OBJECTIVE: We sought to compare history-indicated placement of cervical cerclage based on history- vs ultrasound-indicated placement in women at risk of preterm birth. STUDY DESIGN: We conducted a randomized controlled trial of history-indicated cervical cerclage suture based on history (clinician preference) vs ultrasound (< 20 mm cervical length) indicated in women at increased risk. RESULTS: The incidence of the primary outcome, preterm delivery between 24(+0) and 33(+6) weeks, was similar: 19/125 (15%) in the history-indicated group vs 18/122 (15%) in the ultrasound-indicated group (relative risk [RR], 0.97; 95% confidence interval [CI], 0.54-1.76). Those women randomized to the ultrasound-indicated arm were significantly more likely to receive a cerclage (32% vs 19%; RR, 1.66; 95% CI, 1.07-2.47) and progesterone (39% vs 25%; RR, 1.55; 95% CI, 1.06-2.25). CONCLUSION:Screening women at high risk with cervical ultrasound to determine cerclage placement results in more intervention but similar outcome compared with history-indicated placement.
RCT Entities:
OBJECTIVE: We sought to compare history-indicated placement of cervical cerclage based on history- vs ultrasound-indicated placement in women at risk of preterm birth. STUDY DESIGN: We conducted a randomized controlled trial of history-indicated cervical cerclage suture based on history (clinician preference) vs ultrasound (< 20 mm cervical length) indicated in women at increased risk. RESULTS: The incidence of the primary outcome, preterm delivery between 24(+0) and 33(+6) weeks, was similar: 19/125 (15%) in the history-indicated group vs 18/122 (15%) in the ultrasound-indicated group (relative risk [RR], 0.97; 95% confidence interval [CI], 0.54-1.76). Those women randomized to the ultrasound-indicated arm were significantly more likely to receive a cerclage (32% vs 19%; RR, 1.66; 95% CI, 1.07-2.47) and progesterone (39% vs 25%; RR, 1.55; 95% CI, 1.06-2.25). CONCLUSION: Screening women at high risk with cervical ultrasound to determine cerclage placement results in more intervention but similar outcome compared with history-indicated placement.
Authors: S S Hassan; R Romero; D Vidyadhari; S Fusey; J K Baxter; M Khandelwal; J Vijayaraghavan; Y Trivedi; P Soma-Pillay; P Sambarey; A Dayal; V Potapov; J O'Brien; V Astakhov; O Yuzko; W Kinzler; B Dattel; H Sehdev; L Mazheika; D Manchulenko; M T Gervasi; L Sullivan; A Conde-Agudelo; J A Phillips; G W Creasy Journal: Ultrasound Obstet Gynecol Date: 2011-06-15 Impact factor: 7.299
Authors: Manju Chandiramani; Paul T Seed; Nicolas M Orsi; Uma V Ekbote; Phillip R Bennett; Andrew H Shennan; Rachel M Tribe Journal: PLoS One Date: 2012-12-26 Impact factor: 3.240