This retrospective case-control study included 38 pregnant women who were diagnosed as having cervical incompetence and treated with cervical cerclage
using the modified Shirodkar method.
Management strategies for the prevention of preterm birth: part II- update on cervical cerclage
. Current Opinion in Obstetrics and Gynecology 2009,21:485-490.
The study excluded women under 18 years of age, and those with a prior history of cervical surgery or cervical cerclage
. Major known complications in the current pregnancy, such as twin-to-twin transfusion syndrome, major congenital anomaly, fetal demise, and any symptoms of labor or late miscarriage were also grounds for exclusion.
A retrospective cohort study was conducted involving all women who underwent emergency cervical cerclage
with polydioxanone sutures at our institution between 2007 and 2015.
The most prevalent predisposing condition was pPROM in 25.2% (31/123) of the patients, followed by pregnancy with a retained IUCD (21.1% [26/123]), pregnancy after IVF (20.3% [25/123]), a history of transabdominal amniocentesis during the current pregnancy (8.9% [11/123]), or cervical cerclage
Various reports have suggested safety of such management particularly with Methotrexate, (6) embolization of Uterine vessels, (7, 8) or Shirodkar cervical cerclage
, (9) followed by dilatation and curettage.
The role of cervical cerclage
in pregnancy outcome in women with uterine anomaly.
Since our study took place prior to these new ACOG recommendations, we had been routinely recording ultrasound (US) parameters including cervical length in an US database to identify patients who were candidates for the only intervention at the time, cervical cerclage
The exclusion criteria were suspected chorioamnionitis (fevergreater than 38.5), vaginal bleeding, history of surgical procedure on the cervix, cervical cerclage
, autoimmune disease, sexual intercourse or use of products that can affect vaginal pH over the past 24 hours, major congenital fetal anomalies that were diagnosed in the previous ultrasound exam or screening tests for the first and second trimester of pregnancy.
In these circumstances, in the absence of labor or intra-amniotic infection, a "rescue" cervical cerclage
may be considered as a last resort (see page 34 for more on cerclage).
Under expert obstetrician Bryan Beattie, at UHW, she underwent a cervical cerclage
at 14 weeks, which, basically, ties a stitch in the cervix to prevent it opening too early.
The mainstay of treatment in developing countries is cervical cerclage
, although the indications and contraindications of this mode of treatment are not documented.