing world, which possibly extends to multi-ethnic communities in the UK. Emergency cerclage has been found to have a relative degree of success in patients detected on ultrasound or presenting clinically. Our study aimed to look at the emergency cerclage outcome in the multi-ethnic population of our district hospital. METHODS: Sixty-two cases of cervical cerclage were reviewed retrospectively from 2000 to 2006 with 16 cases being emergencies. Maternal history, presentation, operation details and outcome were ... Read More »
» Published in Arch Gynecol Obstet. 2008 Feb;277(2):139-42. Epub 2007 Jul 25.

37. Cervical stitch (cerclage) for preventing pregnancy loss: individual patient data meta-analysis.
Match Strength: 13.834

BACKGROUND: Several observational studies have claimed high success rates for cerclage in women with cervical insufficiency. A recent Cochrane review found no conclusive evidence of benefit, although significant heterogeneity was present for some of the important clinical outcomes. OBJECTIVES: We undertook an individual patient data (IPD) meta-analysis to examine effect of cerclage on neonatal and maternal outcomes. In an attempt to explain the heterogeneity, we investigated whether obstetric factors including multiple gestation are associated with effectiveness. SEARCH STRATEGY: Search ... Read More »
» Published in BJOG. 2007 Dec;114(12):1460-76. Epub 2007 Sep 27.

38. Cervical function and prematurity.
Match Strength: 13.575

The cervix maintains the fetus in situ during pregnancy and dilates during labour to allow delivery of the baby. Congenital or iatrogenically-induced structural abnormalities of the cervix are associated with an increased risk of preterm birth. The role of cervical infection is less clear. Cervical studies may be useful in the prediction of preterm delivery: both a shortened cervical length identified on transvaginal ultrasound examination and an increased level of fetal fibronectin in cervico-vaginal secretions are associated with an increased risk of preterm delivery. In singleton pregnancy, ... Read More »
» Published in Best Pract Res Clin Obstet Gynaecol. 2007 May 7;

39. Atosiban vs ritodrine used prophylactically with cerclage in ICSI pregnancies to prevent pre-term birth in women identified as being at high risk on the basis of transvaginal ultrasound scan.
Match Strength: 13.362

Our objective was to compare the effectiveness and safety of atosiban and ritodrine, in pregnancies obtained by intracytoplasmic sperm injection (ICSI) undergoing cervical cerclage. Data from a prospective study were compared with those from a retrospective study. Sixteen ICSI pregnant women, 20-24 weeks' gestation and maternal age >18 years, received atosiban (bolus dose 6.75 mg i.v., followed by 300 microg/min i.v. for 3 h and 100 microg/min i.v. for 45 h). Cervical cerclage was performed 3 h after starting atosiban. The control group (group B) of 16 ICSI pregnant women were matched and ... Read More »
» Published in J Obstet Gynaecol. 2006 Jul;26(5):396-401.

40. Transabdominal cerclage: the significance of dual pathology and increased preterm delivery.
Match Strength: 12.759

Transabdominal cerclage is a recognised treatment for cervical weakness with a history of recurrent mid-trimester loss and a failed elective vaginal suture. The emergence of dual pathology, such as antiphospholipid syndrome and bacterial vaginosis, is associated with an increased risk of preterm delivery (RR 2.34, 95% CI 1.15-5.8). The first 40 cases are described where strict adherence to an investigation protocol and consistent treatment plan has been implemented ... Read More »
» Published in BJOG. 2005 Oct;112(10):1424-6.

41. Shirodkar versus McDonald Cerclage for the Prevention of Preterm Birth in Women with Short Cervical Length.
Match Strength: 12.651

The efficacy of Shirodkar cerclage was compared with that of the McDonald procedure for the prevention of preterm birth (PTB) in women with a short cervix. Secondary analysis using data from all published randomized trials including women with a short cervical length (CL) was performed comparing the use of Shirodkar versus McDonald sutures. Analysis was limited to singletons with short CL on transvaginal ultrasound. The primary outcome measure was PTB < 33 weeks. Statistical analysis was performed using bivariate and multivariable techniques. From 607 women randomly assigned in the study, ... Read More »
» Published in Am J Perinatol. 2006 Dec 27;

42. Favorable outcome following emergency second trimester cerclage.
Match Strength: 12.383

BACKGROUND: To evaluate the outcome of midtrimester emergency cerclage with or without bulging of membranes. METHODS: A retrospective cohort study of 99 women who underwent emergency second trimester cerclage (16-27 gestational weeks). In 75 women the cervix was dilated and effaced but without bulging of membranes (group 1), and in 24 women the dilation and effacement of the cervix were accompanied by bulging of membranes into the vagina in an hourglass formation (group 2). McDonald technique was applied in all patients. RESULTS: Prolongation of pregnancy was significantly longer in group 1 ... Read More »
» Published in Int J Gynaecol Obstet. 2006 Dec 20;

43. A comparison of sonographic cervical parameters in predicting spontaneous preterm birth in high-risk singleton gestations.
Match Strength: 11.777

OBJECTIVES: To assess the role of cervical sonography and to compare various sonographic cervical parameters in their ability to predict spontaneous preterm birth in high-risk singleton gestations. DESIGN: A prospective cohort of 469 high-risk gestations were longitudinally evaluated between 15 and 24 weeks' gestation on 1265 occasions with transvaginal cervical sonography and transfundal pressure. The cervical parameters obtained were funnel width and length, cervical length, percent funneling and cervical index. The information obtained was used for patient management. Restriction of ... Read More »
» Published in Ultrasound Obstet Gynecol. 2001 Sep;18(3):204-10. Comment in: Ultrasound Obstet Gynecol. 2001 Sep;18(3):195-9.

44. Cervical Cerclage: Twenty Years' Experience
Match Strength: 11.168

During a 20-year period, 40 pregnancies were managed in 32 patients with a diagnosis of an incompetent cervix, a ratio of 1:775 deliveries. Diagnosis before development of symptoms produced a 92% fetal salvage, with 68% reaching 36 weeks of gestation. Development of symptoms before cerclage resulted in only a 40% fetal salvage. Fetal salvage was reduced in cases where membranes bulged beyond the cervix, the cervix was more than 3 cm dilated, or the gestational age was greater than 26 weeks at the time of suture placement. No difference was noted between the Shirodkar and McDonald procedures. ... Read More »
» Published in South Med J. 1979 Aug;72(8):933-7.

45. Short cervix on ultrasound: does indomethacin prevent preterm birth?
Match Strength: 11.110

OBJECTIVE: Our aim was to estimate if indomethacin therapy prevents preterm birth (PTB) in women with a short cervical length (CL) on transvaginal ultrasound (TVU). STUDY DESIGN: Individual-level data from all randomized trials including asymptomatic women with a short CL on TVU were analyzed for use of indomethacin at the time of the short CL. The trials eligible would be ones that randomized women with a short CL <25 mm, identified between 14 and 27 weeks. The eligible trials randomized such women to receive either cerclage or no cerclage. Only women who did NOT receive cerclage were ... Read More »
» Published in Am J Obstet Gynecol. 2006 Sep;195(3):809-13.

46. Use of mesh cerclage in prevention of early preterm delivery: a promising new surgical method for women with dilated cervix and membrane herniation?
Match Strength: 11.053

OBJECTIVE: To present our innovative surgical method for prevention of early preterm delivery in women with cervical dilatation and membrane herniation. STUDY DESIGN: A woman in the 24th gestational week, with membrane herniation due to a 2-3 cm dilatation of the cervix, is presented. The surgical technique for occlusion and reinforcement of the dilated cervix with circular suture and polypropylene mesh is described. RESULTS: We succeeded in preventing early preterm delivery and achieving 38 gestational weeks when the mesh cerclage was electively removed. CONCLUSIONS: Occlusion of the dilated ... Read More »
» Published in Wien Klin Wochenschr. 2006;118 Suppl 2:76-9.

47. Laparoscopic metroplasty for bicornuate uterus.
Match Strength: 10.505

This is a case study of a 29-year-old nulliparous woman with a bicornuate uterus who had a poor obstetric history in whom we performed a laparoscopic metroplasty. She was advised to use barrier contraception for 3 months. A repeat hystero-laparoscopy performed 3 months later revealed a single large uniform uterine cavity without any adhesions. The patient had an incompetent cervical os after surgery and was advised to undergo cervical cerclage on conception. Publication Types: Case ... Read More »
» Published in J Minim Invasive Gynecol. 2006 Jan-Feb;13(1):70-3.

48. Cervical length and prediction of preterm delivery.
Match Strength: 10.362

PURPOSE OF REVIEW: To present a summary of the literature and most recent advances in the clinical use of cervical length for the prediction of preterm birth. RECENT FINDINGS: Cervical length is predictive of preterm birth in all populations studied, including asymptomatic women with prior cone biopsy, mullerian anomalies, or multiple dilation and evacuations. While cervical length remains the most predictive measurement, funneling may add to its predictive value in certain populations. In terms of interventions aimed at preventing preterm birth once a short cervical length has been identified ... Read More »
» Published in Curr Opin Obstet Gynecol. 2007 Apr;19(2):191-5.

49. Routine Cervical Length in Twins and Perinatal Outcomes.
Match Strength: 10.231

A retrospective review of twin gestations was undertaken to evaluate whether routine cervical lengths (CLs) in such instances change pregnancy outcome. Data were collected from the ultrasound database and chart review. Exclusion criteria included twins reduced to singletons, twins not delivering at our institution, and incomplete information. Twin gestations with a CL were compared with those without a CL. Outcomes of interest included gestational age (GA) at delivery, preterm delivery (PTD), antepartum admissions, antepartum length of stay (LOS), cerclage placement, birthweight, neonatal ... Read More »
» Published in Am J Perinatol. 2006 Dec 27;

50. Cervical length and funneling at 23 weeks of gestation in the prediction of spontaneous early preterm delivery.
Match Strength: 9.523

OBJECTIVES: To establish the relationship of cervical length at 23 weeks of gestation to the risk of spontaneous delivery before 33 weeks and to determine the possible additional risk if funneling is present. METHODS: During a 36-month period, 6819 women with singleton pregnancies underwent transvaginal sonographic cervical assessment at 22-24 weeks as a screening test for preterm delivery. The distribution of cervical length and the prevalence of funneling, defined as dilatation of the internal os of > or = 5 mm in width, were established. Women who underwent cervical cerclage, iatrogenic ... Read More »
» Published in Ultrasound Obstet Gynecol. 2001 Sep;18(3):200-3. Comment in: Ultrasound Obstet Gynecol. 2001 Sep;18(3):195-9.

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