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[PMID]:29374885
[Au] Autor:Wang HL; Yang Z; Shen Y; Wang QL
[Ad] Endereço:Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.
[Ti] Título:[Clinical outcome of therapeutic cervical cerclage in short cervix syndrome].
[So] Source:Zhonghua Fu Chan Ke Za Zhi;53(1):43-46, 2018 Jan 25.
[Is] ISSN:0529-567X
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To investigate the clinical effect of therapeutic cervical cerclage on short cervix syndrome for anti-premature birth in the second trimester. Totally 44 singleton pregnant patients were diagnosed as short cervix syndrome, which was cervical length ≤2.5 cm without cervical dilatation, and received treatment from January 2008 and July 2015 in Peking University Third Hospital were collected. Among them, 30 patients who received therapeutic cervical cerclage were defined as cerclage group and another 14 cases who received conservative treatment were defined as un-cerclage group. The days of conservative treatment, delivery rate of different gestational weeks, birth weight of newborns, neonatal survival rate within 7 days of birth were analyzed between the two groups. There were no significant differences between the two groups in days of pregnancy conservative treatment [103 (84-141) vs 105 (85-114) days], delivery weeks [38.0 (35.5-39.4) vs 38.5 (37.3-39.5) weeks], birth weight of newborns [3 120 (2 750-3 400) vs 3 130 (2 760-3 545) g], and survival rate of newborns [100% (30/30) vs 13/14]. The fetuses of both groups were all delivered after 28 weeks. There was no significant difference in accumulated delivery rate between the two groups after 32 weeks, 34 weeks, and 37 weeks, respectively (all 0.05) . The treatment of cervical cerclage is not superior to conservative means in single pregnancy of cervical length ≤2.5 cm without cervical dilatation. For such patients with short cervix syndrome, the treatment of cervical cerclage may not be necessary, but dynamic monitoring and search for the causing factors and prompt treatment are more important.
[Mh] Termos MeSH primário: Cerclagem Cervical
Colo do Útero/fisiopatologia
Resultado da Gravidez/epidemiologia
Incompetência do Colo do Útero/terapia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Peso ao Nascer
Parto Obstétrico
Feminino
Idade Gestacional
Seres Humanos
Recém-Nascido
Parto
Gravidez
Complicações na Gravidez
Segundo Trimestre da Gravidez
Nascimento Prematuro
Incompetência do Colo do Útero/diagnóstico
Incompetência do Colo do Útero/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180129
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.0529-567X.2018.01.009


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[PMID]:28068860
[Au] Autor:Sinkey RG; Garcia MR; Odibo AO
[Ad] Endereço:a Department of Obstetrics and Gynecology , University of South Florida Morsani College of Medicine , Tampa , FL , USA.
[Ti] Título:Does adjunctive use of progesterone in women with cerclage improve prevention of preterm birth?
[So] Source:J Matern Fetal Neonatal Med;31(2):202-208, 2018 Jan.
[Is] ISSN:1476-4954
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To evaluate outcomes among pregnancies with cerclage as compared to cerclage and adjunctive progesterone. METHODS: A retrospective cohort study was performed from 1 October 2011-30 June 2015 including women with a singleton gestation with vaginal cerclage. Exclusion criteria included multiple gestations, simultaneous 17-alpha hydroxyprogesterone caproate (17-OHPC) and vaginal progesterone (vag-p) use, and patients lost to follow-up. Primary outcome was prevention of preterm birth less than 35 (PTB <35) weeks gestational age (GA). RESULTS: One hundred thirty-six patients met inclusion criteria; 73 women had cerclage only, 53 had cerclage and 17-OHPC, 10 had cerclage and vag-p. GA at cerclage placement was similar across groups (p = 0.068). There was a difference in prevention of PTB <35 weeks GA among groups (p = 0.035) with a trend toward earlier delivery among patients with cerclage and vag-p. Rates of PTB <35 weeks in the cerclage (29%) and cerclage and 17-OHPC groups (34%) were similar (p = 0.533). The odds ratio for risk of PTB <35 weeks among women with cerclage and vag-p as compared to all other patients was 5.21 (95%CI: 1.3-21.2). CONCLUSION: The combination of cerclage with intramuscular progesterone resulted in similar PTB prevention as compared to cerclage alone. There may be an association between cerclage, vaginal progesterone and higher rates of PTB which may be attributed to characteristics of the group rather than the therapies studied.
