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CC BY-NC-ND 4.0 · AJP Rep 2019; 09(02): e195-e199
DOI: 10.1055/s-0039-1688778
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Cerclage Location and Gestational Age at Delivery

Fatima Estrada
1   Departments of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
,
Scarlett Karakash
2   Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University, Stanford, California
,
Terry SeeToe
3   Division of Research, State University of New York, New York, New York
,
Jeremy Weedon
3   Division of Research, State University of New York, New York, New York
,
Howard Minkoff
1   Departments of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
› Author Affiliations
Further Information

Publication History

26 July 2018

14 March 2019

Publication Date:
28 June 2019 (online)

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Abstract

Objective Multiple authors have suggested cerclage position is a determinant of “success.” We assessed the interaction between cervical length (CL), cerclage height (cerH), proximal residual length (PRL), gestational age at delivery, and rate of delivery ≤ 34 weeks, in this study.

Study Design Present study is a retrospective cohort study of all cerclages placed at Maimonides Medical Center from 2006 to 2016. Outcomes: gestational age at delivery and delivery before 34 weeks; predictors: PRL, cerH, CL; and indications for cerclage: history (Hx), physical exam (PE), and ultrasound (US) indicated cerclage. A general linear model was used to predict power-transformed age at delivery from cerH, CL, and indication for cerclage. Subanalyses by indication were conducted. Logistic regression was used for delivery ≤ 34 weeks.

Results The cerH by indication did not reach statistical significance (p = 0.090). When stratified by indications, the effect of cerH on age at delivery was apparent for Hx (adjusted R 2 = 0.18, p < 0.001) and PE (adjusted R 2 = 0.43, p = 0.004) cerclages but not for US cerclages (adjusted R 2 = 0.08, p = 0.206). Logistic regression predicting delivery ≤ 34 weeks (n = 29) produced similar results.

Conclusions For Hx and PE indicated cerclages, the location of the stitch may influence the timing of delivery. Specifically, the higher the cerclage, the more advanced the gestational age at delivery.

Keywords

preterm delivery - cervical cerclage - cervical length - cerclage height - proximal residual length - history indicated cerclage - physical exam indicated cerclage - ultrasound indicated cerclage
 

  • References

  • 1 American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. Practice Bulletin No. 171: Management of Preterm Labor. Obstet Gynecol 2016; 128 (04) e155-e164
    CrossrefPubMedGoogle Scholar
  • 2 March of dimes prematurity campaign: activities and milestones. Available at: https://www.marchofdimes.org/mission/march-of-dimes-prematurity-campaign.aspx . Accessed May 30, 2017
    PubMed
  • 3 American College of Obstetricians and Gynecologists'. Practice bulletin no 142: cerclage for the management of cervical insufficiency. Obstet Gynecol 2014; 123 (2, Pt. 1): 372-379
    CrossrefPubMedGoogle Scholar
  • 4 Robert R, Creasy RK, Iams JD, Lockwood CJ, Moore T, Greene MF. Creasy and Resnik's Maternal–Fetal Medicine: Principles and Practice, 7th edition. Philadelphia, PA: Elsevier Inc.; 2014: 658-660
    Google Scholar
  • 5 Odibo A, To M, Berghella V, Rust O, Althuisius S. Shirodkar versus Mcdonald cerclage for the prevention of preterm birth (PTB) in women with short cervical length. AJOG 2005; 193 (06) S155
    PubMedGoogle Scholar
  • 6 McDonald IA. Suture of the cervix for inevitable miscarriage. J Obstet Gynaecol Br Emp 1957; 64 (03) 346-350
    CrossrefPubMedGoogle Scholar
  • 7 Guzman ER, Houlihan C, Vintzileos A, Ivan J, Benito C, Kappy K. The significance of transvaginal ultrasonographic evaluation of the cervix in women treated with emergency cerclage. Am J Obstet Gynecol 1996; 175 (02) 471-476
    CrossrefPubMedGoogle Scholar
  • 8 Scheib S, Visintine JF, Miroshnichenko G, Harvey C, Rychlak K, Berghella V. Is cerclage height associated with the incidence of preterm birth in women with an ultrasound-indicated cerclage?. Am J Obstet Gynecol 2009; 200 (05) e12-e15
    CrossrefPubMedGoogle Scholar
  • 9 Mella MT, Berghella V. Prediction of preterm birth: cervical sonography. Semin Perinatol 2009; 33 (05) 317-324
    CrossrefPubMedGoogle Scholar
  • 10 Rozenberg P, Sénat MV, Gillet A, Ville Y. Comparison of two methods of cervical cerclage by ultrasound cervical measurement. J Matern Fetal Neonatal Med 2003; 13 (05) 314-317
    CrossrefPubMedGoogle Scholar
  • 11 Melle L, Le Ray C, Delorme P, Anselem O, Goffinet F, Marcellin L. [Does post operative sonographic position of preventive cervical cerclage affect gestational age at birth?]. Gynécol Obstét Fertil 2016; 44 (12) 679-684
    CrossrefPubMedGoogle Scholar
  • 12 Scheib S, Visintine JF, Miroshnichenko G, Harvey C, Rychlak K, Berghella V. Is cerclage height associated with the incidence of preterm birth in women with an ultrasound-indicated cerclage?. Am J Obstet Gynecol 2009; 200 (05) e12-e15
    CrossrefPubMedGoogle Scholar
  • 13 Suhag A, Reina J, Sanapo L. , et al. Prior ultrasound-indicated Cerclage: Comparison of cervical length screening or History indicated cerclage in the next pregnancy. Obstet Gynecol 2015; 126 (05) 962-968
    CrossrefPubMedGoogle Scholar