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Vincenzo Berghella - One of the best experts on this subject based on the ideXlab platform.

  • cervical stitch Cerclage for preventing preterm birth in multiple pregnancy
    Cochrane Database of Systematic Reviews, 2014
    Co-Authors: Timothy J Rafael, Vincenzo Berghella, Zarko Alfirevic
    Abstract:

    Background Cervical Cerclage is a surgical intervention involving placing a stitch around the uterine cervix. The suture material aims to prevent cervical shortening and opening, thereby reducing the risk of preterm birth. The effectiveness and safety of this procedure in multiple gestations remains controversial. Objectives To assess whether the use of a cervical Cerclage in multiple gestations, either at high risk of pregnancy loss based on just the multiple gestation (history-indicated Cerclage), the ultrasound findings of 'short cervix' (ultrasound-indicated Cerclage), or the physical exam changes in the cervix (physical exam-indicated Cerclage), improves obstetrical and perinatal outcomes. The primary outcomes assessed were perinatal deaths, serious neonatal morbidity, and perinatal deaths and serious neonatal morbidity. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2014) and reference lists of retrieved studies. Selection criteria All randomised controlled trials (RCTs) of cervical Cerclage in multiple pregnancies. Quasi-RCTs and RCTs using a cluster-randomised design were eligible for inclusion (but none were identified). Studies using a cross-over design and those presented only as abstracts were not eligible for inclusion. We included studies comparing cervical Cerclage with no cervical Cerclage in multiple pregnancies. Studies comparing cervical stitch versus any other preventative therapy (e.g. progesterone) in multiple pregnancies, and studies involving comparisons between different Cerclage protocols (history-indicated versus ultrasound-indicated versus physical exam-indicated Cerclage) were also eligible for inclusion but none were identified. Data collection and analysis Two review authors independently assessed trials for inclusion and risk of bias. Two review authors extracted data. Data were checked for accuracy. Main results We included five trials, which in total randomised 1577 women, encompassing both singleton and multiple gestations. After excluding singletons, the final analysis included 128 women, of which 122 women had twin gestations, and six women had triplet gestations. Two trials (n = 73 women) assessed history-indicated Cerclage, while three trials (n = 55 women) assessed ultrasound-indicated Cerclage. The five trials were judged to be of average to above average quality, with three of the trials at unclear risk regarding selection and detection biases. Concerning the primary outcomes, when outcomes for Cerclage were pooled together for all indications and compared with no Cerclage, there was no statistically significant differences in perinatal deaths (19.2% versus 9.5%; risk ratio (RR) 1.74, 95% confidence intervals (CI) 0.92 to 3.28, five trials, n = 262), serious neonatal morbidity (15.8% versus 13.6%; average RR 0.96, 95% CI 0.13 to 7.10, three trials, n = 116), or composite perinatal death and neonatal morbidity (40.4% versus 20.3%; average RR 1.54, 95% CI 0.58 to 4.11, three trials, n = 116). Among the secondary outcomes, there were no significant differences between the Cerclage and the no Cerclage groups. To name a few, there were no significant differences among the following: preterm birth less than 34 weeks (average RR 1.16, 95% CI 0.44 to 3.06, four trials, n = 83), preterm birth less than 35 weeks (average RR 1.11, 95% CI 0.58 to 2.14, four trials, n = 83), low birthweight less than 2500 g (average RR 1.10, 95% CI 0.82 to 1.48, four trials, n = 172), very low birthweight less than 1500 g (average RR 1.42, 95% CI 0.52 to 3.85, four trials, n = 172), and respiratory distress syndrome (average RR 1.70, 95% CI 0.15 to 18.77, three trials, n = 116). There were also no significant differences between the Cerclage and no Cerclage groups when examining caesarean section (elective and emergency) (RR 1.24, 95% CI 0.65 to 2.35, three trials, n = 77) and maternal side-effects (RR 3.92, 95% CI 0.17 to 88.67, one trial, n = 28). Examining the differences between prespecified subgroups, ultrasound-indicated Cerclage was associated with an increased risk of low birthweight (average RR 1.39, 95% CI 1.06 to 1.83, Tau² = 0.01, I² = 15%, three trials, n = 98), very low birthweight (average RR 3.31, 95% CI 1.58 to 6.91, Tau² = 0, I² = 0%, three trials, n = 98), and respiratory distress syndrome (average RR 5.07, 95% CI 1.75 to 14.70, Tau² = 0, I² = 0%, three trials, n = 98). However, given the low number of trials, as well as substantial heterogeneity and subgroup differences, these data must be interpreted cautiously. No trials reported on long-term infant neurodevelopmental outcomes. There were no physical exam-indicated Cerclages available for comparison among the studies included. Authors' conclusions This review is based on limited data from five small studies of average to above average quality. For multiple gestations, there is no evidence that Cerclage is an effective intervention for preventing preterm births and reducing perinatal deaths or neonatal morbidity.

