Longitudinal change in cervical length following vaginal or abdominal cervical cerclage: a randomized comparison

Cervical cerclage has been shown to reduce the risk of recurrent spontaneous preterm birth in a high-risk patient population; however, the mechanism is not well understood. Transabdominal cerclage is superior to low and high vaginal cerclage in reducing early spontaneous preterm birth and fetal loss...

Full description

Saved in:
Bibliographic Details
Published in:American journal of obstetrics & gynecology MFM 2023-07, Vol.5 (7), p.100987-100987, Article 100987
Main Authors: Ridout, Alexandra E., Carter, Jenny, Seed, Paul T., Chandiramani, Manju, David, Anna L., Tribe, Rachel M., Shennan, Andrew H.
Format: Article
Language:English
Subjects:
cervical cerclage
cervical length
preterm birth prediction
spontaneous preterm birth
transabdominal cerclage
Citations: Items that this one cites
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by
cites cdi_FETCH-LOGICAL-c357t-88c3762a5a3e118b26392ec3d84714fd36b11f13be1b42c69d5e2d2903639e093
container_end_page 100987
container_issue 7
container_start_page 100987
container_title American journal of obstetrics & gynecology MFM
container_volume 5
creator Ridout, Alexandra E.
Carter, Jenny
Seed, Paul T.
Chandiramani, Manju
David, Anna L.
Tribe, Rachel M.
Shennan, Andrew H.
description Cervical cerclage has been shown to reduce the risk of recurrent spontaneous preterm birth in a high-risk patient population; however, the mechanism is not well understood. Transabdominal cerclage is superior to low and high vaginal cerclage in reducing early spontaneous preterm birth and fetal loss in women with previous failed vaginal cerclage. Cervical length measurements are commonly used to monitor high-risk women and may explain the mechanism of success. This study aimed to evaluate the rate of change in longitudinal cervical length after randomized placement of low transvaginal, high transvaginal, or transabdominal cerclage in women with a previous failed vaginal cerclage. This was a planned analysis of longitudinal transvaginal ultrasound cervical length measurements from patients enrolled in the Vaginal Randomised Intervention of Cerclage trial, a randomized controlled trial comparing transabdominal cerclage or high transvaginal cerclage with low transvaginal cerclage. Cervical length measurements at specific gestational ages were compared over time and between groups, using generalized estimating equations fitted using the maximum-likelihood random-effects estimator. In addition, cervical length measurements were compared in women with transabdominal cerclage placed before and during pregnancy. The diagnostic accuracy of cervical length as a predictor of spontaneous preterm birth at
doi_str_mv 10.1016/j.ajogmf.2023.100987
format article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2810916106</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S2589933323001295</els_id><sourcerecordid>2810916106</sourcerecordid><originalsourceid>FETCH-LOGICAL-c357t-88c3762a5a3e118b26392ec3d84714fd36b11f13be1b42c69d5e2d2903639e093</originalsourceid><addsrcrecordid>eNp9kE1LxDAQhoMoKuv-A5EcvXTNR5ttPQgifsGCFz2HNJnWLG2yJt0V_fVm7SqePGWYPG9m8iB0SsmMEiouljO19G3fzBhhPLVIVc730DEryiqrOOf7f-ojNI1xSQhhNM8LJg7REZ_TXIhSHKPVwrvWDmtjneqwflWuBWwd1hA2VqdWB64dXnHju86_W9fijWq_WR-wqo3vx-APngrdqRYuscJBue39Jxisfb9SwUbvTtBBo7oI0905QS93t883D9ni6f7x5nqRaV7Mh6wsNZ8LpgrFgdKyZoJXDDQ3ZZ52bwwXNaUN5TXQOmdaVKYAZlhFeAKBVHyCzsd3V8G_rSEOsrdRQ9cpB34dJSspqaigRCQ0H1EdfIwBGrkKtlfhQ1Iit7rlUo665Va3HHWn2NluwrruwfyGfuQm4GoEIP1zYyHIqC04DcYG0IM03v4_4QsDSpND</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2810916106</pqid></control><display><type>article</type><title>Longitudinal change in cervical length following vaginal or abdominal cervical cerclage: a randomized comparison</title><source>ScienceDirect Journals</source><creator>Ridout, Alexandra E. ; Carter, Jenny ; Seed, Paul T. ; Chandiramani, Manju ; David, Anna L. ; Tribe, Rachel M. ; Shennan, Andrew H.