Prognosis and Prognostic Factors of Patients with Emergent Cerclage
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
