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.
 Berghella V, Ludmir J, Simonazzi G, Owen J. Transvaginal cervical cerclage: evidence for perioperative management strategies. Am J Obstet Gynecol. 2013 Feb 12. DOI:pii: S0002-9378(13)00161-0. 10.1016/j.ajog.2013.02.020. [Epub ahead of print].Search in Google Scholar
 Berghella V, Odibo AO, To MS, Rust OA, Althuisius SM. Cerclage for short cervix on ultrasonography: meta-analysis of trials using individual patient level data. Obstet Gynecol. 2005;106:181–9.10.1097/01.AOG.0000168435.17200.53Search in Google Scholar
 Iams JD, Goldenberg RL, Meis PJ, Mercer BM, Moawad A, Das A, et al. The length of the cervix and the risk of spontaneous premature delivery. N Engl J Med. 1996;334:567–72.10.1056/NEJM199602293340904Search in Google Scholar
 Owen J, Hankins G, Iams J, Berghella V, Sheffield J, Perez-Delboy 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.e1–8.10.1016/j.ajog.2009.08.015Search in Google Scholar
 Romero R, Kusanovic JP, Espinoza J, Gotsch F, Nhan-Chang CL, Erez O, et al. What is amniotic fluid ‘sludge’? Ultrasound Obstet Gynecol. 2007;30:793–8.10.1002/uog.5173Search in Google Scholar
 Saling E. Prevention of habitual abortion and prematurity by early total occlusion of the external os uteri. Eur J Obstet Gynecol Reprod Biol. 1984;17:165–70.10.1016/0028-2243(84)90140-0Search in Google Scholar
 Schieb S, Visintine J, Miroshnichenko G, Harvey C, Rychlak K, Berghella V. Is cerclage height associated with incidence of preterm birth in ultrasound indicated cerclage? Am J Obstet Gynecol. 2009;200:e12–5.10.1016/j.ajog.2008.09.021Search in Google Scholar
 Shirodkar VH. A new method of operative treatment for habitual abortion in the second trimester of pregnancy. Antiseptic. 1955;52:299–300.Search in Google Scholar
 To MS, Alfirevic Z, Heath VC, Cicero S, Cacho AM, Williamson PR, et al. Cervical cerclage for prevention of preterm delivery in women with short cervix: randomized controlled trial. Lancet. 2004;363:1849–53.10.1016/S0140-6736(04)16351-4Search in Google Scholar
The authors stated that there are no conflicts of interest regarding the publication of this article.
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