Knot positioning during McDonald cervical cerclage, does it make a difference? A cohort study

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Surgical Techniques

Background:

• Cervical insufficiency is a significant cause of preterm birth.
• McDonald cerclage is a common surgical intervention to prevent preterm birth.
• The optimal placement of the cerclage knot is not well-established.

Purpose of the Study:

• To investigate the impact of McDonald cerclage knot position (anterior vs. posterior) on maternal and neonatal outcomes.
• To compare key obstetric and neonatal parameters between the two knot placement groups.

Main Methods:

• Historical cohort study of 550 women undergoing prophylactic McDonald cervical cerclage.
• Comparison of maternal outcomes (e.g., term birth rate, cervical length) and neonatal outcomes (e.g., NICU admission, respiratory distress syndrome).
• Statistical analysis including survival analysis for gestational age at delivery.

Main Results:

• No statistically significant differences were observed in gestational age at delivery, term birth rate, or post-cerclage cervical length between anterior and posterior knot groups.
• Maternal complications such as symptomatic vaginitis, UTI, difficult cerclage removal, and cervical lacerations showed no significant difference.
• Neonatal outcomes, including take-home baby rates, NICU admissions, respiratory distress syndrome, and neonatal sepsis, were comparable between the groups.

Conclusions:

• The position of the knot in McDonald cervical cerclage (anterior or posterior) does not significantly influence the studied maternal and neonatal outcomes.
• This finding suggests that knot placement may not be a critical factor in the success of prophylactic McDonald cerclage.