Abstract
Aim: We aimed to determine the factors affecting the success of
prophylactic cerclage the role of which is controversial in preventing preterm labor in singleton pregnant women.
Material and Method: In this study main criterion of which for the
failure of cerclage was early preterm delivery before the 32 week
cases with prophylactic cerclage in one center were examined retrospectively. As an indication for prophylactic cerclage, patients
with two or more late miscarriage history or in patients with story of
early preterm delivery while the ultrasound scan of the cervix was
shorter than 25 mm in the current pregnancy. Age, BMI, uterine
intervention story, miscarriage story in second trimester, history
of the conization, positive vaginal culture before cerclage, gestational week during cerclage, CRP levels one week after cerclage
and changes in cervical length in ultrasonography two weeks after
cerclage were tested. Descriptive statistics and binary logistic regression analyzes were performed.
Results: Cervical cerclage was applied to 152 women between
2011 and 2018.54 singleton pregnancies whose clinical follow-up
was regular, McDonald’s prophylactic cerclage was administered
and thus meet the study criteria were included in the study. The
multivariate analyzes in our study showed that following factors
were independent prognostic factors for the failure of cerclage;
history of cerclage in previous pregnancy [OR=2.124 (1.846–4.111)
p=0.016], administration of cerclage after the 20th gestational
week [OR=1.126 (1.020–1.232) p=0.04] and the uterus instrumentation story [OR=1.342 (1.214, 7.873) p=0.015].
Conclusion: This study showed that past uterine interventions,
presence of cerclage anamnesis and intervention after 20 weeks
of gestation were independent risk factors for cerclage success.
Uterine instrumentation has significant clinical consequences
therefore, women who are considered for surgical curettage
should be informed about potential risks and medical management or cervical ripening should be considered.
References
- 1. Noori M, Helmig RB, Hein M, Steer PJ. Could a cervical occlusion suture be efective at improving perinatal outcome. BJOG Int J Obstet Gynaecol 2007;114:532–536. 2. Sneider K, Christiansen OB, Sundtoft IB, Langhoff-Roos J. Recurrence rates after abdominal and vaginal cerclages in women with cervical insufficiency: a validated cohort study. Arch Gynecol Obstet 2017;295:859–866. 3. Ragab A, Mesbah Y. To do or not to do emergency cervical cerclage (a rescue stitch) at 24–28 weeks gestation in addition to progesterone for patients coming early in labor? A prospective randomized trial for efficacy and safety. Arch Gynecol Obstet 2015;292:1255–1260. 4. Abbott D, To M, Shennan A. Cervical cerclage: a review of current evidence. Aust N Z J Obstet Gynaecol 2012;52:220–223. 5. Berghella V, Ciardulli A, Rust OA, To M, Otsuki K, Althuisius S et al. Cerclage for Short Cervix on Ultrasound in Singleton Gestations without Prior Spontaneous Preterm Birth: a Systematic Review and Meta-analysis of Trials using individual patient-level data. Ultrasound in Obstetrics & Gynecology 2017;50:569–577. 6. Yim HJ, Song JE, Kim JE, Son GH, Lee KY. Preoperative and postoperative serum C-reactive protein levels to predict the outcome of ultrasound-indicated cerclage. Obstet Gynecol Sci 2016;59:97–102. 7. Campbell, S. Prevention of spontaneous preterm birth: universal cervical length assessment and vaginal progesterone in women with a short cervix: time for action! American Journal of Obstetrics and Gynecology, 2018:151–158. 8. Owen J, Hankins G, Iams JD, Berghella V, Sheffield JS, PerezDelboy A et al. Multicenter randomized trial of cerclage for preterm birth prevention in high-risk women with shortened midtrimester cervical length. Am J Obstet Gynecol 2009;201(375): e371-e378. 9. Hui SY, Chor CM, Lau TK, Lao TT, Leung TY. Cerclage pessary for preventing preterm birth in women with a singleton pregnancy and a short cervix at 20–24 weeks: a randomized controlled trial. Am J Perinatol 2013;30:283–288. 