Physical Examination-Indicated Cerclage

Robert M. Ehsanipoor, Neil S. Seligman, Gabriele Saccone, Linda M. Szymanski, Christina Lynn Wissinger, Erika F. Werner, Vincenzo Berghella

Research output: Contribution to journalReview article

36 Citations (Scopus)

Abstract

Objective: To estimate the effectiveness of physical examination-indicated cerclage in the setting of second-trimester cervical dilatation by systematic review and meta-analysis of published studies. Data Sources: We searched MEDLINE, EMBASE, Scopus, ClinicalTrials.gov, Web of Science, and the Cochrane Library for studies published between 1966 and 2014 that evaluated cervical cerclage for the treatment of cervical insufficiency. Methods of Study Selection: The search yielded 6,314 citations. We included cohort studies and randomized controlled trials comparing cerclage placement with expectant management of women with cervical dilatation between 14 and 27 weeks of gestation. Two investigators independently reviewed each citation for inclusion or exclusion and discordant decisions were arbitrated by a third reviewer. Summary estimates were reported as the mean difference and 95% confidence interval (CI) for continuous variables or relative risk and with 95% CI for dichotomous outcomes. Fixed- and random-effects meta-analysis was used, depending on heterogeneity. Tabulation, Integration, and Results: Ten studies met inclusion criteria and were included in the final analysis. One was a randomized controlled trial, two were prospective cohort studies, and the remaining seven were retrospective cohort studies. Of the 757 women, 485 (64%) underwent physical examination-indicated cerclage placement and 272 (36%) were expectantly managed. Cerclage was associated with increased neonatal survival (71% compared with 43%; relative risk 1.65, 95% CI 1.19-2.28) and prolongation of pregnancy (mean difference 33.98 days, 95% CI 17.88-50.08). Conclusion: Physical examination-indicated cerclage is associated with a significant increase in neonatal survival and prolongation of pregnancy of approximately 1 month when compared with no such cerclage. The strength of this conclusion is limited by the potential for bias in the included studies.

Original languageEnglish (US)
Pages (from-to)125-135
Number of pages11
JournalObstetrics and Gynecology
Volume126
Issue number1
DOIs
StatePublished - Jan 1 2015

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Physical Examination
Confidence Intervals
First Labor Stage
Cohort Studies
Pregnancy
Meta-Analysis
Randomized Controlled Trials
Cervical Cerclage
Library Science
Survival
Information Storage and Retrieval
Second Pregnancy Trimester
MEDLINE
Retrospective Studies
Research Personnel
Prospective Studies
Therapeutics

All Science Journal Classification (ASJC) codes

  • Obstetrics and Gynecology

Cite this

Ehsanipoor, R. M., Seligman, N. S., Saccone, G., Szymanski, L. M., Wissinger, C. L., Werner, E. F., & Berghella, V. (2015). Physical Examination-Indicated Cerclage. Obstetrics and Gynecology, 126(1), 125-135. https://doi.org/10.1097/AOG.0000000000000850
Ehsanipoor, Robert M. ; Seligman, Neil S. ; Saccone, Gabriele ; Szymanski, Linda M. ; Wissinger, Christina Lynn ; Werner, Erika F. ; Berghella, Vincenzo. / Physical Examination-Indicated Cerclage. In: Obstetrics and Gynecology. 2015 ; Vol. 126, No. 1. pp. 125-135.
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Ehsanipoor, RM, Seligman, NS, Saccone, G, Szymanski, LM, Wissinger, CL, Werner, EF & Berghella, V 2015, 'Physical Examination-Indicated Cerclage', Obstetrics and Gynecology, vol. 126, no. 1, pp. 125-135. https://doi.org/10.1097/AOG.0000000000000850

Physical Examination-Indicated Cerclage. / Ehsanipoor, Robert M.; Seligman, Neil S.; Saccone, Gabriele; Szymanski, Linda M.; Wissinger, Christina Lynn; Werner, Erika F.; Berghella, Vincenzo.

In: Obstetrics and Gynecology, Vol. 126, No. 1, 01.01.2015, p. 125-135.

