Outcomes after periviable ultrasound-indicated cerclage

被引:8
作者
Drassinower, Daphnie [1 ]
Coviello, Elizabeth [1 ]
Landy, Helain J. [1 ]
Gyamfi-Bannerman, Cynthia [2 ]
Perez-Delboy, Annette [2 ]
Friedman, Alexander M. [2 ]
机构
[1] MedStar Georgetown Univ Hosp, Dept Obstet & Gynecol, Washington, DC USA
[2] Columbia Univ, Med Ctr, Dept Obstet & Gynecol, New York, NY USA
基金
美国国家卫生研究院;
关键词
Ultrasound-indicated cerclage; periviability; perioperative complications; CERVICAL CERCLAGE; TRANSVAGINAL ULTRASOUND; PREVENTION; LENGTH; BIRTH; WOMEN;
D O I
10.1080/14767058.2017.1395848
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Background: Cerclage placed for a sonographically short cervix has been shown to reduce the risk of preterm delivery in women with a history of prior preterm birth. While short cervix is traditionally placed before viability, the threshold gestational age at which viability is achieved continues to decrease, and, as a result, a larger subset of women may be ineligible to receive this potentially beneficial procedure. Objective: To evaluate the association between obstetric outcomes and perioperative complications after placement of an ultrasound-indicated cerclage at periviability compared to placement in the previable period. Methods: This retrospective cohort study of patients who underwent ultrasound-indicated cerclage evaluated obstetric outcomes and perioperative complications based on gestational age at cerclage placement. Ultrasound-indicated cerclage was considered to have been placed at periviability if placed at 22 to <24 weeks (exposed) and at previability if placed at 16 to <22 weeks gestational age (unexposed). The primary outcome was preterm delivery <36 weeks. Secondary outcomes included mean gestational age at delivery, preterm delivery <32 weeks, <28, and <24 weeks, preterm premature rupture of membranes (PPROM), chorioamnionitis, and perioperative complications. Adjusted analyses were performed to account for demographic and obstetric factors. Results: Of the 426 patients included in the analysis, 94 (22%) had cerclage placed between >= 22 weeks to <24 weeks, while 332 (78%) had cerclage placed at <22 weeks. On univariate analysis, women who had a periviable cerclage placed were less likely to have a recurrent preterm delivery <36 weeks compared to women with previable cerclage placement (26.6 versus 38.3%, respectively, p = .04). The adjusted model did not demonstrate a significant difference in risk for preterm delivery <36 weeks associated with periviable versus previable cerclage (odds ratio 0.66, 95%CI 0.37-1.17). Secondary outcomes were similar between the previable and periviable groups, including mean gestational age at delivery (35.1 versus 36.2 weeks, respectively, p = .08) and preterm delivery before 32-week gestation (20.7 versus 13.8%, respectively, p = .17). Intraoperative and postoperative complications were rare and rates were similar between groups. Conclusions: Obstetric outcomes between patients receiving periviable and previable cerclage are similar. Ultrasound-indicated cerclage placement is associated with a relatively low rate of complications. Given the evidence supporting benefit of cerclage for women with short ultrasound cervical length and prior preterm birth, our findings demonstrate that benefits of placement at >= 22 weeks to <24 weeks may outweigh risks.
引用
收藏
页码:932 / 938
页数:7
相关论文
共 19 条
  • [1] Final results of the Cervical Incompetence Prevention Randomized Cerclage Trial (CIPRACT): Therapeutic cerclage with bed rest versus bed rest alone
    Althuisius, SM
    Dekker, GA
    Hummel, P
    Bekedam, DJ
    van Geijn, HP
    [J]. AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 2001, 185 (05) : 1106 - 1112
  • [2] [Anonymous], 2014, Obstetrics and Gynecology, V123, P372, DOI [10.1097/01.AOG.0000443276.68274.cc, DOI 10.1097/01.AOG.0000443276.68274.CC]
  • [3] Cerclage for prevention of preterm birth in women with a short cervix found on transvaginal ultrasound examination: A randomized trial
    Berghella, V
    Odibo, AO
    Tolosa, JE
    [J]. AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 2004, 191 (04) : 1311 - 1317
  • [4] Gestational age at cervical length measurement and incidence of preterm birth
    Berghella, Vincenzo
    Roman, Amanda
    Daskalakis, Constantine
    Ness, Amen
    Baxter, Jason K.
