Skip to main content
SpringerLink
Log in

A comparison of pregnancy outcome of modified transvaginal cervicoisthmic cerclage performed prior to and during pregnancy

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To compare the pregnancy outcome of the modified transvaginal cerclage performed preconception and during pregnancy.

Methods

A retrospective trial was carried out in the Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital in Zhejiang, China. A total of 604 women with cervical incompetence underwent the cerclage, and the time of the operation was decided by the patients or depended on when the patient presented. Main outcome measures were the gestational age and the fetal outcome.

Results

After the cerclage, the mean gestational age at delivery and the term delivery rate were significantly higher in history-indicated conception cerclage compared to preconception cerclage (36.8 ± 3.7 vs 35.8 ± 4.7, p < 0.01; 76.1 vs 66.9%, p < 0.05). The mean gestational age at delivery and the term delivery rate were significantly higher in ultrasound-indicated compared to physical examination-indicated conception cerclage (35.0 ± 5.7 vs 31.0 ± 5.5, p < 0.01; 63.2 vs 23.3%, p < 0.001). The fetal survival rate had no difference in these two comparisons, respectively.

Conclusions

The modified transvaginal cervicoisthmic cerclage is a promising and safe technique to improve obstetric outcomes in women with cervical incompetence in different cerclage indications, and history-indicated conception cerclage appears to have better pregnancy outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Simcox R, Shennan A (2007) Cervical cerclage in the prevention of preterm birth. Best Pract Res Clin Obstet Gynaecol 21(5):831–842

    Article  PubMed  Google Scholar 

  2. Shirodkar V (1955) A new method of operative treatment for habitual abortion in the second trimester of the pregnancy. Antiseptic 52:299–300

    Google Scholar 

  3. McDonald IA (1957) Suture of the cervix for inevitable miscarriage. J Obstet Gynaecol Br Emp 64(3):346–350

    Article  CAS  PubMed  Google Scholar 

  4. Benson RC, Durfee RB (1965) Transabdominal cervico uterine cerclage during pregnancy for the treatment of cervical incompetency. Obstet Gynecol 25:145–155

    CAS  PubMed  Google Scholar 

  5. Berghella V, Ludmir J, Simonazzi G, Owen J (2013) Transvaginal cervical cerclage: evidence for perioperative management strategies. Am J Obstet Gynecol 209(3):181–192

    Article  PubMed  Google Scholar 

  6. Tusheva OA, Cohen SL, McElrath TF, Einarsson JI (2012) Laparoscopic placement of cervical cerclage. Rev Obstet Gynecol 5(3–4):e158–e165

    PubMed  PubMed Central  Google Scholar 

  7. Audu BM, Chama CM, Kyari OA (2003) Complications of cervical cerclage in women with cervical incompetence. Int J Gynaecol Obstet 83(3):299–300

    Article  CAS  PubMed  Google Scholar 

  8. Ades A, May J, Cade TJ, Umstad MP (2014) Laparoscopic transabdominal cervical cerclage: a 6-year experience. Aust N Z J Obstet Gynaecol 54(2):117–120

    Article  PubMed  Google Scholar 

  9. Jin XY, Kuang L, Lin XN, Huang D, Zhang SY (2009) Cervical cerclage before blastocyst transfer in patients having cryopreserved embryo transfer. Fertil Steril 92(1):392 e9–392 e12

    Article  Google Scholar 

  10. Owen J, Hankins G, Iams JD, Berghella V, Sheffield JS, Perez-Delboy A et al (2009) Multicenter randomized trial of cerclage for preterm birth prevention in high-risk women with shortened midtrimester cervical length. Am J Obstet Gynecol 201(4):375 e1–375 e8

    Article  Google Scholar 

  11. Gundabattula SR, Marakani LR, Dasari S, Surampudi K, Pochiraju M, Nirmalan PK (2013) Outcomes of pregnancy in women who had rescue cerclage for cervical insufficiency: a single-center retrospective study. J Obstet Gynaecol Res 39(8):1293–1300

    Article  PubMed  Google Scholar 

  12. Rebarber A, Bender S, Silverstein M, Saltzman DH, Klauser CK, Fox NS (2014) Outcomes of emergency or physical examination-indicated cerclage in twin pregnancies compared to singleton pregnancies. Eur J Obstet Gynecol Reprod Biol 173:43–47

    Article  PubMed  Google Scholar 

  13. Chen Y, Liu H, Gu J, Yao S (2015) Therapeutic effect and safety of laparoscopic cervical cerclage for treatment of cervical insufficiency in first trimester or non-pregnant phase. Int J Clin Exp Med 8(5):7710–7718

