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Cervical cerclage: a successful procedure no matter which technique is used
  1. E A Bonney,
  2. M Mweemba,
  3. A Naheed,
  4. J J Walker,
  5. N A B Simpson
  1. Perinatal Group, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK

Abstract

Introduction In women at risk of midtrimester loss or extreme preterm birth (PTB), insertion of a cervical cerclage has been shown to reduce that risk.1 Three common techniques are used. We present the findings of an audit on our results following insertion of McDonald, Shirodkar and Transabdominal cervicoisthmic sutures.

Methods Retrospective data were collected from the Leeds Teaching Hospitals maternity database on 178 women who had had a cervical suture over the past 5 years. Success was defined as the discharge of a live baby from hospital (whether term or preterm). Comparisons were made between the three cerclage techniques using Fisher's exact test.

Results Elective insertion of McDonald, Shirodkar and Transabdominal sutures was carried out in 54, 63 and 24 women respectively. These produced success rates of 83%, 97% and 84% respectively (Shirodkar vs McDonald p=0.02; Shirodkar vs Transabdominal p=0.05). Ultrasound-indicated sutures were placed in 19 women (McDonald n=5; Shirodkar n=14). The success rates (60% vs 93%) were not significantly different (p=0.15), although the numbers were small.

Discussion These results demonstrate excellent live baby rates following insertion of cervical cerclage in patients at high risk of PTB. These figures may be used when counselling women who may be suitable for cervical cerclage. Although the Shirodkar procedure was associated with greater success, this was not a randomised trial and the optimal route for elective cerclage remains to be established through multicentre studies such as MAVRIC.2

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