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Archives of Gynecology and Obstetrics

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01-04-2017 | Maternal-Fetal Medicine

Recurrence rates after abdominal and vaginal cerclages in women with cervical insufficiency: a validated cohort study

Authors: Kirstine Sneider, Ole Bjarne Christiansen, Iben Blaabjerg Sundtoft, Jens Langhoff-Roos

Published in: Archives of Gynecology and Obstetrics | Issue 4/2017

Abstract

Purpose

To estimate the incidence of cervical insufficiency and compare recurrence rates of second trimester miscarriage/delivery in second and third pregnancies after prophylactic vaginal cerclage, abdominal cerclage, or no cerclage.

Methods

Retrospective chart review of a representative register-based sample of 621 women with a spontaneous second trimester miscarriage/delivery in the first pregnancy in Denmark (1997–2012). We used strict criteria for the diagnosis of cervical insufficiency. The outcome of subsequent pregnancies was described by treatment with prophylactic vaginal cerclage, abdominal cerclage, or no prophylactic cerclage. Women were followed until June 2015.

Results

Of 621 women, 149 (24%) fulfilled the strict criteria of cervical insufficiency. Prophylactic treatment with abdominal cerclage (n = 20), vaginal cerclage (n = 59), and no prophylactic cerclage (n = 61) resulted in a second pregnancy ending before 28 weeks in 5, 30, and 72% (p < 0.001) and before 34 weeks in 10, 46, and 84% (p < 0.001), respectively. Take-home baby rate was 95% after abdominal cerclage, 73% after vaginal cerclage, and 33% after no cerclage. In a third pregnancy, abdominal cerclage (n = 47), vaginal cerclage (n = 38), and no cerclage (n = 8) resulted in pregnancy ending before 34 weeks of gestation in 2, 21, and 25%, respectively (p = 0.01).

Conclusions

Cervical insufficiency was diagnosed in 24% of women with an initial second trimester spontaneous miscarriage/delivery. In second and third pregnancies, recurrence rates were significantly lower after prophylactic vaginal or abdominal cerclage compared with no cerclage.

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Kim M, Ishioka S, Endo T et al (2014) Importance of uterine cervical cerclage to maintain a successful pregnancy for patients who undergo vaginal radical trachelectomy. Int J Clin Oncol 19:906–911. doi:10.1007/s10147-013-0631-9 CrossRefPubMed

Anum EA, Hill LD, Pandya A, Strauss JF (2009) Connective tissue and related disorders and preterm birth: clues to genes contributing to prematurity. Placenta 30:207–215CrossRefPubMedPubMedCentral

Leppert PC, Yu SY, Keller S et al (1987) Decreased elastic fibers and desmosine content in incompetent cervix. Am J Obstet Gynecol 157:1134–1139CrossRefPubMed

Owen J (2012) Cervical Insufficiency. Int J Gynecol Obstet 85:271–279

Abenhaim H a, Tulandi T (2009) Cervical insufficiency: re-evaluating the prophylactic cervical cerclage. J Matern Fetal Neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet 22:510–516

Harger JH (1980) Comparison of success and morbidity in cervical cerclage procedures. Obstet Gynecol 56:543–548PubMed

Lidegaard O (1994) [Cervical insufficiency and cerclage in Denmark 1980–1990. A registry-based epidemiological study. Ugeskr Laeger 156:7200–7202PubMed

Ludmir J (1988) Sonographic detection of cervical incompetence. Clin Obstet Gynecol 31:101–109CrossRefPubMed

Drakeley a J, Quenby S, Farquharson RG (1998) Mid-trimester loss–appraisal of a screening protocol. Hum Reprod (Oxford, England) 13:1975–1980CrossRef

10.

Lash AF, Lash SR (1950) Habitual abortion; the incompetent internal os of the cervix. Am J Obstet Gynecol 59:68–76CrossRefPubMed

11.

Shirodkar VN (1955) A new method of operative treatment for habitual abortions in the second trimester of pregnancytle. Antiseptic 55:299–303

12.

McDonald IA (1957) Suture of the cervix for inevitable miscarriage. J Obstet Gynaecol Br Emp 64:346–350CrossRefPubMed

13.

Owen J, Hankins G, Iams JD et al (2009) Multicenter randomized trial of cerclage for preterm birth prevention in high-risk women with shortened midtrimester cervical length. Am J Obstet Gynecol 201(375):e1–e8

14.

Alfirevic Z, Stampalija T, Roberts D, Jorgensen AL (2012) Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy. Cochrane Database Syst Rev 4:CD008991

15.

Benson RC, Durfee RB (1965) Transabdominal cervico uterine cerclage during pregnancy for the treatment of cervical incompetency. Obstet Gynecol 25:145–155PubMed

16.

Romero R, Espinoza J, Erez O, Hassan S (2006) The role of cervical cerclage in obstetric practice: can the patient who could benefit from this procedure be identified? Am J Obstet Gynecol 194:1–9CrossRefPubMed

17.