[Mh] Termos MeSH primário: Cerclagem Cervical
Resultado da Gravidez/epidemiologia
Nascimento Prematuro/tratamento farmacológico
Nascimento Prematuro/prevenção & controle
Progesterona/uso terapêutico
Progestinas/uso terapêutico
[Mh] Termos MeSH secundário: Administração Intravaginal
Adulto
Feminino
Seres Humanos
Recém-Nascido
Estimativa de Kaplan-Meier
Gravidez
Progesterona/administração & dosagem
Progestinas/administração & dosagem
Estudos Retrospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Progestins); 4G7DS2Q64Y (Progesterone)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171128
[Lr] Data última revisão:
171128
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170111
[St] Status:MEDLINE
[do] DOI:10.1080/14767058.2017.1280019


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[PMID]:28673792
[Au] Autor:Monsanto SP; Daher S; Ono E; Pendeloski KPT; Trainá É; Mattar R; Tayade C
[Ad] Endereço:Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada.
[Ti] Título:Cervical cerclage placement decreases local levels of proinflammatory cytokines in patients with cervical insufficiency.
[So] Source:Am J Obstet Gynecol;217(4):455.e1-455.e8, 2017 Oct.
[Is] ISSN:1097-6868
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Cervical insufficiency is characterized by premature, progressive dilation and shortening of the cervix during pregnancy. If left unattended, this can lead to the prolapse and rupture of the amniotic membrane, which usually results in midtrimester pregnancy loss or preterm birth. Previous studies have shown that proinflammatory cytokines such as interleukin-1ß, interleukin-6, interleukin-8, and tumor necrosis factor alpha are up-regulated in normal parturition but are also associated with preterm birth. Studies evaluating such markers in patients with cervical insufficiency have evaluated only their diagnostic potential. Even fewer studies have studied them within the context of cerclage surgery. OBJECTIVES(S): The objective of the study was to evaluate the impact of local and systemic inflammatory markers on the pathogenesis of cervical insufficiency and the effect of cerclage surgery on the local immune microenvironment of women with cervical insufficiency. STUDY DESIGN: We recruited 28 pregnant women (12-20 weeks' gestation) diagnosed with insufficiency and referred for cerclage surgery and 19 gestational age-matched normal pregnant women as controls. Serum and cervicovaginal fluid samples were collected before and after cerclage surgery and during a routine checkup for normal women and analyzed using a targeted 13-plex proinflammatory cytokine assay. RESULTS: Before surgery, patients with cervical insufficiency had higher levels of interleukin-1ß, interleukin-6, interleukin-12, monocyte chemoattractant protein-1 and tumor necrosis factor alpha in cervicovaginal fluid compared to controls, but after surgery, these differences disappeared. No differences were found in serum of insufficiency versus control women. In patients with insufficiency, the levels of interleukin-1ß, interleukin-6, interleukin-8, monocyte chemoattractant protein-1, and interferon gamma in cervicovaginal fluid declined significantly after cerclage compared with before intervention, but these changes were not detected in serum. CONCLUSION: Compared with normal women, patients with cervical insufficiency have elevated levels of proinflammatory cytokines in cervicovaginal fluid but not in serum, suggesting a dysregulation of the local immune environment. Cerclage intervention led to a significant decline in these proinflammatory cytokines, suggesting that cerclage may help reduce local inflammation in cervical insufficiency.