10. Song RK, Cha HH, Shin MY, Choi SJ, Oh SY, Kim JH et al. Post-cerclage ultrasonographic cervical length can predict preterm delivery in elective cervical cerclage patients. Obstet Gynecol Sci 2016;59:17–23. 11. Taghavi K, Gasparri M L, Bolla D, Surbek D. Predictors of cerclage failure in patients with singleton pregnancy undergoing prophylactic cervical cerclage. Archives of Gynecology and Obstetric 2018;297:347–352. 12. Owen J, Szychowski J. Association between post-randomization sonographic cervical length and birth gestational age in a multicenter trial of ultrasound-indicated cerclage. Am J Obstet Gynecol 2009;201: S197. 13. Lemmers M, Verschoor MA, Hooker AB, Opmeer BC, Limpens J, Huirne JA et al. Dilatation and curettage increases the risk of subsequent preterm birth: a systematic review and meta-analysis. Hum Reprod 2016;31:34–45. 14. Yim HJ, Song JE, Kim JE, Son GH, Lee KY. Preoperative and postoperative serum C-reactive protein levels to predict the outcome of ultrasound-indicated cerclage. Obstet Gynecol 2016;59:97–102. 15. Song RK, Cha HH, Shin MY, Choi SJ, Oh SY, Kim JH et al. Post-cerclage ultrasonographic cervical length can predict preterm delivery in elective cervical cerclage patients. Obstet Gynecol 2016;59:17–23. 16. Drassinower D, Vink J, Zork N, Pessel C, Vani K, Brubaker SG et al. Does the rate of cervical shortening after cerclage predict preterm birth? J Matern Fetal Neonatal Med 2016;29:2233– 2239. 17. Dijkstra K, Funai EF, O’Neill L, Rebarber A, Paidas MJ, Young BK. Change in cervical length after cerclage as a predictor of preterm delivery. Obstet Gynecol 2000;96:346–350.
Abstract
Amaç: Preterm doğumu önlemedeki rolü tartışmalı olan profilaktik serklajın tekil gebe kadınlardaki başarısını etkileyen faktörleri
belirlemeyi amaçladık.
Materyal ve Metot: Serklaj başarısızlığının ana ölçütü 32 haftadan önce erken preterm doğum olan bu çalışmada tek merkezde
proflaktik servikal serklaj uygulanan vakalar retrospektif olarak incelendi. Profilaktik serklaj için endikasyon olarak, ya önceki gebelikte iki ya da daha fazla geç düşük öyküsü ya da erken preterm
doğum öyküsü olan hastalarda mevcut gebeliğinde transvajinal
ultrasonda serviksin 25 mm kısa olması kriterleri arandı. Başarıyı
öngören faktörler olarak yaş, vücut kitle indeksi, uterin müdahale öyküsü, ikinci trimestırdaki düşük hikayesi, geçirilmiş konizasyon, serklaj öncesi pozitif vajinal kültür, serklajın yapıldığı gebelik
haftası, serklajdan bir hafta sonraki C-reaktif protein düzeyleri ve
transvajinal ultrasonografi ile serklajdan iki hafta sonraki servikal
uzunluktaki değişikler test edildi. Tanımlayıcı istatistikler ve ikili
lojistik regresyon analizleri yapıldı.
Bulgular: 152 kadına 2011 ve 2018 yılları arasında servikal serklaj uygulandı. Klinik takipleri düzenli, McDonald usulü profilaktik
serklaj atılan ve böylece çalışma kriterlerini karşılayan 54 tekil gebeliği olan hasta çalışmaya dahil edildi. Çalışmamızda çok değişkenli analizler, serklajın başarısızlığı için önceki gebeliğinde serklaj atılmasının [OR=2,124 (1,846–4,111) p=0,016], serklajın 20.
gebelik haftasından sonra atılmasının [OR=1,126 (1,020–1,232)
p=0,04] ve uterus enstrümantasyonu hikayesinin [OR=1,342
(1,214, 7,873) p=0,015] bağımsız öngörücüsü faktörler olduğunu
gösterdi. Proflaktik serklaj uygulanan hastaların 33 ‘ü (%61) 32
haftadan sonra doğurdu.
Sonuç: Bu çalışma geçirilmiş uterin müdahalelerin, serklaj öykünün varlığının ve 20 gebelik haftasından sonra yapılan uygulamanın proflaktik serklaj başarısında bağımsız risk faktörleri
olduğunu gösterdi. Uterin enstrümantasyonun özellikle düşük/
düşük yönetiminin göz önünde bulundurulması durumunda doğurganlık çağındaki kadınlar için anlamlı klinik sonuçları vardır.
Dolayısıyla cerrahi tahliye düşünülen kadınlar potansiyel riskler
hakkında bilgilendirilmeli ve tıbbi yönetim veya servikal olgunlaştırma düşünülmelidir.
