The effect of cervical cerclage on the rate of cervical shortening Short title: Cerclage rate of change Daphnie DRASSINOWER, MD1, Joy VINK, MD1, Cara PESSEL MD1, Kavita VANI, MD2, Sara G. BRUBAKER,MD1, Noelia ZORK, MD1, Cande V. ANANTH, PhD, MPH2,3
1
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia,
USA University Medical Center, New York, NY, USA 2
Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA 3
Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
Corresponding author: Daphnie Drassinower, MD Department of OB/GYN, Division of Maternal Fetal Medicine Columbia University Medical Center 622 West 168th St., PH16-66 New York, NY 10032 Email: [email protected]
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/uog.14810
This article is protected by copyright. All rights reserved
Key words: cerclage, rate of change, cervical shortening, preterm delivery, cervical length
Abstract Objectives: Although cerclage has been shown to reduce the risk of recurrent preterm birth in a select patient population, the mechanism by which this occurs is not well understood. Our objective was to evaluate whether cerclage affects the rate of cervical shortening taking into account exposure to 17-hydroxyprogesterone and vaginal progesterone. Methods: This is a retrospective cohort study of women who had serial cervical length measurements due to a history of spontaneous preterm delivery. Demographic data, obstetric history, progesterone administration, delivery information and serial cervical length measurements were collected. The rate of cervical shortening was compared in women with cerclage to those without cerclage. Subgroup analyses were performed to compare rates of cervical shortening by indication for cerclage (history indicated vs ultrasound-indicated) and outcome in the current pregnancy (cerclage vs no cerclage among those that delivered preterm). Results: A total of 414 women were included of whom 32.4 % (n=134) had a cerclage. There was no difference in the rate of cervical shortening between the cerclage (0.8 mm per week) and no cerclage groups (1.0 mm per week, P=0.43). The rates of cervical shortening among history-indicated and ultrasound-indicated cerclage groups were similar (0.9 vs 1.3 mm per week respectively, p=0.2). Among patients with a preterm delivery in the index pregnancy, the rate of cervical shortening among those with (1.31 mm per week), and without cerclage (1.28 mm per week, p=0.78) was also similar.
This article is protected by copyright. All rights reserved
Conclusions: Cervical shortening among women with cerclage occurs at a similar rate as women without a cerclage, regardless of indication for cerclage or pregnancy outcome.
Introduction Spontaneous preterm birth (sPTB) remains a significant obstetric dilemma as premature infants are at increased risk of neonatal death or lifelong morbidity(1). Despite extensive efforts to reduce sPTB, the armamentarium to identify and prevent it remain limited. Cervical cerclage is an intervention that has been shown to be useful in preventing sPTB in a select patient population(2-7). A patient-level meta-analysis of five randomized trials showed a significant reduction in recurrent sPTB at
1
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia,
USA University Medical Center, New York, NY, USA 2
Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA 3
Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
Corresponding author: Daphnie Drassinower, MD Department of OB/GYN, Division of Maternal Fetal Medicine Columbia University Medical Center 622 West 168th St., PH16-66 New York, NY 10032 Email: [email protected]
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/uog.14810
This article is protected by copyright. All rights reserved
Key words: cerclage, rate of change, cervical shortening, preterm delivery, cervical length
Abstract Objectives: Although cerclage has been shown to reduce the risk of recurrent preterm birth in a select patient population, the mechanism by which this occurs is not well understood. Our objective was to evaluate whether cerclage affects the rate of cervical shortening taking into account exposure to 17-hydroxyprogesterone and vaginal progesterone. Methods: This is a retrospective cohort study of women who had serial cervical length measurements due to a history of spontaneous preterm delivery. Demographic data, obstetric history, progesterone administration, delivery information and serial cervical length measurements were collected. The rate of cervical shortening was compared in women with cerclage to those without cerclage. Subgroup analyses were performed to compare rates of cervical shortening by indication for cerclage (history indicated vs ultrasound-indicated) and outcome in the current pregnancy (cerclage vs no cerclage among those that delivered preterm). Results: A total of 414 women were included of whom 32.4 % (n=134) had a cerclage. There was no difference in the rate of cervical shortening between the cerclage (0.8 mm per week) and no cerclage groups (1.0 mm per week, P=0.43). The rates of cervical shortening among history-indicated and ultrasound-indicated cerclage groups were similar (0.9 vs 1.3 mm per week respectively, p=0.2). Among patients with a preterm delivery in the index pregnancy, the rate of cervical shortening among those with (1.31 mm per week), and without cerclage (1.28 mm per week, p=0.78) was also similar.
This article is protected by copyright. All rights reserved
Conclusions: Cervical shortening among women with cerclage occurs at a similar rate as women without a cerclage, regardless of indication for cerclage or pregnancy outcome.
Introduction Spontaneous preterm birth (sPTB) remains a significant obstetric dilemma as premature infants are at increased risk of neonatal death or lifelong morbidity(1). Despite extensive efforts to reduce sPTB, the armamentarium to identify and prevent it remain limited. Cervical cerclage is an intervention that has been shown to be useful in preventing sPTB in a select patient population(2-7). A patient-level meta-analysis of five randomized trials showed a significant reduction in recurrent sPTB at
