Am J Perinatol 2007; 24(8): 457-460
DOI: 10.1055/s-2007-986685
© Thieme Medical Publishers

Diagnosis of Short Cervix in a Community Hospital Prior to Placement of a Therapeutic Cerclage

Carla A. Martinez1 , Mark A. Turrentine2 , Mildred M. Ramirez1
  • 1Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Science Center at Houston, Houston, Texas
  • 2Department of Obstetrics and Gynecology, Kelsey-Seybold Clinic, Houston, Texas
Further Information

Publication History

Publication Date:
14 September 2007 (online)

ABSTRACT

The purpose of this study was to describe how obstetricians in the community define a short cervix prior to cerclage placement. A secondary analysis of cerclages placed for the diagnosis of short cervix, defined by either digital or ultrasound examination, were identified from a cohort of 1076 cerclages placed at a community hospital from January 1, 2000, through December 31, 2004. Two hundred twenty-six cerclages were placed for the diagnosis of short cervix. Fifty-eight women (25.7%) were nulliparous. The mean estimated gestational age at placement was 15.4 ± 3.8 weeks. More than half of the cerclages (n = 125; 55.3%) were placed prior to 15 weeks estimated gestational age. Of those cases with documented cervical length by ultrasound (n = 171), 36 of these patients (21.1%) had a cervical length of ≥ 25 mm. The most common indications for cerclage placement were short cervix only (40.3%), previous cone biopsy/loop electrocautery excision procedure (28.8%), and multiple gestation (9.7%). In a community hospital, cerclages for short cervix are often performed in nulliparous women without antecedent risk factors at a gestational age when cervical length is not a reliable tool for predicting adverse pregnancy outcome.

REFERENCES

  • 1 Iams J D, Goldenberg R L, Meis P J et al.. The length of the cervix and the risk of spontaneous premature delivery.  N Engl J Med. 1996;  334 567-572
  • 2 Owen J, Yost N, Berghella V et al.. Can shortened midtrimester cervical length predict very early spontaneous preterm birth?.  Am J Obstet Gynecol. 2004;  191 298-303
  • 3 Higgins S P, Kornman L H, Bell R J, Brennecke S P. Cervical surveillance as an alternative to elective cervical cerclage for pregnancy management of suspected cervical incompetence.  Aust N Z J Obstet Gynaecol. 2004;  44 228-232
  • 4 Rust O A, Atlas R O, Reed J, van Gaalen J, Balducci J. Revisiting the short cervix detected by transvaginal ultrasound in the second trimester: why cerclage therapy may not help.  Am J Obstet Gynecol. 2001;  185 1098-1105
  • 5 Althuisius S M, Dekker G A, Hummel P, Bekedam D J, van Geijn H P. Final results of the cervical incompetence prevention randomized cerclage trial (CIPRACT): therapeutic cerclage with bed rest versus bed rest alone.  Am J Obstet Gynecol. 2001;  185 1106-1112
  • 6 Berghella V, Odibo A O, Tolosa J E. Cerclage for prevention of preterm birth in women with a short cervix found on transvaginal ultrasound examination: a randomized trial.  Am J Obstet Gynecol. 2004;  191 1311-1317
  • 7 To M S, Alfirevic Z, Heath V CF et al.. Cervical cerclage for prevention of preterm delivery in women with short cervix: randomized controlled trial.  Lancet. 2004;  363 1849-1853
  • 8 Turrentine M A, Stewart D J, Ramirez M M. Use of the cervical cerclage: comparison of a community and university hospital setting.  Obstet Gynecol. 2007;  109 320-325
  • 9 Drakeley A J, Roberts D, Alfirevic Z. Cervical stitch (cerclage) for preventing pregnancy loss in women.  Cochrane Database Syst Rev. 2004;  (2):Volume 2
  • 10 Sonek J D, Iams J D, Blumenfeld M, Johnson F, Landon M, Gabbe S. Measurement of cervical length in pregnancy: comparison between vaginal ultrasonography and digital examination.  Obstet Gynecol. 1990;  76 172-175
  • 11 Holcomb W L, Smeltzer J S. Cervical effacement: variation in belief among clinicians.  Obstet Gynecol. 1991;  78 43-45
  • 12 Jackson G M, Ludmir J, Bader T J. The accuracy of digital examination and ultrasound in the evaluation of cervical length.  Obstet Gynecol. 1992;  79 214-218
  • 13 Hibbard J U, Snow J, Moawad A H. Short cervical length by ultrasound and cerclage.  J Perinatol. 2000;  20 161-165
  • 14 Pramod R, Okun N, McKay D et al.. Cerclage for the short cervix demonstrated by transvaginal ultrasound: current practice and opinion.  J Obstet Gynaecol Can. 2004;  26 564-570
  • 15 Norwitz E R, Bahtiyar M O, Sibai B M. Defining standards of care in maternal-fetal medicine.  Am J Obstet Gynecol. 2004;  191 1491-1496
  • 16 Berghella V, Talucci M, Desai A. Does transvaginal sonographic measurement of cervical length before 14 weeks predict preterm delivery in high risk pregnancies?.  Ultrasound Obstet Gynecol. 2003;  21 140-144
  • 17 Carvalho M HB, Bittar R E, Brizot M L, Maganha P PS, Borges Da Fonseca E SV, Zugaib M. Cervical length at 11-14 weeks' and 22-24 weeks' gestation evaluated by transvaginal sonography, and gestational age at delivery.  Ultrasound Obstet Gynecol. 2003;  21 135-139
  • 18 Ozdemir I, Demirci F, Yucel O, Erkorkmaz U. Ultrasonographic cervical length measurement at 10-14 and 20-24 weeks gestation and the risk of preterm delivery.  Eur J Obstet Gynecol Reprod Biol. 2007;  130 176-179
  • 19 Belej-Rak T, Okun N, Windrim R, Ross S, Hannah M E. Effectiveness of cervical cerclage for a sonographically shortened cervix: a systematic review and meta-analysis.  Am J Obstet Gynecol. 2003;  189 1679-1687

0 Presented at the 27th Annual Meeting of the Society for Maternal-Fetal Medicine, February 5-10, 2007, San Francisco, California.

Carla A MartinezM.D. 

Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Science Center at Houston

6410 Fannin Street, Suite 3.430, Houston, TX 77030