    [J]. OBSTETRICS AND GYNECOLOGY, 2007, 110 (02) : 311 - 317
  • [5] Cerclage for Short Cervix on Ultrasonography in Women With Singleton Gestations and Previous Preterm Birth A Meta-Analysis
    Berghella, Vincenzo
    Rafael, Timothy J.
    Szychowski, Jeff M.
    Rust, Orion A.
    Owen, John
    [J]. OBSTETRICS AND GYNECOLOGY, 2011, 117 (03) : 663 - 671
  • [6] Vaginal progesterone vs cervical cerclage for the prevention of preterm birth in women with a sonographic short cervix, previous preterm birth, and singleton gestation: a systematic review and indirect comparison metaanalysis
    Conde-Agudelo, Agustin
    Romero, Roberto
    Nicolaides, Kypros
    Chaiworapongsa, Tinnakorn
    O'Brien, John M.
    Cetingoz, Elcin
    da Fonseca, Eduardo
    Creasy, George
    Soma-Pillay, Priya
    Fusey, Shalini
    Cam, Cetin
    Alfirevic, Zarko
    Hassan, Sonia S.
    [J]. AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 2013, 208 (01) : 42.e1 - 42.e18
  • [7] Cervical Cerclage During Periviability Can We Stabilize a Moving Target?
    Dahlke, Joshua D.
    Sperling, Jeffrey D.
    Chauhan, Suneet P.
    Berghella, Vincenzo
    [J]. OBSTETRICS AND GYNECOLOGY, 2016, 127 (05) : 934 - 940
  • [8] Perioperative complications of history-indicated and ultrasound-indicated cervical cerclage
    Drassinower, Daphnie
    Poggi, Sarah H.
    Landy, Helain J.
    Gilo, Noridelle
    Benson, James E.
    Ghidini, Alessandro
    [J]. AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 2011, 205 (01) : 53.e1 - 53.e5
  • [9] Periviable birth
    Ecker, Jeffrey L.
    Kaimal, Anjali
    Mercer, Brian M.
    Blackwell, Sean C.
    deRegnier, Raye Ann O.
    Farrell, Ruth M.
    Grobman, William A.
    Resnik, Jamie L.
    Sciscione, Anthony C.
    [J]. AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 2015, 213 (05) : 604 - 614
  • [10] The length of the cervix and the risk of spontaneous premature delivery
    Iams, JD
    Goldenberg, RL
    Meis, PJ
    Mercer, BM
    Moawad, A
    Das, A
    Thom, E
    McNellis, D
    Copper, RL
    Johnson, F
    Roberts, JM
    Hauth, JC
    Northern, A
    Neely, C
    MuellerHeubach, E
    Swain, M
    Frye, A
    Lindheimer, M
    Jones, P
    Brown, MEL
    Siddiqi, TA
    Elder, N
    Coombs, T
    VanHorn, J
    Bain, R
    Leuchtenburg, L
    Fischer, M
    Harger, JH
    Cotroneo, M
    Stallings, C
    Yaffe, S
    Catz, C
    Klebanoff, M
    Landon, MB
    Schneider, J
    Mueller, C
    Carey, JC
    Meier, A
    Liles, E
    Newman, RB
    Collins, BA
    Metcalf, T
    Odell, V
    Sibai, B
    Ramsey, R
    Fricke, JL
    Treadwell, M
    Norman, GS
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1996, 334 (09) : 567 - 572