[Mh] Termos MeSH primário: Cerclagem Cervical
Muco do Colo Uterino/metabolismo
Citocinas/metabolismo
Incompetência do Colo do Útero/metabolismo
[Mh] Termos MeSH secundário: Adulto
Estudos de Casos e Controles
Feminino
Seres Humanos
Gravidez
Incompetência do Colo do Útero/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Cytokines)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171002
[Lr] Data última revisão:
171002
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170705
[St] Status:MEDLINE


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[PMID]:28639273
[Au] Autor:Wang S; Feng L
[Ad] Endereço:Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
[Ti] Título:A single-center retrospective study of pregnancy outcomes after emergency cerclage for cervical insufficiency.
[So] Source:Int J Gynaecol Obstet;139(1):9-13, 2017 Oct.
[Is] ISSN:1879-3479
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To compare maternal and perinatal outcomes after emergency cerclage with those after elective cerclage. METHODS: In a retrospective review, data were assessed from women with a viable singleton pregnancy who underwent elective or emergency cerclage for cervical insufficiency at the Tongji Hospital, Wuhan, China, between January 2010 and July 2015. Subgroup analyses based on cervical length (CL; ≤15, 15-25, and 25-30 mm) were also conducted among women undergoing emergency cerclage. RESULTS: In total, 68 women underwent elective cerclage and 53 underwent emergency cerclage. The suture-to-delivery interval was significantly longer in the elective group (19.17 ± 5.86 weeks) than in the emergency group (11.29 ± 7.27 weeks; P<0.001). There was no difference between the elective and emergency groups in mean pregnancy length at delivery, frequency of Apgar score below 7 at 5 minutes (live births only), or birth weight (live births only). An inverse trend in the degree of CL shortening with pregnancy outcomes was observed; women with a CL of 25-30 mm had the best outcomes. CONCLUSION: Pregnancy outcomes were similar after emergency and elective cerclage. There was an inverse trend in the degree of CL shortening with pregnancy outcomes in the emergency cerclage group, with better outcomes observed for women with longer CL.
[Mh] Termos MeSH primário: Incompetência do Colo do Útero/epidemiologia
[Mh] Termos MeSH secundário: Adulto
Cerclagem Cervical
Medida do Comprimento Cervical
China/epidemiologia
Procedimentos Cirúrgicos Eletivos
Serviços Médicos de Emergência
Feminino
Seres Humanos
Gravidez
Resultado da Gravidez
Estudos Retrospectivos
Fatores de Tempo
Incompetência do Colo do Útero/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171006
[Lr] Data última revisão:
171006
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170623
[St] Status:MEDLINE
[do] DOI:10.1002/ijgo.12244


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[PMID]:28586127
[Au] Autor:Alfirevic Z; Stampalija T; Medley N
[Ad] Endereço:Department of Women's and Children's Health, The University of Liverpool, First Floor, Liverpool Women's NHS Foundation Trust, Crown Street, Liverpool, UK, L8 7SS.
[Ti] Título:Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy.
