Document Detail


Does cerclage location influence perinatal outcome?
MedLine Citation:
PMID:  14710099     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The study was undertaken to measure cerclage location within the cervix and to determine whether placement closer to the internal os is related to perinatal outcome. STUDY DESIGN: We analyzed data collected during a randomized trial of cervical cerclage versus no cerclage that was conducted at Lehigh Valley Hospital between May 1998 and June 2001 in women with ultrasound findings of short cervix less than 25 mm or funneling between 16 and 24 weeks' gestation. Women who were randomly assigned to the cerclage arm had cervical measurements performed before cerclage, including dilation of the internal os, depth of membrane prolapse into the endocervical canal, cervical length below any funnel (distal length), and total cervical length (including any funnel). Measurements obtained after cerclage placement included the distance from external os to cerclage (A), and a repeat of the same four measurements. The distance from the external os to the cerclage (A) was divided by the total cervical length (B) and a cerclage to cervical length ratio (A/B) was calculated. The relationship between these measurements and gestational age at birth was assessed by linear regression analysis. RESULTS: Of 150 patients enrolled, 74 received a McDonald cerclage suture. Mean distal cervical length was 1.9+/-0.9 cm before and 2.9+/-1.0 cm after cerclage (P=.001). The mean distance between the cerclage and external os (A) was 1.8+/-0.6 cm; the total cervical length after cerclage (B) was 3.6+/-0.9 cm. The mean cerclage to cervical length ratio (A/B) was 0.5+/-0.1. Linear regression analysis did not demonstrate a correlation between either the cerclage to external os measurement (A) or the cervical length ratio (A/B) and gestational age at birth (R(2)=0.0006 and 0.008, P=.8 and.6, respectively). CONCLUSION: The length of the cervix below the level of cerclage is not related to duration of pregnancy in women treated with cerclage because of ultrasound evidence of cervical effacement.
Authors:
Orion A Rust; Robert O Atlas; Joseph Meyn; Mark Wells; Sharon Kimmel
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  189     ISSN:  0002-9378     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2003 Dec 
Date Detail:
Created Date:  2004-01-07     Completed Date:  2004-01-30     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1688-91     Citation Subset:  AIM; IM    
Affiliation:
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lehigh Valley Hospital and Health Network, CC & I-78, PO Box 689, Allentown, PA 18105-1556, USA. Orion.Rust@LVH.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Cerclage, Cervical / methods*
Cervix Uteri / physiopathology*
Female
Gestational Age
Humans
Incidence
Linear Models
Obstetric Labor, Premature / prevention & control*
Perinatal Care
Pregnancy
Pregnancy Outcome*
Probability
Reference Values
Risk Assessment
Ultrasonography, Prenatal
Uterine Cervical Incompetence / surgery*,  ultrasonography*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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