Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Evidence-Based Medicine

Background:

• Cervical cerclage, a surgical procedure involving a suture around the cervix, aims to prevent preterm birth by providing mechanical support.
• The effectiveness and safety of cervical cerclage remain subjects of ongoing research and clinical debate.
• This review is an updated analysis of randomized trials investigating cervical cerclage, last published in 2012.

Purpose of the Study:

• To evaluate if cervical cerclage improves obstetric care and fetal outcomes in singleton pregnancies at high risk of pregnancy loss.
• High-risk criteria included a history of pregnancy loss, ultrasound-detected short cervix, or physical examination findings.
• The study assessed cerclage against no treatment or alternative interventions.

Main Methods:

• A systematic review and meta-analysis of randomized controlled trials (RCTs) identified through Cochrane Pregnancy and Childbirth's Trials Register and reference lists.
• Included trials involved singleton pregnancies where cerclage was indicated due to high-risk factors.
• Data were independently assessed by three reviewers, with risk of bias and data extraction performed by two reviewers. GRADE approach was used for evidence quality assessment.

Main Results:

• Cervical cerclage likely reduces the risk of perinatal death (RR 0.82, moderate quality evidence) and significantly reduces preterm births before 37, 34, and 28 weeks gestation (high quality evidence).
• No significant differences were observed in serious neonatal morbidity or rates of healthy baby discharge between cerclage and no cerclage groups.
• Comparisons between cerclage and vaginal progesterone, or between different indications for cerclage (history vs. ultrasound), were limited by small sample sizes and insufficient data.

Conclusions:

• Cervical cerclage is effective in reducing preterm birth and likely reduces perinatal deaths in high-risk pregnancies.
• Current evidence does not support differential effects based on specific indications (e.g., history, short cervix), but data are limited.
• Further research is needed to determine the comparative effectiveness of cervical cerclage versus other preventative treatments, such as vaginal progesterone.