[So] Source:Cochrane Database Syst Rev;6:CD008991, 2017 06 06.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Cervical cerclage is a well-known surgical procedure carried out during pregnancy. It involves positioning of a suture (stitch) around the neck of the womb (cervix), aiming to give mechanical support to the cervix and thereby reduce risk of preterm birth. The effectiveness and safety of this procedure remains controversial. This is an update of a review last published in 2012. OBJECTIVES: To assess whether the use of cervical stitch in singleton pregnancy at high risk of pregnancy loss based on woman's history and/or ultrasound finding of 'short cervix' and/or physical exam improves subsequent obstetric care and fetal outcome. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register (30 June 2016) and reference lists of identified studies. SELECTION CRITERIA: We included all randomised trials of cervical suturing in singleton pregnancies. Cervical stitch was carried out when the pregnancy was considered to be of sufficiently high risk due to a woman's history, a finding of short cervix on ultrasound or other indication determined by physical exam. We included any study that compared cerclage with either no treatment or any alternative intervention. We planned to include cluster-randomised studies but not cross-over trials. We excluded quasi-randomised studies. We included studies reported in abstract form only. DATA COLLECTION AND ANALYSIS: Three review authors independently assessed trials for inclusion. Two review authors independently assessed risk of bias and extracted data. We resolved discrepancies by discussion. Data were checked for accuracy. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS: This updated review includes a total of 15 trials (3490 women); three trials were added for this update (152 women). Cerclage versus no cerclageOverall, cerclage probably leads to a reduced risk of perinatal death when compared with no cerclage, although the confidence interval (CI) crosses the line of no effect (RR 0.82, 95% CI 0.65 to 1.04; 10 studies, 2927 women; moderate quality evidence). Considering stillbirths and neonatal deaths separately reduced the numbers of events and sample size. Although the relative effect of cerclage is similar, estimates were less reliable with fewer data and assessed as of low quality (stillbirths RR 0.89, 95% CI 0.45 to 1.75; 5 studies, 1803 women; low quality evidence; neonatal deaths before discharge RR 0.85, 95% CI 0.53 to 1.39; 6 studies, 1714 women; low quality evidence). Serious neonatal morbidity was similar with and without cerclage (RR 0.80, 95% CI 0.55 to 1.18; 6 studies, 883 women; low-quality evidence). Pregnant women with and without cerclage were equally likely to have a baby discharged home healthy (RR 1.02, 95% CI 0.97 to 1.06; 4 studies, 657 women; moderate quality evidence).Pregnant women with cerclage were less likely to have preterm births compared to controls before 37, 34 (average RR 0.77, 95% CI 0.66 to 0.89; 9 studies, 2415 women; high quality evidence) and 28 completed weeks of gestation.Five subgroups based on clinical indication provided data for analysis (history-indicated; short cervix based on one-off ultrasound in high risk women; short cervix found by serial scans in high risk women; physical exam-indicated; and short cervix found on scan in low risk or mixed populations). There were too few trials in these clinical subgroups to make meaningful conclusions and no evidence of differential effects. Cerclage versus progesteroneTwo trials (129 women) compared cerclage to prevention with vaginal progesterone in high risk women with short cervix on ultrasound; these trials were too small to detect reliable, clinically important differences for any review outcome. One included trial compared cerclage with intramuscular progesterone (75 women) which lacked power to detect group differences. History indicated cerclage versus ultrasound indicated cerclageEvidence from two trials (344 women) was too limited to establish differences for clinically important outcomes. AUTHORS' CONCLUSIONS: Cervical cerclage reduces the risk of preterm birth in women at high-risk of preterm birth and probably reduces risk of perinatal deaths. There was no evidence of any differential effect of cerclage based on previous obstetric history or short cervix indications, but data were limited for all clinical groups. The question of whether cerclage is more or less effective than other preventative treatments, particularly vaginal progesterone, remains unanswered.
[Mh] Termos MeSH primário: Cerclagem Cervical/métodos
Nascimento Prematuro/prevenção & controle
[Mh] Termos MeSH secundário: Administração Intravaginal
Cerclagem Cervical/efeitos adversos
Cesárea/utilização
Feminino
Seres Humanos
Injeções Intramusculares
Morte Perinatal/prevenção & controle
Gravidez
Nascimento Prematuro/epidemiologia
Progesterona/administração & dosagem
Ensaios Clínicos Controlados Aleatórios como Assunto
Natimorto/epidemiologia
Técnicas de Sutura
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
4G7DS2Q64Y (Progesterone)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170901
[Lr] Data última revisão:
170901
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170607
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD008991.pub3


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[PMID]:28570639
[Au] Autor:Cook JR; Chatfield S; Chandiramani M; Kindinger L; Cacciatore S; Sykes L; Teoh T; Shennan A; Terzidou V; Bennett PR
[Ad] Endereço:Parturition Research Group, Imperial College London, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, Du Cane Road, London, United Kingdom.