  • comparison of 2 stitches vs 1 stitch for transvaginal cervical Cerclage for preterm birth prevention
    American Journal of Obstetrics and Gynecology, 2013
    Co-Authors: Maria Giraldoisaza, Grace P Fried, Sarah E Hegarty, Maria A Suescumdiaz, Arnold W Cohen, Vincenzo Berghella
    Abstract:

    OBJECTIVE: The objective of the study was to compare the efficacy and outcomes of 2 vs 1 stitch at the time of cervical Cerclage placement for preterm birth prevention. STUDY DESIGN: This was a retrospective cohort study of women with singleton gestation undergoing history- or ultrasound-indicated transvaginal cervical Cerclage prior to 24 weeks. The primary outcome was delivery at less than 37 weeks. The secondary outcomes included gestational age at delivery at less than 35, less than 34, less than 32, less than 28, and less than 24 weeks, perioperative details at the time of Cerclage placement and removal, and maternal and neonatal outcomes. Comparison was made between patients with 2 vs 1 stitch at the time of Cerclage placement. History- and ultrasound-indicated Cerclages were analyzed separately. RESULTS: Four hundred forty-four patients met inclusion criteria, 237 being history indicated (2 stitches, n = 86, 1 stitch, n = 151), and 207 ultrasound indicated (2 stitches, n = 117, 1 stitch, n = 90). Gestational age at delivery at less than 37 weeks was not significantly different between the 2 groups for both history- and ultrasound-indicated Cerclage, even after adjusting for demographic differences and suture type (39% vs 35%; adjusted odds ratio, 1.38; 95% confidence interval, 0.64-3.01; and 44% vs 49%; adjusted odds ratio, 0.66; 95% confidence interval, 0.27-1.61, respectively). CONCLUSION: Two stitches at the time of Cerclage do not appear to improve pregnancy outcome either in the history- or the ultrasound-indicated procedures, compared with 1 stitch.

  • Cerclage for the prevention of preterm birth in high risk women receiving intramuscular 17 α hydroxyprogesterone caproate
    Journal of Maternal-fetal & Neonatal Medicine, 2012
    Co-Authors: Jeff M Szychowski, Vincenzo Berghella, John Owen, Gary D V Hankins, Jay D Iams, Jeanne S Sheffield, Annette Perezdelboy, Deborah A Wing, Edwin Guzman
    Abstract:

    Objective: To assess Cerclage benefit in women with short cervix also receiving 17-α-hydroxyprogesterone caproate (17P) to prevent recurrent preterm birth (PTB). Methods: Secondary analysis of a multicenter trial of ultrasound-indicated Cerclage for shortened cervical length (CL). Women with prior spontaneous PTB at 16–33 6/7 weeks, singleton gestation and CL < 25 mm between 16 and 22 6/7 weeks were counseled on use of 17P and randomized to Cerclage or no Cerclage. Outcomes of women who received 17P were analyzed by randomization group. Primary outcome was PTB < 35 weeks. Results: 99 women received 17P: 47 Cerclage; 52 no Cerclage. Rates of PTB < 35 weeks were similar, 30% for Cerclage and 38% for no Cerclage (aOR 0.64 (0.27–1.52)). In women with CL < 15 mm, PTB < 35 weeks was reduced for the Cerclage group (17% vs. 75%, p = 0.02). However, this difference was nullified after controlling for total progesterone doses received (p = 0.40). Conclusions: Cerclage was shown not to offer additional benefit for t...

  • Is Cerclage Height Associated with the Incidence of Preterm Birth in Women with a History-Indicated Cerclage?
    American Journal of Perinatology, 2010
    Co-Authors: Gennady Miroshnichenko, John Visintine, Anju Suhag, Andrew Gerson, Vincenzo Berghella
    Abstract:

    This study was performed to determine if Cerclage height is associated with spontaneous preterm birth in patients with a history-indicated Cerclage. We performed a retrospective cohort study of women with a history-indicated Cerclage. Functional cervical length and the Cerclage height (distance from Cerclage to the external cervical os) were obtained. The cohort was grouped into thirds, based on Cerclage height percentile. Our primary outcome was spontaneous preterm birth

  • Interval to spontaneous delivery after elective removal of Cerclage.
    American Journal of Obstetrics and Gynecology, 2009
    Co-Authors: Maria Bisulli, John Visintine, Anju Suhag, Regina L. Arvon, Jolene Seibel-seamon, Vincenzo Berghella
    Abstract:

    Objective The purpose of this study was to estimate the time interval between elective Cerclage removal and spontaneous delivery. Methods Singleton pregnancies with McDonald Cerclage were evaluated for the interval between elective Cerclage removal (36-37 weeks) and spontaneous delivery. We also compared spontaneous delivery within 48 hours after Cerclage removal between women with ultrasound-indicated vs history-indicated Cerclage. Results We identified 141 women with elective Cerclage removal. The mean interval between removal and delivery was 14 days. Only 11% of women delivered within 48 hours. Women with ultrasound-indicated Cerclage were more likely to deliver within 48 hours, compared with women with history-indicated Cerclage (odds ratio, 5.14; 95% confidence interval, 1.10-24.05). Conclusion The mean interval between elective Cerclage removal and spontaneous delivery is 14 days. Women with Cerclage who achieved 36-37 weeks should be counseled that their chance of spontaneous delivery within 48 hours after elective Cerclage removal is only 11%.

