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Ultrasound indicated cerclage: Shirodkar vs. McDonald.
MedLine Citation:
PMID:  22873518     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Abstract Objective: To compare the efficacy of Shirodkar to McDonald cerclage in patients with singleton pregnancies undergoing an ultrasound-indicated cerclage. Methods: Historical cohort of all patients with singleton pregnancies undergoing cerclage for the indication of a short cervix on ultrasound (ultrasound-indicated) at one institution in 2005-2010 We compared outcomes based on cerclage type, Shirodkar or McDonald. Outcome measures were gestational age at delivery, delivery ≥35 weeks, ≥32 weeks, and PPROM. Multivariable regression analysis was performed to control for significant variables. Results: Seventy-four patients with singleton pregnancies underwent an ultrasound-indicated cerclage in the study period (47 Shirodkar, 27 McDonald). Shirodkar was associated with later gestational ages at delivery (mean GA at delivery 36.98 +/- 3.39 weeks vs. 33.34 +/- 6.37,weeks, p=0.006), a higher likelihood of delivering ≥35 weeks (83% vs. 55.6%, p=0.011) and ≥32 weeks (91.5% vs. 59.3%, p=0.001), and a lower likelihood of PPROM (13.0% vs. 46.2%, p=0.002). On adjusted analysis controlling for differing baseline characteristics, Shirodkar remained significantly associated with an increased incidence of delivery ≥32 weeks (OR 5.180, 95% CI 1.024, 26.205). Conclusion: Compared to the McDonald technique, the Shirodkar technique was more effective in prolonging pregnancy in patients with singleton pregnancies undergoing ultrasound-indicated cerclage. A prospective trial is needed to compare these two techniques.
Authors:
Heather Hume; Andrei Rebarber; Daniel H Saltzman; Ashley S Roman; Nathan S Fox
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-9
Journal Detail:
Title:  The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians     Volume:  -     ISSN:  1476-4954     ISO Abbreviation:  J. Matern. Fetal. Neonatal. Med.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101136916     Medline TA:  J Matern Fetal Neonatal Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai School of Medicine, New York University School of Medicine, New York, NY.
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