[Ti] Título:Cerclage position, cervical length and preterm delivery in women undergoing ultrasound indicated cervical cerclage: A retrospective cohort study.
[So] Source:PLoS One;12(6):e0178072, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The objectives were to assess whether anatomical location of ultrasound (USS) indicated cervical cerclage and/or the degree of cervical shortening (cervical length; CL) prior to and following cerclage affects the risk of preterm birth (PTB). METHOD: A retrospective cohort study of 179 women receiving cerclage for short cervix (≤25mm) was performed. Demographic data, CL before and after cerclage insertion, height of cerclage (distance from external os) and gestation at delivery were collected. Relative risk (RR) and odds ratio (OR) of preterm delivery were calculated according to the anatomical location of the cerclage within the cervix and the CL before and after cerclage as categorical and continuous variables. Partition tree analysis was used to identify the threshold cerclage height that best predicts PTB. RESULTS: 25% (n = 45) delivered <34 weeks and 36% (n = 65) delivered <37 weeks. Risk of PTB was greater with cerclage in the distal 10mm (RR2.37, 95% CI 1.45-3.87) or the distal half of a closed cervix (RR2.16, 95% CI 1.45-3.87). Increasing absolute cerclage height was associated with a reduction in PTB (OR 0.87, 95% CI 0.82-0.94). A cerclage height <14.5 mm best predicts PTB (70.8%). Increasing CL following cerclage was associated with a reduction in PTB (OR0.87, 95% CI 0.82-0.94). Conversely, the risk of PTB was increased where CL remained static or shortened further following cerclage (RR2.34, 95% CI 1.04-5.25). CONCLUSION: The higher a cerclage was placed within a shortened cervix, the lower the subsequent odds of PTB. Women whose cerclage is placed in the distal 10mm of closed cervix or whose cervix fails to elongate subsequently, should remain under close surveillance as they have the highest risk of PTB.
[Mh] Termos MeSH primário: Cerclagem Cervical
Colo do Útero/patologia
Nascimento Prematuro
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Recém-Nascido
Gravidez
Estudos Retrospectivos
Reino Unido
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170602
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0178072


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[PMID]:28397052
[Au] Autor:Wang S; Wang Y; Feng L
[Ad] Endereço:Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
[Ti] Título:Pregnancy outcomes following transvaginal cerclage for cervical insufficiency: Results from a single-center retrospective study.
[So] Source:J Huazhong Univ Sci Technolog Med Sci;37(2):237-242, 2017 Apr.
[Is] ISSN:1672-0733
[Cp] País de publicação:China
[La] Idioma:eng
[Ab] Resumo:To study maternal and perinatal outcomes after cervical cerclage in both singleton and twin pregnancies, we retrospectively reviewed women undergoing cervical cerclage for cervical insufficiency at Tongji Hospital, Wuhan, China from January 1, 2010 to July 31, 2015 to evaluate primary and secondary outcomes for subgroups with cervical length (CL) ≤15, >15 to <25, and ≥25 mm. Of 166 patients who underwent cervical cerclage, after exclusion of patients with missed abortion and continuing pregnancy, 141 patients (121 singleton and 20 twin pregnancies) were included in the analysis. Mean gestational age at birth was 34.22 and 28.27 weeks for singleton and twin pregnancies, respectively. There were 17 (14.05%) and 13 (33.33%) neonatal deaths in singleton and twin pregnancies, respectively. Mean age (31.60±4.62 vs. 31.22±4.63 years, P=0.39) and gestational weeks at cerclage (18.50±4.62 vs. 19.31±4.99, P=0.47) were similar for both groups. Mean gestational weeks at delivery (34.22±5.77 vs. 28.27±6.17, P<0.001) and the suture to delivery interval (15.72±7.15 vs. 8.96±6.70, P<0.001) were significantly longer in the singleton group. These variables indicate a linear negative correlation with the degree of CL shortening, with better outcomes in patients with CL ