Dijkstra, K., Funai, E. F., O'Neill, L., Rebarber, A., Paidas, M. J., & Young, B. K. (2000). Change in cervical length after cerclage as a predictor of preterm delivery. Obstetrics and Gynecology, 96(3), 346-350. https://doi.org/10.1016/s0029-7844(00)00924-8
Dijkstra K, Funai EF, O'Neill L, Rebarber A, Paidas MJ, Young BK. Change in cervical length after cerclage as a predictor of preterm delivery. Obstet Gynecol. 2000;96(3):346-350. doi:10.1016/s0029-7844(00)00924-8
Dijkstra, K., et al. "Change in cervical length after cerclage as a predictor of preterm delivery." Obstetrics and Gynecology, vol. 96, no. 3, 2000, pp. 346-350.
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Department of Obstetrics and Gynecology, University Medical Center, Utrecht, The Netherlands. k.dijkstra@azu.nl
Cervical length gain after cerclage does not predict term birth
In an 80-woman ultrasound series from 2000, the size of the cervical gain after a cerclage stitch did not predict term delivery. Serial cervical length checks through 32 weeks separated preterm from term births: across scans after a prophylactic stitch, only at 28 to 32 weeks after an urgent one.
Key Findings
The correlation between the change in cervical length and pregnancy outcome was r = -0.26, which the authors found not significant.
Among the 30 women with urgent cerclage, term and preterm deliveries differed significantly in cervical length only at 28 to 32 weeks.
Among the 50 women with prophylactic cerclage, those who reached term had consistently greater cervical length than those delivering between 20 and 32 weeks' gestation.
Cervical length for all 80 women averaged 27.2 +/- 10.3 mm before the stitch and 34.1 +/- 9.9 mm afterward (P <.001, paired t test).
Interpretation
The report is a published abstract, and the full text was not available for this summary. Each woman had vaginal ultrasound scans of the cervix before and after the stitch, and most had three more scans through 32 weeks. The authors conclude that lengthening after cerclage does not predict reaching term. They also conclude that repeated scans late in the second trimester or early in the third predict preterm birth, and that they could give earlier warning after a prophylactic stitch than after an urgent one.
RRM Context
Restorative reproductive medicine begins with finding out why a pregnancy is at risk. Objective measures help answer that question. In this series of women with a cerclage, serial cervical length in later pregnancy was linked to preterm birth.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To determine whether the degree of cervical lengthening after cerclage and whether serial follow-up measurements of cervical length after cerclage are predictive of pregnancy outcome.
Methods
Eighty women whose primary physician determined that a prophylactic (n = 50) or urgent cerclage (n = 30) was indicated had transvaginal ultrasonographic evaluation before and after cerclage. Thereafter, most women had three additional transvaginal ultrasound examinations until 32 weeks' gestation. At each examination, the mean of three measurements was calculated. Statistical analyses were done by t test, analysis of variance, and logistic regression, with significance set at P <.05.
Results
The mean +/- standard deviation precerclage cervical length was 27.2 +/- 10.3 mm and after cerclage was 34.1 +/- 9.9 mm (n = 80, P <.001, paired t test). No significant association was found (r = -0.26) between the difference in cervical length (postcerclage - precerclage lengths) and pregnancy outcome. Patients with a prophylactic cerclage had a mean cervical length that was consistently longer in patients delivering at term compared with those who delivered preterm at 20 to 32 weeks' gestation. In the urgent cerclage group a significant difference in cervical length between those who delivered at term compared with preterm was evident only at 28 to 32 weeks.
Conclusion
The increase in cervical length after cerclage is not predictive of term delivery. Serial cervical length measurements in the late second or early third trimester predict preterm birth but could provide earlier warning in patients with a prophylactic cerclage than in patients with urgent cerclage.