References
- 1. Noori M, Helmig RB, Hein M, Steer PJ. Could a cervical occlusion suture be efective at improving perinatal outcome. BJOG Int J Obstet Gynaecol 2007;114:532–536. 2. Sneider K, Christiansen OB, Sundtoft IB, Langhoff-Roos J. Recurrence rates after abdominal and vaginal cerclages in women with cervical insufficiency: a validated cohort study. Arch Gynecol Obstet 2017;295:859–866. 3. Ragab A, Mesbah Y. To do or not to do emergency cervical cerclage (a rescue stitch) at 24–28 weeks gestation in addition to progesterone for patients coming early in labor? A prospective randomized trial for efficacy and safety. Arch Gynecol Obstet 2015;292:1255–1260. 4. Abbott D, To M, Shennan A. Cervical cerclage: a review of current evidence. Aust N Z J Obstet Gynaecol 2012;52:220–223. 5. Berghella V, Ciardulli A, Rust OA, To M, Otsuki K, Althuisius S et al. Cerclage for Short Cervix on Ultrasound in Singleton Gestations without Prior Spontaneous Preterm Birth: a Systematic Review and Meta-analysis of Trials using individual patient-level data. Ultrasound in Obstetrics & Gynecology 2017;50:569–577. 6. Yim HJ, Song JE, Kim JE, Son GH, Lee KY. Preoperative and postoperative serum C-reactive protein levels to predict the outcome of ultrasound-indicated cerclage. Obstet Gynecol Sci 2016;59:97–102. 7. Campbell, S. Prevention of spontaneous preterm birth: universal cervical length assessment and vaginal progesterone in women with a short cervix: time for action! American Journal of Obstetrics and Gynecology, 2018:151–158. 8. Owen J, Hankins G, Iams JD, Berghella V, Sheffield JS, PerezDelboy A et al. Multicenter randomized trial of cerclage for preterm birth prevention in high-risk women with shortened midtrimester cervical length. Am J Obstet Gynecol 2009;201(375): e371-e378. 9. Hui SY, Chor CM, Lau TK, Lao TT, Leung TY. Cerclage pessary for preventing preterm birth in women with a singleton pregnancy and a short cervix at 20–24 weeks: a randomized controlled trial. Am J Perinatol 2013;30:283–288. 10. Song RK, Cha HH, Shin MY, Choi SJ, Oh SY, Kim JH et al. Post-cerclage ultrasonographic cervical length can predict preterm delivery in elective cervical cerclage patients. Obstet Gynecol Sci 2016;59:17–23. 11. Taghavi K, Gasparri M L, Bolla D, Surbek D. Predictors of cerclage failure in patients with singleton pregnancy undergoing prophylactic cervical cerclage. Archives of Gynecology and Obstetric 2018;297:347–352. 12. Owen J, Szychowski J. Association between post-randomization sonographic cervical length and birth gestational age in a multicenter trial of ultrasound-indicated cerclage. Am J Obstet Gynecol 2009;201: S197. 13. Lemmers M, Verschoor MA, Hooker AB, Opmeer BC, Limpens J, Huirne JA et al. Dilatation and curettage increases the risk of subsequent preterm birth: a systematic review and meta-analysis. Hum Reprod 2016;31:34–45. 14. Yim HJ, Song JE, Kim JE, Son GH, Lee KY. Preoperative and postoperative serum C-reactive protein levels to predict the outcome of ultrasound-indicated cerclage. Obstet Gynecol 2016;59:97–102. 15. Song RK, Cha HH, Shin MY, Choi SJ, Oh SY, Kim JH et al. Post-cerclage ultrasonographic cervical length can predict preterm delivery in elective cervical cerclage patients. Obstet Gynecol 2016;59:17–23. 16. Drassinower D, Vink J, Zork N, Pessel C, Vani K, Brubaker SG et al. Does the rate of cervical shortening after cerclage predict preterm birth? J Matern Fetal Neonatal Med 2016;29:2233– 2239. 17. Dijkstra K, Funai EF, O’Neill L, Rebarber A, Paidas MJ, Young BK. Change in cervical length after cerclage as a predictor of preterm delivery. Obstet Gynecol 2000;96:346–350.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Research Article |
| Authors | |
| Publication Date | August 1, 2018 |
| Published in Issue | Year 2018 Volume: 8 Issue: 2 |
