[Second trimester cerclage of short cervixes: which technique to use? A retrospective study of 25 cases]

To evaluate pregnancy outcome after therapeutic or emergency cerclage performed on the basis of clinical or/and ultrasound cervical modifications noted before 26 weeks of gestation and to precise which surgical procedure (Shirodkar or McDonald) is the most appropriate in these indications.

Retrospective study between January 1(st) 1996 and December 31(st) 2001 on 25 clinical charts of patients with suspected cervical incompetence who had second trimester cervical cerclage on the basis of clinical or ultrasound cervical length shortening. Patients with first trimester prophylactic cervical cerclage were excluded from analysis. The choice between the two surgical procedures (Shirodkar or McDonald) depended on surgeon preference but the two groups were identical for previous obstetrical history, time of cerclage and cervical modifications. Statistical analysis was performed using Chi 2 test or t-test according to the type of variables.

In our series, 9 patients had cervical cerclage performed with Shirodkar (S) procedure and 16 had McDonald cerclage (MD). Mean operating time (S: 52 +/- 18 minutes; MD: 39 +/- 3 minutes; p=0.1) and mean hospital stay (S: 5.2 +/- 1.3 days; MD: 5.3 +/- 1.5 days; p=0.9) were not significantly different between the two procedures. The difference in mean gestational age at delivery, (S: 35.7 +/- 3.2 Wks; MD: 33.2 +/- 2.9 Wks; p=0.5) and in the number of premature deliveries before 32 completed weeks (S: 22.2%; MD: 43.7%; p=0.4) better in Shirodkar group didn't reach statistical signification. No statistical difference was noted in the number of admission in neonatal intensive care unit (S: 22.2%; MD: 31.2%; p=0.9) and in neonatal survival (S: 1 neonatal death; MD: 1 neonatal death) between the two groups.

No conclusion regarding the most appropriate cervical cerclage procedure can be drawn from our study. However, Shirodkar procedure seems preferable to us due to tendency in a higher mean gestational age at delivery and because it didn't appeared to be longer or more difficult procedure. Multicentric studies may probably give better knowledge in this topic.