Jack Ludmir - One of the best experts on this subject based on the ideXlab platform.

  • transabdominal Cerclage after comprehensive evaluation of women with previous unsuccessful transvaginal Cerclage
    American Journal of Obstetrics and Gynecology, 2007
    Co-Authors: Robert Debbs, Guillermo Dela A Vega, Stephanie Pearson, Harish M Sehdev, Dominic Marchiano, Jack Ludmir
    Abstract:

    OBJECTIVE: The purpose of this study was to assess the outcome after transabdominal-Cerclage placement during pregnancy in women with previous unsuccessful transvaginal Cerclage. STUDY DESIGN: We conducted a retrospective case series that described pregnancy outcome in women who were treated with transabdominal Cerclage between 1994 and 2006. RESULTS: Seventy-five women with negative evaluation for recurrent pregnancy loss and > or = 1 previous unsuccessful transvaginal Cerclage procedures were treated with transabdominal Cerclage. The median gestational age at the time of Cerclage placement was 13 weeks, and the median gestational age at delivery was 36 weeks. Seventy-two women delivered after 24 weeks of gestation, and 3 women delivered or = 1 failed transvaginal Cerclage, transabdominal Cerclage is an effective procedure.

  • Transabdominal Cerclage after comprehensive evaluation of women with previous unsuccessful transvaginal Cerclage.
    American Journal of Obstetrics and Gynecology, 2007
    Co-Authors: Robert Debbs, Stephanie Pearson, Harish M Sehdev, Dominic Marchiano, Guillermo A. De La Vega, Jack Ludmir
    Abstract:

    Objective The purpose of this study was to assess the outcome after transabdominal-Cerclage placement during pregnancy in women with previous unsuccessful transvaginal Cerclage. Study Design We conducted a retrospective case series that described pregnancy outcome in women who were treated with transabdominal Cerclage between 1994 and 2006. Results Seventy-five women with negative evaluation for recurrent pregnancy loss and ≥1 previous unsuccessful transvaginal Cerclage procedures were treated with transabdominal Cerclage. The median gestational age at the time of Cerclage placement was 13 weeks, and the median gestational age at delivery was 36 weeks. Seventy-two women delivered after 24 weeks of gestation, and 3 women delivered ≤24 weeks of gestation. The fetal-salvage after transabdominal Cerclage was 96%. Conclusion Our findings suggest that, in women with a history of ≥1 failed transvaginal Cerclage, transabdominal Cerclage is an effective procedure.

  • Transabdominal Cerclage after comprehensive evaluation of women with previous unsuccessful transvaginal Cerclage.
    American journal of obstetrics and gynecology, 2007
    Co-Authors: Robert Debbs, Stephanie Pearson, Harish M Sehdev, Dominic Marchiano, Guillermo A Dela Vega, Jack Ludmir
    Abstract:

    The purpose of this study was to assess the outcome after transabdominal-Cerclage placement during pregnancy in women with previous unsuccessful transvaginal Cerclage. We conducted a retrospective case series that described pregnancy outcome in women who were treated with transabdominal Cerclage between 1994 and 2006. Seventy-five women with negative evaluation for recurrent pregnancy loss and > or = 1 previous unsuccessful transvaginal Cerclage procedures were treated with transabdominal Cerclage. The median gestational age at the time of Cerclage placement was 13 weeks, and the median gestational age at delivery was 36 weeks. Seventy-two women delivered after 24 weeks of gestation, and 3 women delivered < or = 24 weeks of gestation. The fetal-salvage after transabdominal Cerclage was 96%. Our findings suggest that, in women with a history of > or = 1 failed transvaginal Cerclage, transabdominal Cerclage is an effective procedure.

Phillip R Bennett - One of the best experts on this subject based on the ideXlab platform.

  • mavric a multicentre randomised controlled trial of transabdominal versus transvaginal cervical Cerclage
    American Journal of Obstetrics and Gynecology, 2020
    Co-Authors: Andrew Shennan, Manju Chandiramani, Phillip R Bennett, Anna L David, Joanna Girling, Alexandra Ridout, Paul T Seed, Nigel Simpson, Steven Thornton, Graham Tydeman
    Abstract:

    ABSTRACT Background Vaginal Cerclage (a suture around the cervix) is commonly placed in women with recurrent pregnancy loss. These women may experience late miscarriage or extreme preterm delivery, despite being managed with Cerclage. Transabdominal Cerclage has been advocated following failed Cerclage, although its efficacy is unproven by randomised controlled trial. Objective The objective of this study was to compare transabdominal Cerclage or high vaginal Cerclage to low vaginal Cerclage in women with a history of failed Cerclage. Our primary outcome was delivery before 32 completed weeks of pregnancy. Study Design This was a multicentre randomised controlled trial. Women were randomly assigned (1:1:1) to receive transabdominal Cerclage, high vaginal Cerclage or low vaginal Cerclage, either prior to conception or before 14 weeks’ gestation. Results 111/139 women recruited who conceived were analysed: 39 to transabdominal Cerclage, 39 to high vaginal Cerclage and 33 to low vaginal Cerclage. Rates of preterm birth No neonatal deaths occurred. In an exploratory analysis, women with transabdominal Cerclage had fewer fetal losses compared to low vaginal Cerclage [3% (1/39) vs 21% (7/33), RR 0.12 (95% CI 0.016 to 0.93), p=0.02]. Number needed to treat to prevent one fetal loss was 5.3 (95% CI 2.9 to 26). Conclusions Transabdominal Cerclage is the treatment of choice for women with failed vaginal Cerclage. It is superior to low vaginal Cerclage in reducing risk of early preterm birth and fetal loss in women with previous failed vaginal Cerclage. High vaginal Cerclage does not confer this benefit. Numbers needed to treat are sufficiently low to justify transabdominal surgery and caesarean delivery required in this select cohort.

  • mavric a multicenter randomized controlled trial of transabdominal vs transvaginal cervical Cerclage
    American Journal of Obstetrics and Gynecology, 2020
    Co-Authors: Andrew Shennan, Manju Chandiramani, Phillip R Bennett, Anna L David, Joanna Girling, Alexandra Ridout, Paul T Seed, Nigel Simpson, Steven Thornton, Graham Tydeman
    Abstract:

    ABSTRACT Background Vaginal Cerclage (a suture around the cervix) is commonly placed in women with recurrent pregnancy loss. These women may experience late miscarriage or extreme preterm delivery, despite being managed with Cerclage. Transabdominal Cerclage has been advocated following failed Cerclage, although its efficacy is unproven by randomised controlled trial. Objective The objective of this study was to compare transabdominal Cerclage or high vaginal Cerclage to low vaginal Cerclage in women with a history of failed Cerclage. Our primary outcome was delivery before 32 completed weeks of pregnancy. Study Design This was a multicentre randomised controlled trial. Women were randomly assigned (1:1:1) to receive transabdominal Cerclage, high vaginal Cerclage or low vaginal Cerclage, either prior to conception or before 14 weeks’ gestation. Results 111/139 women recruited who conceived were analysed: 39 to transabdominal Cerclage, 39 to high vaginal Cerclage and 33 to low vaginal Cerclage. Rates of preterm birth No neonatal deaths occurred. In an exploratory analysis, women with transabdominal Cerclage had fewer fetal losses compared to low vaginal Cerclage [3% (1/39) vs 21% (7/33), RR 0.12 (95% CI 0.016 to 0.93), p=0.02]. Number needed to treat to prevent one fetal loss was 5.3 (95% CI 2.9 to 26). Conclusions Transabdominal Cerclage is the treatment of choice for women with failed vaginal Cerclage. It is superior to low vaginal Cerclage in reducing risk of early preterm birth and fetal loss in women with previous failed vaginal Cerclage. High vaginal Cerclage does not confer this benefit. Numbers needed to treat are sufficiently low to justify transabdominal surgery and caesarean delivery required in this select cohort.

  • Cerclage position cervical length and preterm delivery in women undergoing ultrasound indicated cervical Cerclage a retrospective cohort study
    PLOS ONE, 2017
    Co-Authors: Joanna R Cook, Lindsay M Kindinger, Vasso Terzidou, Andrew Shennan, Manju Chandiramani, Lynne Sykes, T G Teoh, Susan Chatfield, Stefano Cacciatore, Phillip R Bennett
    Abstract:

    OBJECTIVE: The objectives were to assess whether anatomical location of ultrasound (USS) indicated cervical Cerclage and/or the degree of cervical shortening (cervical length; CL) prior to and following Cerclage affects the risk of preterm birth (PTB). METHOD: A retrospective cohort study of 179 women receiving Cerclage for short cervix (≤25mm) was performed. Demographic data, CL before and after Cerclage insertion, height of Cerclage (distance from external os) and gestation at delivery were collected. Relative risk (RR) and odds ratio (OR) of preterm delivery were calculated according to the anatomical location of the Cerclage within the cervix and the CL before and after Cerclage as categorical and continuous variables. Partition tree analysis was used to identify the threshold Cerclage height that best predicts PTB. RESULTS: 25% (n = 45) delivered <34 weeks and 36% (n = 65) delivered <37 weeks. Risk of PTB was greater with Cerclage in the distal 10mm (RR2.37, 95% CI 1.45–3.87) or the distal half of a closed cervix (RR2.16, 95% CI 1.45–3.87). Increasing absolute Cerclage height was associated with a reduction in PTB (OR 0.87, 95% CI 0.82–0.94). A Cerclage height <14.5 mm best predicts PTB (70.8%). Increasing CL following Cerclage was associated with a reduction in PTB (OR0.87, 95% CI 0.82–0.94). Conversely, the risk of PTB was increased where CL remained static or shortened further following Cerclage (RR2.34, 95% CI 1.04–5.25). CONCLUSION: The higher a Cerclage was placed within a shortened cervix, the lower the subsequent odds of PTB. Women whose Cerclage is placed in the distal 10mm of closed cervix or whose cervix fails to elongate subsequently, should remain under close surveillance as they have the highest risk of PTB.

  • Cerclage position, cervical length and preterm delivery in women undergoing ultrasound indicated cervical Cerclage: A retrospective cohort study.
    PloS one, 2017
    Co-Authors: Joanna R Cook, Lindsay M Kindinger, Vasso Terzidou, Andrew Shennan, Manju Chandiramani, Lynne Sykes, T G Teoh, Susan Chatfield, Stefano Cacciatore, Phillip R Bennett
    Abstract:

    OBJECTIVE: The objectives were to assess whether anatomical location of ultrasound (USS) indicated cervical Cerclage and/or the degree of cervical shortening (cervical length; CL) prior to and following Cerclage affects the risk of preterm birth (PTB). METHOD: A retrospective cohort study of 179 women receiving Cerclage for short cervix (≤25mm) was performed. Demographic data, CL before and after Cerclage insertion, height of Cerclage (distance from external os) and gestation at delivery were collected. Relative risk (RR) and odds ratio (OR) of preterm delivery were calculated according to the anatomical location of the Cerclage within the cervix and the CL before and after Cerclage as categorical and continuous variables. Partition tree analysis was used to identify the threshold Cerclage height that best predicts PTB. RESULTS: 25% (n = 45) delivered

  • time interval from elective removal of cervical Cerclage to onset of spontaneous labour
    European Journal of Obstetrics & Gynecology and Reproductive Biology, 2012
    Co-Authors: L Alabiisama, Manju Chandiramani, Phillip R Bennett, Lynne Sykes, Sagar Patel, T G Teoh
    Abstract:

    OBJECTIVE: To determine the time interval between elective removal of a cervical Cerclage to the onset of spontaneous labour in women who had either a history- or ultrasound-indicated cervical Cerclage. STUDY DESIGN: A retrospective cohort study of women with a singleton pregnancy that had either a modified Shirodkar or McDonald cervical Cerclage inserted were evaluated for the time interval between elective Cerclage removal and onset of spontaneous labour and also spontaneous labour with 72 h of cervical Cerclage removal. RESULTS: Two hundred and sixty-nine singleton pregnancies with either a modified Shirodkar or McDonald cervical Cerclage were analysed. The mean gestational age at Cerclage removal was 36.7 ± 1.10 weeks and gestational age at spontaneous labour was 39.0 ± 1.94 weeks (mean ± SD). The median interval between Cerclage removal and spontaneous labour was 14 days. Only 18% of women laboured spontaneously within 72 h. Women with ultrasound-indicated Cerclage were more likely to deliver within 72 h, compared with women with a history-indicated cervical Cerclage (odds ratio, 3.68; 95% confidence interval, 1.31-10.85, p=0.01). CONCLUSION: Independent of the indication or technique used for cervical Cerclage, the rate of early spontaneous labour following elective removal of cervical Cerclage is sufficiently low to justify outpatient management.

Andrew Shennan - One of the best experts on this subject based on the ideXlab platform.

  • mavric a multicentre randomised controlled trial of transabdominal versus transvaginal cervical Cerclage
    American Journal of Obstetrics and Gynecology, 2020
    Co-Authors: Andrew Shennan, Manju Chandiramani, Phillip R Bennett, Anna L David, Joanna Girling, Alexandra Ridout, Paul T Seed, Nigel Simpson, Steven Thornton, Graham Tydeman
    Abstract:

    ABSTRACT Background Vaginal Cerclage (a suture around the cervix) is commonly placed in women with recurrent pregnancy loss. These women may experience late miscarriage or extreme preterm delivery, despite being managed with Cerclage. Transabdominal Cerclage has been advocated following failed Cerclage, although its efficacy is unproven by randomised controlled trial. Objective The objective of this study was to compare transabdominal Cerclage or high vaginal Cerclage to low vaginal Cerclage in women with a history of failed Cerclage. Our primary outcome was delivery before 32 completed weeks of pregnancy. Study Design This was a multicentre randomised controlled trial. Women were randomly assigned (1:1:1) to receive transabdominal Cerclage, high vaginal Cerclage or low vaginal Cerclage, either prior to conception or before 14 weeks’ gestation. Results 111/139 women recruited who conceived were analysed: 39 to transabdominal Cerclage, 39 to high vaginal Cerclage and 33 to low vaginal Cerclage. Rates of preterm birth No neonatal deaths occurred. In an exploratory analysis, women with transabdominal Cerclage had fewer fetal losses compared to low vaginal Cerclage [3% (1/39) vs 21% (7/33), RR 0.12 (95% CI 0.016 to 0.93), p=0.02]. Number needed to treat to prevent one fetal loss was 5.3 (95% CI 2.9 to 26). Conclusions Transabdominal Cerclage is the treatment of choice for women with failed vaginal Cerclage. It is superior to low vaginal Cerclage in reducing risk of early preterm birth and fetal loss in women with previous failed vaginal Cerclage. High vaginal Cerclage does not confer this benefit. Numbers needed to treat are sufficiently low to justify transabdominal surgery and caesarean delivery required in this select cohort.

  • mavric a multicenter randomized controlled trial of transabdominal vs transvaginal cervical Cerclage
    American Journal of Obstetrics and Gynecology, 2020
    Co-Authors: Andrew Shennan, Manju Chandiramani, Phillip R Bennett, Anna L David, Joanna Girling, Alexandra Ridout, Paul T Seed, Nigel Simpson, Steven Thornton, Graham Tydeman
    Abstract:

    ABSTRACT Background Vaginal Cerclage (a suture around the cervix) is commonly placed in women with recurrent pregnancy loss. These women may experience late miscarriage or extreme preterm delivery, despite being managed with Cerclage. Transabdominal Cerclage has been advocated following failed Cerclage, although its efficacy is unproven by randomised controlled trial. Objective The objective of this study was to compare transabdominal Cerclage or high vaginal Cerclage to low vaginal Cerclage in women with a history of failed Cerclage. Our primary outcome was delivery before 32 completed weeks of pregnancy. Study Design This was a multicentre randomised controlled trial. Women were randomly assigned (1:1:1) to receive transabdominal Cerclage, high vaginal Cerclage or low vaginal Cerclage, either prior to conception or before 14 weeks’ gestation. Results 111/139 women recruited who conceived were analysed: 39 to transabdominal Cerclage, 39 to high vaginal Cerclage and 33 to low vaginal Cerclage. Rates of preterm birth No neonatal deaths occurred. In an exploratory analysis, women with transabdominal Cerclage had fewer fetal losses compared to low vaginal Cerclage [3% (1/39) vs 21% (7/33), RR 0.12 (95% CI 0.016 to 0.93), p=0.02]. Number needed to treat to prevent one fetal loss was 5.3 (95% CI 2.9 to 26). Conclusions Transabdominal Cerclage is the treatment of choice for women with failed vaginal Cerclage. It is superior to low vaginal Cerclage in reducing risk of early preterm birth and fetal loss in women with previous failed vaginal Cerclage. High vaginal Cerclage does not confer this benefit. Numbers needed to treat are sufficiently low to justify transabdominal surgery and caesarean delivery required in this select cohort.

  • Cerclage position cervical length and preterm delivery in women undergoing ultrasound indicated cervical Cerclage a retrospective cohort study
    PLOS ONE, 2017
    Co-Authors: Joanna R Cook, Lindsay M Kindinger, Vasso Terzidou, Andrew Shennan, Manju Chandiramani, Lynne Sykes, T G Teoh, Susan Chatfield, Stefano Cacciatore, Phillip R Bennett
    Abstract:

    OBJECTIVE: The objectives were to assess whether anatomical location of ultrasound (USS) indicated cervical Cerclage and/or the degree of cervical shortening (cervical length; CL) prior to and following Cerclage affects the risk of preterm birth (PTB). METHOD: A retrospective cohort study of 179 women receiving Cerclage for short cervix (≤25mm) was performed. Demographic data, CL before and after Cerclage insertion, height of Cerclage (distance from external os) and gestation at delivery were collected. Relative risk (RR) and odds ratio (OR) of preterm delivery were calculated according to the anatomical location of the Cerclage within the cervix and the CL before and after Cerclage as categorical and continuous variables. Partition tree analysis was used to identify the threshold Cerclage height that best predicts PTB. RESULTS: 25% (n = 45) delivered <34 weeks and 36% (n = 65) delivered <37 weeks. Risk of PTB was greater with Cerclage in the distal 10mm (RR2.37, 95% CI 1.45–3.87) or the distal half of a closed cervix (RR2.16, 95% CI 1.45–3.87). Increasing absolute Cerclage height was associated with a reduction in PTB (OR 0.87, 95% CI 0.82–0.94). A Cerclage height <14.5 mm best predicts PTB (70.8%). Increasing CL following Cerclage was associated with a reduction in PTB (OR0.87, 95% CI 0.82–0.94). Conversely, the risk of PTB was increased where CL remained static or shortened further following Cerclage (RR2.34, 95% CI 1.04–5.25). CONCLUSION: The higher a Cerclage was placed within a shortened cervix, the lower the subsequent odds of PTB. Women whose Cerclage is placed in the distal 10mm of closed cervix or whose cervix fails to elongate subsequently, should remain under close surveillance as they have the highest risk of PTB.