</creator><creatorcontrib>Ridout, Alexandra E. ; Carter, Jenny ; Seed, Paul T. ; Chandiramani, Manju ; David, Anna L. ; Tribe, Rachel M. ; Shennan, Andrew H. ; Multicentre Abdominal vs Vaginal Randomised Intervention of Cerclage Trial Collaborative Group</creatorcontrib><description>Cervical cerclage has been shown to reduce the risk of recurrent spontaneous preterm birth in a high-risk patient population; however, the mechanism is not well understood. Transabdominal cerclage is superior to low and high vaginal cerclage in reducing early spontaneous preterm birth and fetal loss in women with previous failed vaginal cerclage. Cervical length measurements are commonly used to monitor high-risk women and may explain the mechanism of success. This study aimed to evaluate the rate of change in longitudinal cervical length after randomized placement of low transvaginal, high transvaginal, or transabdominal cerclage in women with a previous failed vaginal cerclage. This was a planned analysis of longitudinal transvaginal ultrasound cervical length measurements from patients enrolled in the Vaginal Randomised Intervention of Cerclage trial, a randomized controlled trial comparing transabdominal cerclage or high transvaginal cerclage with low transvaginal cerclage. Cervical length measurements at specific gestational ages were compared over time and between groups, using generalized estimating equations fitted using the maximum-likelihood random-effects estimator. In addition, cervical length measurements were compared in women with transabdominal cerclage placed before and during pregnancy. The diagnostic accuracy of cervical length as a predictor of spontaneous preterm birth at &lt;32 weeks of gestation was explored. This study included 78 women who underwent longitudinal cervical length assessment (70% of the analyzed cohort) with a history of failed cerclage, of whom 25 (32%) were randomized to low transvaginal cerclage, 26 (33%) to high transvaginal cerclage, and 27 (35%) to transabdominal cerclage. Abdominal cerclage was superior to low (P=.008) and high (P=.001) vaginal cerclage at maintaining cervical length over the surveillance period (14 to 26 weeks of gestation) (+0.08 mm/week, 95% confidence interval, −0.40 to 0.22; P=.580). On average, the cervical length was 1.8 mm longer by the end of the 12-week surveillance period in women with transabdominal cerclage (+1.8 mm; 95% confidence interval, −7.89 to 4.30; P=.564). High vaginal cerclage was no better than low cervical cerclage in the prevention of cervical shortening; the cervix shortened by 13.2 mm over 12 weeks in those with low vaginal cerclage (95% confidence interval, −21.7 to −4.7; P=.002) and by 20 mm over 12 weeks in those with high vaginal cerclage (95% confidence interval, −33.1 to −7.4; P=.002). Preconception transabdominal cerclage resulted in a longer cervix than those performed during pregnancy; this difference was significant after 22 weeks of gestation (48.5 mm vs 39.6 mm; P=.039). Overall, cervical length was an excellent predictor of spontaneous preterm birth at &lt;32 weeks of gestation (receiver operating characteristic curve, 0.92; 95% confidence interval, 0.82–1.00). In women with a previous failed cervical cerclage, in the next pregnancy, the cervical length in women treated with vaginal cerclage funneled and shortened over time, whereas there was preservation of cervical length in women who receive transabdominal cerclage. Cervical length remained longer in transabdominal procedures performed before pregnancy than in transabdominal procedures performed during pregnancy. Overall, cervical length was an excellent predictor of spontaneous preterm birth in our cohort. Our findings may explain the mechanism of benefit for transabdominal cerclage, with its high placement better maintaining the structural integrity of the cervix at the level of the internal os.</description><identifier>ISSN: 2589-9333</identifier><identifier>EISSN: 2589-9333</identifier><identifier>DOI: 10.1016/j.ajogmf.2023.100987</identifier><identifier>PMID: 37146686</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>cervical cerclage ; cervical length ; preterm birth prediction ; spontaneous preterm birth ; transabdominal cerclage</subject><ispartof>American journal of obstetrics &amp; gynecology MFM, 2023-07, Vol.5 (7), p.100987-100987, Article 100987</ispartof><rights>2023 The Authors</rights><rights>Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c357t-88c3762a5a3e118b26392ec3d84714fd36b11f13be1b42c69d5e2d2903639e093</cites><orcidid>0000-0003-0988-7229</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S2589933323001295$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3547,27923,27924,45779</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37146686$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ridout, Alexandra E.</creatorcontrib><creatorcontrib>Carter, Jenny</creatorcontrib><creatorcontrib>Seed, Paul T.</creatorcontrib><creatorcontrib>Chandiramani, Manju</creatorcontrib><creatorcontrib>David, Anna L.</creatorcontrib><creatorcontrib>Tribe, Rachel M.</creatorcontrib><creatorcontrib>Shennan, Andrew H.</creatorcontrib><creatorcontrib>Multicentre Abdominal vs Vaginal Randomised Intervention of Cerclage Trial Collaborative Group</creatorcontrib><title>Longitudinal change in cervical length following vaginal or abdominal cervical cerclage: a randomized comparison</title><title>American journal of obstetrics &amp; gynecology MFM</title><addtitle>Am J Obstet Gynecol MFM</addtitle><description>Cervical cerclage has been shown to reduce the risk of recurrent spontaneous preterm birth in a high-risk patient population; however, the mechanism is not well understood. Transabdominal cerclage is superior to low and high vaginal cerclage in reducing early spontaneous preterm birth and fetal loss in women with previous failed vaginal cerclage. Cervical length measurements are commonly used to monitor high-risk women and may explain the mechanism of success. This study aimed to evaluate the rate of change in longitudinal cervical length after randomized placement of low transvaginal, high transvaginal, or transabdominal cerclage in women with a previous failed vaginal cerclage. This was a planned analysis of longitudinal transvaginal ultrasound cervical length measurements from patients enrolled in the Vaginal Randomised Intervention of Cerclage trial, a randomized controlled trial comparing transabdominal cerclage or high transvaginal cerclage with low transvaginal cerclage. Cervical length measurements at specific gestational ages were compared over time and between groups, using generalized estimating equations fitted using the maximum-likelihood random-effects estimator. In addition, cervical length measurements were compared in women with transabdominal cerclage placed before and during pregnancy. The diagnostic accuracy of cervical length as a predictor of spontaneous preterm birth at &lt;32 weeks of gestation was explored. This study included 78 women who underwent longitudinal cervical length assessment (70% of the analyzed cohort) with a history of failed cerclage, of whom 25 (32%) were randomized to low transvaginal cerclage, 26 (33%) to high transvaginal cerclage, and 27 (35%) to transabdominal cerclage. Abdominal cerclage was superior to low (P=.008) and high (P=.001) vaginal cerclage at maintaining cervical length over the surveillance period (14 to 26 weeks of gestation) (+0.08 mm/week, 95% confidence interval, −0.40 to 0.22; P=.580). On average, the cervical length was 1.8 mm longer by the end of the 12-week surveillance period in women with transabdominal cerclage (+1.8 mm; 95% confidence interval, −7.89 to 4.30; P=.564). High vaginal cerclage was no better than low cervical cerclage in the prevention of cervical shortening; the cervix shortened by 13.2 mm over 12 weeks in those with low vaginal cerclage (95% confidence interval, −21.7 to −4.7; P=.002) and by 20 mm over 12 weeks in those with high vaginal cerclage (95% confidence interval, −33.1 to −7.4; P=.002). Preconception transabdominal cerclage resulted in a longer cervix than those performed during pregnancy; this difference was significant after 22 weeks of gestation (48.5 mm vs 39.6 mm; P=.039). Overall, cervical length was an excellent predictor of spontaneous preterm birth at &lt;32 weeks of gestation (receiver operating characteristic curve, 0.92; 95% confidence interval, 0.82–1.00). In women with a previous failed cervical cerclage, in the next pregnancy, the cervical length in women treated with vaginal cerclage funneled and shortened over time, whereas there was preservation of cervical length in women who receive transabdominal cerclage. Cervical length remained longer in transabdominal procedures performed before pregnancy than in transabdominal procedures performed during pregnancy. Overall, cervical length was an excellent predictor of spontaneous preterm birth in our cohort. Our findings may explain the mechanism of benefit for transabdominal cerclage, with its high placement better maintaining the structural integrity of the cervix at the level of the internal os.