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Physical Examination-Indicated Cerclage: A Systematic Review and Meta-analysis
Robert M Ehsanipoor1, Neil S Seligman, Gabriele Saccone
1Departments of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland, University of Rochester, Rochester, New York, and Warren Alpert Medical School of Brown University, Providence, Rhode Island; the Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy; and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.
Physical examination-indicated cerclage significantly improves neonatal survival and prolongs pregnancy by about one month for women with second-trimester cervical dilation. However, potential bias in studies limits the strength of this conclusion.
Area of Science:
- Maternal-fetal medicine
- Obstetrics
- Perinatal outcomes
Background:
- Cervical insufficiency is a condition leading to mid-trimester pregnancy loss.
- Physical examination-indicated cerclage is a procedure to prevent such losses.
- Evidence on its effectiveness in cases of cervical dilation is debated.
Purpose of the Study:
- To systematically review and meta-analyze published studies.
- To estimate the effectiveness of physical examination-indicated cerclage.
- To assess outcomes in women with second-trimester cervical dilatation.
Main Methods:
- Comprehensive literature search across multiple databases (MEDLINE, EMBASE, Scopus, etc.) from 1966 to 2014.
- Inclusion of cohort studies and randomized controlled trials comparing cerclage with expectant management.
- Meta-analysis using fixed- and random-effects models to determine summary estimates for neonatal survival and pregnancy duration.
Main Results:
- Ten studies involving 757 women were analyzed.
- Physical examination-indicated cerclage was associated with increased neonatal survival (RR 1.65, 95% CI 1.19-2.28).
- Cerclage also led to a significant prolongation of pregnancy by approximately 34 days (95% CI 17.88-50.08).
Conclusions:
- Physical examination-indicated cerclage significantly improves neonatal survival rates.
- The procedure effectively prolongs pregnancy duration by about one month.
- Potential for bias in the included studies warrants cautious interpretation of findings.
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