    PubMed  PubMed Central  Google Scholar 

  14. Vetr M (2008) Cervical cerclage. Results of the last ten year period (1997–2008) in Faculty Hospital Olomouc. Ceska Gynekol 73(4):209–213

    CAS  PubMed  Google Scholar 

  15. Debby A, Sadan O, Glezerman M, Golan A (2007) Favorable outcome following emergency second trimester cerclage. Int J Gynaecol Obstet 96(1):16–19

    Article  CAS  PubMed  Google Scholar 

  16. Witt MU, Joy SD, Clark J, Herring A, Bowes WA, Thorp JM (2009) Cervicoisthmic cerclage: transabdominal vs transvaginal approach. Am J Obstet Gynecol 201(1):105 e1–105 e4 (PMCID: 3157044)

    Article  Google Scholar 

  17. Nicolet G, Cohen M, Begue L, Reyftmann L, Boulot P, Dechaud H (2009) Laparoscopic cervico-isthmic cerclage evaluation. Gynecol Obstet Fertil 37(4):294–299

    Article  CAS  PubMed  Google Scholar 

  18. Luo L, Chen SQ, Jiang HY, Niu G, Wang Q, Yao SZ (2014) Successful treatment of cervical incompetence using a modified laparoscopic cervical cerclage technique: a cohort study. Eur J Obstet Gynecol Reprod Biol 179:125–129

    Article  PubMed  Google Scholar 

  19. Mingione MJ, Scibetta JJ, Sanko SR, Phipps WR (2003) Clinical outcomes following interval laparoscopic transabdominal cervico-isthmic cerclage placement: case series. Hum Reprod 18(8):1716–1719

    Article  CAS  PubMed  Google Scholar 

  20. Foster TL, Moore ES, Sumners JE (2011) Operative complications and fetal morbidity encountered in 300 prophylactic transabdominal cervical cerclage procedures by one obstetric surgeon. J Obstet Gynaecol 31(8):713–717

    Article  CAS  PubMed  Google Scholar 

  21. Slattery MM, Morrison JJ (2002) Preterm delivery. Lancet 360(9344):1489–1497

    Article  PubMed  Google Scholar 

  22. Agrawal V, Hirsch E (2012) Intrauterine infection and preterm labor. Semin Fetal Neonatal Med 17(1):12–19 (PMCID: 3242863)

    Article  PubMed  Google Scholar 

  23. Rust OA, Atlas RO, Meyn J, Wells M, Kimmel S (2003) Does cerclage location influence perinatal outcome? Am J Obstet Gynecol 189(6):1688–1691

    Article  PubMed  Google Scholar 

  24. Funai EF, Paidas MJ, Rebarber A, O’Neill L, Rosen TJ, Young BK (1999) Change in cervical length after prophylactic cerclage. Obstet Gynecol 94(1):117–119

    CAS  PubMed  Google Scholar 

  25. Debbs RH, DeLa Vega GA, Pearson S, Sehdev H, Marchiano D, Ludmir J (2007) Transabdominal cerclage after comprehensive evaluation of women with previous unsuccessful transvaginal cerclage. Am J Obstet Gynecol 197(3):317 e1–317 e4

    Article  Google Scholar 

Download references

Funding

This study was sponsored by The Key Research and Development Program of Zhejiang Province (2017C03022) and The National Natural Science Foundation of China (81401264).

Author information

Authors and Affiliations

  1. Assisted Reproduction Unit, Department of Obstetrics and Gynecology, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou, 310016, People’s Republic of China

    Minling Wei, Xiaoying Jin, Cuiyu Yang, Dong Huang & Songying Zhang

  2. Department of Obstetrics and Gynecology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, People’s Republic of China

    T. C. Li

Authors
  1. Minling Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiaoying Jin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. C. Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cuiyu Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dong Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Songying Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MW contributed to data collection, data analysis, manuscript writing. XJ and CY helped with data collection. TL was involved in data presentation, manuscript writing. DH helped with data analysis. SZ contributed to project management, operation performed.

Corresponding author

Correspondence to Songying Zhang.

Ethics declarations

Conflict of interest

We declare no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wei, M., Jin, X., Li, T.C. et al. A comparison of pregnancy outcome of modified transvaginal cervicoisthmic cerclage performed prior to and during pregnancy. Arch Gynecol Obstet 297, 645–652 (2018). https://doi.org/10.1007/s00404-017-4636-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-017-4636-x

Keywords

Search

Navigation