Davis G, Berghella V, Talucci M, Wapner RJ (2000) Patients with a prior failed transvaginal cerclage: a comparison of obstetric outcomes with either transabdominal or transvaginal cerclage. Am J Obstet Gynecol 183:836–839CrossRefPubMed

18.

Sneider K, Langhoff-Roos J, Sundtoft IB, Christiansen OB (2015) Validation of second trimester miscarriages and spontaneous deliveries. Clin Epidemiol 7:517–527. doi:10.2147/CLEP.S85107 CrossRefPubMedPubMedCentral

19.

Ellett K, Buxton EJ, Luesley DM (1992) The effect of ethnic origin on the rate of spontaneous late mid-trimester abortion. Ethn Dis 2:84–86PubMed

20.

Poggi SH, Vyas NA, Pezzullo JC et al (2012) Does increasing body mass index affect cerclage efficacy? J Perinatol Off J Calif Perinat Assoc 32:777–779CrossRef

21.

Dodd JM, Jones L, Flenady V et al (2013) Prenatal administration of progesterone for preventing preterm birth in women considered to be at risk of preterm birth. Cochrane Database Syst Rev 7:CD004947

22.

Romero R, Nicolaides K, Conde-Agudelo A et al (2012) Vaginal progesterone in women with an asymptomatic sonographic short cervix in the midtrimester decreases preterm delivery and neonatal morbidity: A systematic review and metaanalysis of individual patient data. Am J Obstet Gynecol 206:207–208CrossRef

23.

Norman JE, Marlow N, Messow C-M, et al (2016) Vaginal progesterone prophylaxis for preterm birth (the OPPTIMUM study): a multicentre, randomised, double-blind trial. Lancet (London, England) 387:2106–2116. doi:10.1016/S0140-6736(16)00350-0 CrossRef

24.

(1993) Final report of the Medical Research Council/Royal College of Obstetricians and Gynaecologists multicentre randomised trial of cervical cerclage MRC/RCOG Working Party on Cervical Cerclage. Br J Obstet Gynaecol 100:516–523

25.

Romero R, Miranda J, Chaiworapongsa T et al (2014) Sterile intra-amniotic inflammation in asymptomatic patients with a sonographic short cervix: prevalence and clinical significance. J Matern Fetal Neonat Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet 1–17. doi:10.3109/14767058.2014.954243

26.

Seong WJ (2016) Amniotic fluid CA-125 as a marker of intra-amniotic inflammation associated with preterm delivery: a preliminary single center study. Arch Gynecol Obstet 293:55–59. doi:10.1007/s00404-015-3775-1 CrossRefPubMed

27.

Jung EY, Park KH, Lee SY et al (2015) Non-invasive prediction of intra-amniotic infection and/or inflammation in patients with cervical insufficiency or an asymptomatic short cervix (≤15 mm). Arch Gynecol Obstet 292:579–587. doi:10.1007/s00404-015-3684-3 CrossRefPubMed

28.

Kiefer DG, Peltier MR, Keeler SM et al (2016) Efficacy of midtrimester short cervix interventions is conditional on intraamniotic inflammation. Am J Obstet Gynecol 214(276):e1–e6. doi:10.1016/j.ajog.2015.09.006

29.

Lee SE, Romero R, Park C-W et al (2008) The frequency and significance of intraamniotic inflammation in patients with cervical insufficiency. Am J Obstet Gynecol 198(633):e1–e8. doi:10.1016/j.ajog.2007.11.047

30.

Odibo AO, Berghella V, To MS et al (2007) Shirodkar versus McDonald cerclage for the prevention of preterm birth in women with short cervical length. Am J Perinatol 24:55–60CrossRefPubMed

31.

Tulandi T, Alghanaim N, Hakeem G, Tan X (2014) Pre and post-conceptional abdominal cerclage by laparoscopy or laparotomy. J Minim Invasive Gynaecol 21:987–993CrossRef

32.

Sneider K, Christiansen OB, Sundtoft IB, Langhoff-Roos J (2017) Long-term follow-up after abdominal cerclage: a population-based cohort study. Eur J Obstet Gynecol Reprod Biol 210:207–211. doi:10.1016/j.ejogrb.2017.01.001 CrossRefPubMed

Title: Recurrence rates after abdominal and vaginal cerclages in women with cervical insufficiency: a validated cohort study
Authors: Kirstine Sneider
Ole Bjarne Christiansen
Iben Blaabjerg Sundtoft
Jens Langhoff-Roos
Publication date: 01-04-2017
Publisher: Springer Berlin Heidelberg
Published in: Archives of Gynecology and Obstetrics / Issue 4/2017
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-017-4315-y

At a glance: The STEP trials

Springer Medicine

Recurrence rates after abdominal and vaginal cerclages in women with cervical insufficiency: a validated cohort study

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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