  • Cerclage position, cervical length and preterm delivery in women undergoing ultrasound indicated cervical Cerclage: A retrospective cohort study.
    PloS one, 2017
    Co-Authors: Joanna R Cook, Lindsay M Kindinger, Vasso Terzidou, Andrew Shennan, Manju Chandiramani, Lynne Sykes, T G Teoh, Susan Chatfield, Stefano Cacciatore, Phillip R Bennett
    Abstract:

    OBJECTIVE: The objectives were to assess whether anatomical location of ultrasound (USS) indicated cervical Cerclage and/or the degree of cervical shortening (cervical length; CL) prior to and following Cerclage affects the risk of preterm birth (PTB). METHOD: A retrospective cohort study of 179 women receiving Cerclage for short cervix (≤25mm) was performed. Demographic data, CL before and after Cerclage insertion, height of Cerclage (distance from external os) and gestation at delivery were collected. Relative risk (RR) and odds ratio (OR) of preterm delivery were calculated according to the anatomical location of the Cerclage within the cervix and the CL before and after Cerclage as categorical and continuous variables. Partition tree analysis was used to identify the threshold Cerclage height that best predicts PTB. RESULTS: 25% (n = 45) delivered

Manju Chandiramani - One of the best experts on this subject based on the ideXlab platform.

  • mavric a multicentre randomised controlled trial of transabdominal versus transvaginal cervical Cerclage
    American Journal of Obstetrics and Gynecology, 2020
    Co-Authors: Andrew Shennan, Manju Chandiramani, Phillip R Bennett, Anna L David, Joanna Girling, Alexandra Ridout, Paul T Seed, Nigel Simpson, Steven Thornton, Graham Tydeman
    Abstract:

    ABSTRACT Background Vaginal Cerclage (a suture around the cervix) is commonly placed in women with recurrent pregnancy loss. These women may experience late miscarriage or extreme preterm delivery, despite being managed with Cerclage. Transabdominal Cerclage has been advocated following failed Cerclage, although its efficacy is unproven by randomised controlled trial. Objective The objective of this study was to compare transabdominal Cerclage or high vaginal Cerclage to low vaginal Cerclage in women with a history of failed Cerclage. Our primary outcome was delivery before 32 completed weeks of pregnancy. Study Design This was a multicentre randomised controlled trial. Women were randomly assigned (1:1:1) to receive transabdominal Cerclage, high vaginal Cerclage or low vaginal Cerclage, either prior to conception or before 14 weeks’ gestation. Results 111/139 women recruited who conceived were analysed: 39 to transabdominal Cerclage, 39 to high vaginal Cerclage and 33 to low vaginal Cerclage. Rates of preterm birth No neonatal deaths occurred. In an exploratory analysis, women with transabdominal Cerclage had fewer fetal losses compared to low vaginal Cerclage [3% (1/39) vs 21% (7/33), RR 0.12 (95% CI 0.016 to 0.93), p=0.02]. Number needed to treat to prevent one fetal loss was 5.3 (95% CI 2.9 to 26). Conclusions Transabdominal Cerclage is the treatment of choice for women with failed vaginal Cerclage. It is superior to low vaginal Cerclage in reducing risk of early preterm birth and fetal loss in women with previous failed vaginal Cerclage. High vaginal Cerclage does not confer this benefit. Numbers needed to treat are sufficiently low to justify transabdominal surgery and caesarean delivery required in this select cohort.

  • mavric a multicenter randomized controlled trial of transabdominal vs transvaginal cervical Cerclage
    American Journal of Obstetrics and Gynecology, 2020
    Co-Authors: Andrew Shennan, Manju Chandiramani, Phillip R Bennett, Anna L David, Joanna Girling, Alexandra Ridout, Paul T Seed, Nigel Simpson, Steven Thornton, Graham Tydeman
    Abstract:

    ABSTRACT Background Vaginal Cerclage (a suture around the cervix) is commonly placed in women with recurrent pregnancy loss. These women may experience late miscarriage or extreme preterm delivery, despite being managed with Cerclage. Transabdominal Cerclage has been advocated following failed Cerclage, although its efficacy is unproven by randomised controlled trial. Objective The objective of this study was to compare transabdominal Cerclage or high vaginal Cerclage to low vaginal Cerclage in women with a history of failed Cerclage. Our primary outcome was delivery before 32 completed weeks of pregnancy. Study Design This was a multicentre randomised controlled trial. Women were randomly assigned (1:1:1) to receive transabdominal Cerclage, high vaginal Cerclage or low vaginal Cerclage, either prior to conception or before 14 weeks’ gestation. Results 111/139 women recruited who conceived were analysed: 39 to transabdominal Cerclage, 39 to high vaginal Cerclage and 33 to low vaginal Cerclage. Rates of preterm birth No neonatal deaths occurred. In an exploratory analysis, women with transabdominal Cerclage had fewer fetal losses compared to low vaginal Cerclage [3% (1/39) vs 21% (7/33), RR 0.12 (95% CI 0.016 to 0.93), p=0.02]. Number needed to treat to prevent one fetal loss was 5.3 (95% CI 2.9 to 26). Conclusions Transabdominal Cerclage is the treatment of choice for women with failed vaginal Cerclage. It is superior to low vaginal Cerclage in reducing risk of early preterm birth and fetal loss in women with previous failed vaginal Cerclage. High vaginal Cerclage does not confer this benefit. Numbers needed to treat are sufficiently low to justify transabdominal surgery and caesarean delivery required in this select cohort.

