Effectiveness of cervical cerclage for a sonographically shortened cervix: a systematic review and meta-analysis

Am J Obstet Gynecol. 2003 Dec;189(6):1679-87. doi: 10.1016/s0002-9378(03)00871-8.

Abstract

Objective: The purpose of this study was to determine the effectiveness of cerclage for a shortened cervix on transvaginal ultrasound scanning in terms of the rates of preterm delivery and adverse neonatal and maternal outcomes.

Study design: Pre-MEDLINE and MEDLINE, EMBASE, and the Cochrane Library were searched for human studies that compared cerclage placement to no cerclage on the basis of transvaginal ultrasound findings of a short cervix (< or =2.5 cm). Two authors independently determined eligibility and abstracted data. Meta-analyses were conducted when possible.

Results: Thirty-five studies were reviewed; 6 studies were eligible and were included in the analysis. There was no statistically significant effect of cerclage on the rates of preterm delivery (<37, <34, <32, and <28 weeks of gestation), preterm labor, neonatal mortality or morbidity, gestational age at delivery, or time to delivery. Birth weight was significantly higher with than without cerclage (P=.004).

Conclusion: The available evidence does not support cerclage for a sonographically detected short cervix. A randomized controlled trial is needed to determine whether this intervention will reduce adverse neonatal outcomes.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adolescent
  • Adult
  • Cerclage, Cervical / methods*
  • Female
  • Gestational Age
  • Humans
  • Obstetric Labor, Premature / prevention & control*
  • Pregnancy
  • Pregnancy Outcome*
  • Pregnancy, High-Risk
  • Randomized Controlled Trials as Topic
  • Risk Factors
  • Sensitivity and Specificity
  • Ultrasonography, Prenatal*
  • Uterine Cervical Incompetence / diagnostic imaging*
  • Uterine Cervical Incompetence / surgery*