TY - JOUR
T1 - Expectant management compared with physical examination-indicated cerclage (EM-PEC) in selected women with a dilated cervix at 140/7-256/7 weeks
T2 - results from the EM-PEC international cohort study
AU - Pereira, Leonardo
AU - Cotter, Amanda
AU - Gómez, Ricardo
AU - Berghella, Vincenzo
AU - Prasertcharoensuk, Witoon
AU - Rasanen, Juha
AU - Chaithongwongwatthana, Surasith
AU - Mittal, Suneeta
AU - Daly, Sean
AU - Airoldi, Jim
AU - Tolosa, Jorge E.
N1 - Funding Information:
The GNPRH would like to acknowledge the contributions of the following individuals at each site for their efforts that made this study possible: Thomas Jefferson University, Philadelphia, PA: Jennifer Kolecki, MD, Amen Ness, MD, Jason Baxter, MD; Oregon Health and Science University, Portland, OR: Sophia Rothberger MD, MPH, Heidi Printz, PhD, Katherine Gesteland, MD, MPH; University of Oulu, Oulu, Finland: Marja Vaarasmaki, MD; University of Miami, Miami, Florida: Loren Smarkusky, MD; Center for Perinatal Diagnosis and Research, Sotero del Río Hospital, Pontifica Universidad Católica de Chile, Puente Alto, Chile: Luis Medina, MD; Khon Kaen University, Khon Kaen, Thailand: Pisake Lumbiganon, MD; Chulalongkorn University, Bangkok, Thailand: Sompop Limpongsanurak, MD; All India Institute of Medical Sciences, New Delhi, India: J B Sharma MD, Nupur Gupta, MD; Coombe Women’s Hospital, Dublin, Ireland: Etaoin Kearney, MD; and St. Luke’s Hospital, Bethlehem, Pennsylvania: Albert Sarno, MD.
PY - 2007/11
Y1 - 2007/11
N2 - Objective: The objective of the study was to compare pregnancy outcomes in selected women with a dilated cervix who underwent expectant management or physical examination-indicated cerclage. Study Design: This was a historical cohort study conducted by the Global Network for Perinatal and Reproductive Health. Women between 140/7 and 256/7 weeks' gestation with a dilated cervix were identified at 10 centers by ultrasound or digital examination. Primary outcome was time from presentation until delivery (weeks). Secondary outcomes were neonatal survival, birthweight greater than 1500 g and preterm birth less than 28 weeks. Multivariate regression was used to assess the likelihood of neonatal outcomes and control for confounders. Results: Of 225 women, 152 received a physical examination-indicated cerclage, and 73 were managed expectantly without cerclage. Cervical dilation, gestational age at presentation, and antenatal steroid use differed between groups. In the adjusted analyses, cerclage was associated with longer interval from presentation until delivery, improved neonatal survival, birthweight greater than 1500 g and preterm birth less than 28 weeks, compared with expectant management. Similar results were obtained in the analyses limited to women dilated between 2 and 4 cm (n = 122). Conclusion: In this study, the largest cohort reported to date, physical examination-indicated cerclage appears to prolong gestation and improve neonatal survival, compared with expectant management in selected women with cervical dilation between 140/7 and 256/7 weeks. A randomized, controlled trial should be conducted to determine whether these potential benefits outweigh the risks of cerclage placement in this population.
AB - Objective: The objective of the study was to compare pregnancy outcomes in selected women with a dilated cervix who underwent expectant management or physical examination-indicated cerclage. Study Design: This was a historical cohort study conducted by the Global Network for Perinatal and Reproductive Health. Women between 140/7 and 256/7 weeks' gestation with a dilated cervix were identified at 10 centers by ultrasound or digital examination. Primary outcome was time from presentation until delivery (weeks). Secondary outcomes were neonatal survival, birthweight greater than 1500 g and preterm birth less than 28 weeks. Multivariate regression was used to assess the likelihood of neonatal outcomes and control for confounders. Results: Of 225 women, 152 received a physical examination-indicated cerclage, and 73 were managed expectantly without cerclage. Cervical dilation, gestational age at presentation, and antenatal steroid use differed between groups. In the adjusted analyses, cerclage was associated with longer interval from presentation until delivery, improved neonatal survival, birthweight greater than 1500 g and preterm birth less than 28 weeks, compared with expectant management. Similar results were obtained in the analyses limited to women dilated between 2 and 4 cm (n = 122). Conclusion: In this study, the largest cohort reported to date, physical examination-indicated cerclage appears to prolong gestation and improve neonatal survival, compared with expectant management in selected women with cervical dilation between 140/7 and 256/7 weeks. A randomized, controlled trial should be conducted to determine whether these potential benefits outweigh the risks of cerclage placement in this population.
KW - cerclage
KW - premature cervical dilation
KW - preterm birth
UR - http://www.scopus.com/inward/record.url?scp=35549008014&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=35549008014&partnerID=8YFLogxK
U2 - 10.1016/j.ajog.2007.05.041
DO - 10.1016/j.ajog.2007.05.041
M3 - Article
C2 - 17980182
AN - SCOPUS:35549008014
SN - 0002-9378
VL - 197
SP - 483.e1-483.e8
JO - American journal of obstetrics and gynecology
JF - American journal of obstetrics and gynecology
IS - 5
ER -