Cervical Cerclage During Periviability: Can We Stabilize a Moving Target?
Publication/Presentation Date
5-1-2016
Abstract
The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine recently published consensus guidelines on periviable birth recommending that obstetric interventions (antenatal corticosteroids, tocolysis, magnesium sulfate, antibiotics for preterm premature rupture of membranes or group B streptococcus prophylaxis, and cesarean delivery for fetal indications) may be considered at 23 0/7 weeks of gestation and neonatal resuscitation at 22 0/7 weeks of gestation. Cervical cerclage significantly decreases preterm delivery and improves perinatal outcomes in women with a singleton pregnancy, prior spontaneous preterm birth, and transvaginal cervical length less than 25 mm before 24 0/7 weeks of gestation or in women who experience painless cervix dilation in the second trimester. Randomized trials assessing ultrasonogram-indicated and physical examination-indicated cerclage report a procedure-related complication rate of 0.3% and 0.9%, respectively. If previability is a requisite for receiving a cerclage, an increasing subset of women may not be afforded an intervention that has known benefit, because obstetric and neonatal interventions are likely to occur at earlier gestational ages. Given the low procedure-related complication rate demonstrated in randomized trials, appropriately selected women should continue to be offered the procedure up to 24 0/7 weeks of gestation. Based on current evidence, cerclage placed after 24 0/7 weeks of gestation cannot be recommended, and future inquiry in the form of a well-designed randomized trial after this gestational age should be considered. The goal of this commentary is to review the history of cerclage and discuss the indications, risks, benefits, and implications on future research of this procedure as it relates to gestational age during periviability.
Volume
127
Issue
5
First Page
934
Last Page
940
ISSN
1873-233X
Published In/Presented At
Dahlke, J. D., Sperling, J. D., Chauhan, S. P., & Berghella, V. (2016). Cervical Cerclage During Periviability: Can We Stabilize a Moving Target?. Obstetrics and gynecology, 127(5), 934–940. https://doi.org/10.1097/AOG.0000000000001391
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
27054940
Department(s)
Administration and Leadership
Document Type
Article