</description><subject>cervical cerclage</subject><subject>cervical length</subject><subject>preterm birth prediction</subject><subject>spontaneous preterm birth</subject><subject>transabdominal cerclage</subject><issn>2589-9333</issn><issn>2589-9333</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9kE1LxDAQhoMoKuv-A5EcvXTNR5ttPQgifsGCFz2HNJnWLG2yJt0V_fVm7SqePGWYPG9m8iB0SsmMEiouljO19G3fzBhhPLVIVc730DEryiqrOOf7f-ojNI1xSQhhNM8LJg7REZ_TXIhSHKPVwrvWDmtjneqwflWuBWwd1hA2VqdWB64dXnHju86_W9fijWq_WR-wqo3vx-APngrdqRYuscJBue39Jxisfb9SwUbvTtBBo7oI0905QS93t883D9ni6f7x5nqRaV7Mh6wsNZ8LpgrFgdKyZoJXDDQ3ZZ52bwwXNaUN5TXQOmdaVKYAZlhFeAKBVHyCzsd3V8G_rSEOsrdRQ9cpB34dJSspqaigRCQ0H1EdfIwBGrkKtlfhQ1Iit7rlUo665Va3HHWn2NluwrruwfyGfuQm4GoEIP1zYyHIqC04DcYG0IM03v4_4QsDSpND</recordid><startdate>202307</startdate><enddate>202307</enddate><creator>Ridout, Alexandra E.</creator><creator>Carter, Jenny</creator><creator>Seed, Paul T.</creator><creator>Chandiramani, Manju</creator><creator>David, Anna L.</creator><creator>Tribe, Rachel M.</creator><creator>Shennan, Andrew H.</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0988-7229</orcidid></search><sort><creationdate>202307</creationdate><title>Longitudinal change in cervical length following vaginal or abdominal cervical cerclage: a randomized comparison</title><author>Ridout, Alexandra E. ; Carter, Jenny ; Seed, Paul T. ; Chandiramani, Manju ; David, Anna L. ; Tribe, Rachel M. ; Shennan, Andrew H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c357t-88c3762a5a3e118b26392ec3d84714fd36b11f13be1b42c69d5e2d2903639e093</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>cervical cerclage</topic><topic>cervical length</topic><topic>preterm birth prediction</topic><topic>spontaneous preterm birth</topic><topic>transabdominal cerclage</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ridout, Alexandra E.</creatorcontrib><creatorcontrib>Carter, Jenny</creatorcontrib><creatorcontrib>Seed, Paul T.</creatorcontrib><creatorcontrib>Chandiramani, Manju</creatorcontrib><creatorcontrib>David, Anna L.</creatorcontrib><creatorcontrib>Tribe, Rachel M.</creatorcontrib><creatorcontrib>Shennan, Andrew H.</creatorcontrib><creatorcontrib>Multicentre Abdominal vs Vaginal Randomised Intervention of Cerclage Trial Collaborative Group</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of obstetrics &amp; gynecology MFM</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ridout, Alexandra E.</au><au>Carter, Jenny</au><au>Seed, Paul T.</au><au>Chandiramani, Manju</au><au>David, Anna L.</au><au>Tribe, Rachel M.</au><au>Shennan, Andrew H.</au><aucorp>Multicentre Abdominal vs Vaginal Randomised Intervention of Cerclage Trial Collaborative Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Longitudinal change in cervical length following vaginal or abdominal cervical cerclage: a randomized comparison</atitle><jtitle>American journal of obstetrics &amp; gynecology MFM</jtitle><addtitle>Am J Obstet Gynecol MFM</addtitle><date>2023-07</date><risdate>2023</risdate><volume>5</volume><issue>7</issue><spage>100987</spage><epage>100987</epage><pages>100987-100987</pages><artnum>100987</artnum><issn>2589-9333</issn><eissn>2589-9333</eissn><abstract>Cervical cerclage has been shown to reduce the risk of recurrent spontaneous preterm birth in a high-risk patient population; however, the mechanism is not well understood. Transabdominal cerclage is superior to low and high vaginal cerclage in reducing early spontaneous preterm birth and fetal loss in women with previous failed vaginal cerclage. Cervical length measurements are commonly used to monitor high-risk women and may explain the mechanism of success. This study aimed to evaluate the rate of change in longitudinal cervical length after randomized placement of low transvaginal, high transvaginal, or transabdominal cerclage in women with a previous failed vaginal cerclage. This was a planned analysis of longitudinal transvaginal ultrasound cervical length measurements from patients enrolled in the Vaginal Randomised Intervention of Cerclage trial, a randomized controlled trial comparing transabdominal cerclage or high transvaginal