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PP.28 Cervical Cerclage: Are All Techniques Successful?
  1. EA Bonney1,
  2. A Atkinson2,
  3. R Lancaster2,
  4. JJ Walker1,
  5. NAB Simpson1
  1. 1Division of Clinical Sciences, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK
  2. 2School of Medicine, University of Leeds, Leeds, UK

Abstract

Objective Preterm birth is a global public health issue. In women considered high risk, insertion of a cervical cerclage has been shown to reduce this risk. We present findings from a retrospective cohort evaluating the success of different cerclage procedures (Shirodkar, McDonald and Transabdominal) in a tertiary level obstetric unit.

Study design Retrospective data was collected for 200 women who underwent a cerclage procedure at Leeds Teaching Hospitals NHS Trust between August 2000 and October 2010. Exclusion criteria for the study included multiple pregnancy, insertion of more than one cerclage in a single pregnancy, or an incomplete data record. Success was measured by delivery of a live baby ≥ 34 weeks. Mean gestational age (MGA) for each group was also calculated. Statistical analysis was performed using Fisher’s exact test.

Results The Shirodkar cerclage produced a significantly greater MGA at delivery (36.3 weeks), compared to both McDonald (33.5 weeks; p = 0.004) and transabdominal cerclage (33.3 weeks; p = 0.007). Elective insertion of Shirodkar, McDonald and Transabdominal cerclage was carried out in 70, 37, 25 women respectively. These produced success rates of 81.4%, 70.3% and 72% (Shirodkar vs McDonald p = 0.226, Shirodkar vs Transabdominal p = 0.393). Ultrasound-indicated sutures were placed in 48 women (Shirodkar n = 24, McDonald n = 24). The success rates were 92.7% and 66.7% respectively, however these were not significantly different (p = 0.0723).

Conclusion These results demonstrate consistent rates in births greater than 34 weeks gestation following insertion of cervical cerclage. Although Shirodkar cerclage appears preferable in elective and ultrasound-indicated procedures, prospective randomised trials such as MAVRIC1 need to be completed to confirm this.

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