  • Cerclage position cervical length and preterm delivery in women undergoing ultrasound indicated cervical Cerclage a retrospective cohort study
    PLOS ONE, 2017
    Co-Authors: Joanna R Cook, Lindsay M Kindinger, Vasso Terzidou, Andrew Shennan, Manju Chandiramani, Lynne Sykes, T G Teoh, Susan Chatfield, Stefano Cacciatore, Phillip R Bennett
    Abstract:

    OBJECTIVE: The objectives were to assess whether anatomical location of ultrasound (USS) indicated cervical Cerclage and/or the degree of cervical shortening (cervical length; CL) prior to and following Cerclage affects the risk of preterm birth (PTB). METHOD: A retrospective cohort study of 179 women receiving Cerclage for short cervix (≤25mm) was performed. Demographic data, CL before and after Cerclage insertion, height of Cerclage (distance from external os) and gestation at delivery were collected. Relative risk (RR) and odds ratio (OR) of preterm delivery were calculated according to the anatomical location of the Cerclage within the cervix and the CL before and after Cerclage as categorical and continuous variables. Partition tree analysis was used to identify the threshold Cerclage height that best predicts PTB. RESULTS: 25% (n = 45) delivered <34 weeks and 36% (n = 65) delivered <37 weeks. Risk of PTB was greater with Cerclage in the distal 10mm (RR2.37, 95% CI 1.45–3.87) or the distal half of a closed cervix (RR2.16, 95% CI 1.45–3.87). Increasing absolute Cerclage height was associated with a reduction in PTB (OR 0.87, 95% CI 0.82–0.94). A Cerclage height <14.5 mm best predicts PTB (70.8%). Increasing CL following Cerclage was associated with a reduction in PTB (OR0.87, 95% CI 0.82–0.94). Conversely, the risk of PTB was increased where CL remained static or shortened further following Cerclage (RR2.34, 95% CI 1.04–5.25). CONCLUSION: The higher a Cerclage was placed within a shortened cervix, the lower the subsequent odds of PTB. Women whose Cerclage is placed in the distal 10mm of closed cervix or whose cervix fails to elongate subsequently, should remain under close surveillance as they have the highest risk of PTB.

  • Cerclage position, cervical length and preterm delivery in women undergoing ultrasound indicated cervical Cerclage: A retrospective cohort study.
    PloS one, 2017
    Co-Authors: Joanna R Cook, Lindsay M Kindinger, Vasso Terzidou, Andrew Shennan, Manju Chandiramani, Lynne Sykes, T G Teoh, Susan Chatfield, Stefano Cacciatore, Phillip R Bennett
    Abstract:

    OBJECTIVE: The objectives were to assess whether anatomical location of ultrasound (USS) indicated cervical Cerclage and/or the degree of cervical shortening (cervical length; CL) prior to and following Cerclage affects the risk of preterm birth (PTB). METHOD: A retrospective cohort study of 179 women receiving Cerclage for short cervix (≤25mm) was performed. Demographic data, CL before and after Cerclage insertion, height of Cerclage (distance from external os) and gestation at delivery were collected. Relative risk (RR) and odds ratio (OR) of preterm delivery were calculated according to the anatomical location of the Cerclage within the cervix and the CL before and after Cerclage as categorical and continuous variables. Partition tree analysis was used to identify the threshold Cerclage height that best predicts PTB. RESULTS: 25% (n = 45) delivered

  • time interval from elective removal of cervical Cerclage to onset of spontaneous labour
    European Journal of Obstetrics & Gynecology and Reproductive Biology, 2012
    Co-Authors: L Alabiisama, Manju Chandiramani, Phillip R Bennett, Lynne Sykes, Sagar Patel, T G Teoh
    Abstract:

    OBJECTIVE: To determine the time interval between elective removal of a cervical Cerclage to the onset of spontaneous labour in women who had either a history- or ultrasound-indicated cervical Cerclage. STUDY DESIGN: A retrospective cohort study of women with a singleton pregnancy that had either a modified Shirodkar or McDonald cervical Cerclage inserted were evaluated for the time interval between elective Cerclage removal and onset of spontaneous labour and also spontaneous labour with 72 h of cervical Cerclage removal. RESULTS: Two hundred and sixty-nine singleton pregnancies with either a modified Shirodkar or McDonald cervical Cerclage were analysed. The mean gestational age at Cerclage removal was 36.7 ± 1.10 weeks and gestational age at spontaneous labour was 39.0 ± 1.94 weeks (mean ± SD). The median interval between Cerclage removal and spontaneous labour was 14 days. Only 18% of women laboured spontaneously within 72 h. Women with ultrasound-indicated Cerclage were more likely to deliver within 72 h, compared with women with a history-indicated cervical Cerclage (odds ratio, 3.68; 95% confidence interval, 1.31-10.85, p=0.01). CONCLUSION: Independent of the indication or technique used for cervical Cerclage, the rate of early spontaneous labour following elective removal of cervical Cerclage is sufficiently low to justify outpatient management.