cerclage with low transvaginal cerclage. Cervical length measurements at specific gestational ages were compared over time and between groups, using generalized estimating equations fitted using the maximum-likelihood random-effects estimator. In addition, cervical length measurements were compared in women with transabdominal cerclage placed before and during pregnancy. The diagnostic accuracy of cervical length as a predictor of spontaneous preterm birth at &lt;32 weeks of gestation was explored. This study included 78 women who underwent longitudinal cervical length assessment (70% of the analyzed cohort) with a history of failed cerclage, of whom 25 (32%) were randomized to low transvaginal cerclage, 26 (33%) to high transvaginal cerclage, and 27 (35%) to transabdominal cerclage. Abdominal cerclage was superior to low (P=.008) and high (P=.001) vaginal cerclage at maintaining cervical length over the surveillance period (14 to 26 weeks of gestation) (+0.08 mm/week, 95% confidence interval, −0.40 to 0.22; P=.580). On average, the cervical length was 1.8 mm longer by the end of the 12-week surveillance period in women with transabdominal cerclage (+1.8 mm; 95% confidence interval, −7.89 to 4.30; P=.564). High vaginal cerclage was no better than low cervical cerclage in the prevention of cervical shortening; the cervix shortened by 13.2 mm over 12 weeks in those with low vaginal cerclage (95% confidence interval, −21.7 to −4.7; P=.002) and by 20 mm over 12 weeks in those with high vaginal cerclage (95% confidence interval, −33.1 to −7.4; P=.002). Preconception transabdominal cerclage resulted in a longer cervix than those performed during pregnancy; this difference was significant after 22 weeks of gestation (48.5 mm vs 39.6 mm; P=.039). Overall, cervical length was an excellent predictor of spontaneous preterm birth at &lt;32 weeks of gestation (receiver operating characteristic curve, 0.92; 95% confidence interval, 0.82–1.00). In women with a previous failed cervical cerclage, in the next pregnancy, the cervical length in women treated with vaginal cerclage funneled and shortened over time, whereas there was preservation of cervical length in women who receive transabdominal cerclage. Cervical length remained longer in transabdominal procedures performed before pregnancy than in transabdominal procedures performed during pregnancy. Overall, cervical length was an excellent predictor of spontaneous preterm birth in our cohort. Our findings may explain the mechanism of benefit for transabdominal cerclage, with its high placement better maintaining the structural integrity of the cervix at the level of the internal os.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>37146686</pmid><doi>10.1016/j.ajogmf.2023.100987</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0003-0988-7229</orcidid><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 2589-9333
ispartof American journal of obstetrics & gynecology MFM, 2023-07, Vol.5 (7), p.100987-100987, Article 100987
issn 2589-9333
2589-9333
language eng
recordid cdi_proquest_miscellaneous_2810916106
source ScienceDirect Journals
subjects cervical cerclage
cervical length
preterm birth prediction
spontaneous preterm birth
transabdominal cerclage
title Longitudinal change in cervical length following vaginal or abdominal cervical cerclage: a randomized comparison
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-12T00%3A56%3A59IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Longitudinal%20change%20in%20cervical%20length%20following%20vaginal%20or%20abdominal%20cervical%20cerclage:%20a%20randomized%20comparison&rft.jtitle=American%20journal%20of%20obstetrics%20&%20gynecology%20MFM&rft.au=Ridout,%20Alexandra%20E.&rft.aucorp=Multicentre%20Abdominal%20vs%20Vaginal%20Randomised%20Intervention%20of%20Cerclage%20Trial%20Collaborative%20Group&rft.date=2023-07&rft.volume=5&rft.issue=7&rft.spage=100987&rft.epage=100987&rft.pages=100987-100987&rft.artnum=100987&rft.issn=2589-9333&rft.eissn=2589-9333&rft_id=info:doi/10.1016/j.ajogmf.2023.100987&rft_dat=%3Cproquest_cross%3E2810916106%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c357t-88c3762a5a3e118b26392ec3d84714fd36b11f13be1b42c69d5e2d2903639e093%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2810916106&rft_id=info:pmid/37146686&rfr_iscdi=true