Startseite Extremely short cervix in the second trimester: bed rest or modified Shirodkar cerclage?
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Extremely short cervix in the second trimester: bed rest or modified Shirodkar cerclage?

  • Daniel W. Skupski EMAIL logo , Stephanie N. Lin , Jonathan Reiss und Gary S. Eglinton
Veröffentlicht/Copyright: 8. August 2013
Journal of Perinatal Medicine
Aus der Zeitschrift Journal of Perinatal Medicine Band 42 Heft 1

Abstract

Objective: The objective of this study was to compare modified Shirodkar cerclage to bed rest for treatment of the midtrimester extremely short cervix.

Methods: This study used a concurrent retrospective cohort design at two institutions over the same period, 2000–2010. Patients were included at both institutions when midtrimester endovaginal ultrasound cervical length was ≤15 mm and had modified Shirodkar cerclage (cerclage group) at New York Hospital Queens and bed rest (control group) at Weill Cornell Medical Center. Cerclage was placed as high on the cervix as possible. Indomethacin and antibiotics were used perioperatively.

Results: The cerclage group included 112 patients and the control group included 55 patients. Median postoperative cervical length in the cerclage group was 3.3 cm (interquartile range 3.0–3.6). Cerclage patients were less likely to deliver preterm at 37, 35, 32, and 28 weeks (P=0.0066, 0.0004, 0.0023, and 0.03 respectively) and had longer latency (median 120 vs. 94 days P<0.0001). Kaplan-Meier survival curve showed a significant benefit in favor of cerclage (P=0.0043).

Conclusions: Our data suggest that modified Shirodkar cerclage as high as possible on the cervix with perioperative indomethacin and antibiotics is superior to bed rest for treatment of the midtrimester extremely short cervix (≤15 mm). We propose a randomized trial of this specific technique.

Keywords: Bed rest; cerclage; preterm birth; short cervix
Corresponding author: Daniel W. Skupski, MD, Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York Hospital Queens, Room M-365, 56-45 Main Street, Flushing, NY 11355, USA, Tel.: +1-718-670-1495, Fax: +1-718-539-1669, E-mail:

References

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The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2013-4-25
Accepted: 2013-7-8
Published Online: 2013-08-08
Published in Print: 2014-01-01

©2014 by Walter de Gruyter Berlin Boston

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https://doi.org/10.1515/jpm-2013-0092
Schlagwörter für diesen Artikel
Bed rest; cerclage; preterm birth; short cervix

Artikel in diesem Heft

  1. Masthead
  2. Masthead
  3. Recommendation and Guidelines for Perinatal Practice
  4. Inactivation of high-risk human papillomaviruses by Holder pasteurization: implications for donor human milk banking
  5. Review article
  6. Breastfeeding is natural but not always easy: intervention for common medical problems of breastfeeding mothers – a review of the scientific evidence
  7. Original article – Obstetrics
  8. Maternal mortality due to pandemic influenza A H1N1 2009 virus in Colombia
  9. Commentary
  10. Maternal mortality due to pandemic influenza A H1N1 2009 virus in Colombia
  11. Original articles – Obstetrics
  12. The peripheral whole-blood transcriptome of acute pyelonephritis in human pregnancya
  13. Extremely short cervix in the second trimester: bed rest or modified Shirodkar cerclage?
  14. The importance of repeated measurements of the sFlt-1/PlGF ratio for the prediction of preeclampsia and intrauterine growth restriction
  15. Does the presence of thyroid antibodies affect the course and outcome of pregnancy in type 1 diabetic women?
  16. The impact of perinatal death on obstetrics nurses: a longitudinal and cross-sectional examination
  17. Effect of high-fat diet prior to pregnancy on hepatic gene expression and histology in mouse offspring
  18. The prevalence and clinical features of twin-twin transfusion syndrome with onset during the third trimester
  19. Original article – Newborn
  20. Short and medium-term outcomes of live-born twins after fetoscopic laser therapy for twin-twin transfusion syndromea
  21. Original article – Fetus
  22. Fetal volume at 11–14 gestational weeks: reference ranges and association with first trimester biochemical and biophysical markers
  23. Original articles – Newborn
  24. Resuscitation at birth in neonates with meningomyelocele
  25. Steroid profiling for congenital adrenal hyperplasia by tandem mass spectrometry as a second-tier test reduces follow-up burdens in a tertiary care hospital: A retrospective and prospective evaluation
  26. Influence of antenatal magnesium sulfate application on cord blood levels of brain-derived neurotrophic factor in premature infants
  27. Short communication
  28. Hepatitis C virus-associated thrombocytopenia in pregnancy: impact upon multidisciplinary care provision
  29. Congress Calendar
  30. Congress Calendar
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