Research output: Contribution to journalReview article

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T1 - Physical Examination-Indicated Cerclage

AU - Ehsanipoor, Robert M.

AU - Seligman, Neil S.

AU - Saccone, Gabriele

AU - Szymanski, Linda M.

AU - Wissinger, Christina Lynn

AU - Werner, Erika F.

AU - Berghella, Vincenzo

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N2 - Objective: To estimate the effectiveness of physical examination-indicated cerclage in the setting of second-trimester cervical dilatation by systematic review and meta-analysis of published studies. Data Sources: We searched MEDLINE, EMBASE, Scopus, ClinicalTrials.gov, Web of Science, and the Cochrane Library for studies published between 1966 and 2014 that evaluated cervical cerclage for the treatment of cervical insufficiency. Methods of Study Selection: The search yielded 6,314 citations. We included cohort studies and randomized controlled trials comparing cerclage placement with expectant management of women with cervical dilatation between 14 and 27 weeks of gestation. Two investigators independently reviewed each citation for inclusion or exclusion and discordant decisions were arbitrated by a third reviewer. Summary estimates were reported as the mean difference and 95% confidence interval (CI) for continuous variables or relative risk and with 95% CI for dichotomous outcomes. Fixed- and random-effects meta-analysis was used, depending on heterogeneity. Tabulation, Integration, and Results: Ten studies met inclusion criteria and were included in the final analysis. One was a randomized controlled trial, two were prospective cohort studies, and the remaining seven were retrospective cohort studies. Of the 757 women, 485 (64%) underwent physical examination-indicated cerclage placement and 272 (36%) were expectantly managed. Cerclage was associated with increased neonatal survival (71% compared with 43%; relative risk 1.65, 95% CI 1.19-2.28) and prolongation of pregnancy (mean difference 33.98 days, 95% CI 17.88-50.08). Conclusion: Physical examination-indicated cerclage is associated with a significant increase in neonatal survival and prolongation of pregnancy of approximately 1 month when compared with no such cerclage. The strength of this conclusion is limited by the potential for bias in the included studies.

AB - Objective: To estimate the effectiveness of physical examination-indicated cerclage in the setting of second-trimester cervical dilatation by systematic review and meta-analysis of published studies. Data Sources: We searched MEDLINE, EMBASE, Scopus, ClinicalTrials.gov, Web of Science, and the Cochrane Library for studies published between 1966 and 2014 that evaluated cervical cerclage for the treatment of cervical insufficiency. Methods of Study Selection: The search yielded 6,314 citations. We included cohort studies and randomized controlled trials comparing cerclage placement with expectant management of women with cervical dilatation between 14 and 27 weeks of gestation. Two investigators independently reviewed each citation for inclusion or exclusion and discordant decisions were arbitrated by a third reviewer. Summary estimates were reported as the mean difference and 95% confidence interval (CI) for continuous variables or relative risk and with 95% CI for dichotomous outcomes. Fixed- and random-effects meta-analysis was used, depending on heterogeneity. Tabulation, Integration, and Results: Ten studies met inclusion criteria and were included in the final analysis. One was a randomized controlled trial, two were prospective cohort studies, and the remaining seven were retrospective cohort studies. Of the 757 women, 485 (64%) underwent physical examination-indicated cerclage placement and 272 (36%) were expectantly managed. Cerclage was associated with increased neonatal survival (71% compared with 43%; relative risk 1.65, 95% CI 1.19-2.28) and prolongation of pregnancy (mean difference 33.98 days, 95% CI 17.88-50.08). Conclusion: Physical examination-indicated cerclage is associated with a significant increase in neonatal survival and prolongation of pregnancy of approximately 1 month when compared with no such cerclage. The strength of this conclusion is limited by the potential for bias in the included studies.

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Ehsanipoor RM, Seligman NS, Saccone G, Szymanski LM, Wissinger CL, Werner EF et al. Physical Examination-Indicated Cerclage. Obstetrics and Gynecology. 2015 Jan 1;126(1):125-135. https://doi.org/10.1097/AOG.0000000000000850