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Prognosis and Prognostic Factors of Patients with Emergent Cerclage
![Prognosis and Prognostic Factors of Patients with Emergent Cerclage Prognosis and Prognostic Factors of Patients with Emergent Cerclage](https://medicaldialogues.in/h-upload/2022/05/19/750x450_176654-pregnancy.webp)
Treatment and prophylaxis for spontaneous preterm birth (SPTB) are challenging: administration of progesterone, tocolytic agents, antibiotics, and their combination have been reported to reduce SPTB incidence. Cervical cerclage has also been attempted in some patients.
Cerclage is divided into two types: elective and emergent cerclage. The former is performed at 12–14 weeks’ gestation for patients with historical indications. The latter, also referred to as rescue cerclage, is usually performed at 15–24 weeks for patients with an ultrasound-detectable shortened cervical length (CL) and patients with this latter cerclage, compared with those with the former clearly show poorer perinatal outcomes, especially PTB. Thus, patients after emergent cerclage require special attention, especially for PTB.
Progesterone has been widely recommended as a treatment for threatened PTB in global guidelines. However, in Japan, progesterone is not yet a routine choice because national insurance does not cover it. Without progesterone, Japanese obstetricians employ cerclage. The fundamental policy of their institute is: emergent cerclage should be performed for a patient with CL. The aims of the study by Ami Kobayashi and team was to clarify the following: (1) how often does prolonged pregnancy ≥34 weeks occur in patients with emergent cerclage without progesterone and (2) the risk factors preventing such pregnancy continuation.
This retrospective observational study was performed using medical records of patients for whom emergent cerclage had been performed between April 2006 and December 2018 in Jichi Medical University institute.
Authors made a few important observations in patients necessitating emergent cerclage without progesterone administration. SPTB < 34 weeks occurred after emergency cerclage in 16% of patients.
Three risk factors predicted SPTB < 34 weeks after emergency cerclage: unmeasurable CL (CL 0 mm), a history of SPTB, and the presence of sludge on ultrasound. SPTB < 34 weeks occurred after emergency cerclage in 16% of patients, being comparable with the recent data. This study may have indicated the data of cerclage effectiveness without progesterone, data excluding the effect of progesterone.
Source: Ami Kobayashi, Hironori Takahashi , Shigeki Matsubara; Hindawi Obstetrics and Gynecology International Volume 2021, Article ID 4351783, 7 pages
https://doi.org/10.1155/2021/4351783
MBBS, MD Obstetrics and Gynecology
Dr Nirali Kapoor has completed her MBBS from GMC Jamnagar and MD Obstetrics and Gynecology from AIIMS Rishikesh. She underwent training in trauma/emergency medicine non academic residency in AIIMS Delhi for an year after her MBBS. Post her MD, she has joined in a Multispeciality hospital in Amritsar. She is actively involved in cases concerning fetal medicine, infertility and minimal invasive procedures as well as research activities involved around the fields of interest.
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: editorial@medicaldialogues.in. Contact no. 011-43720751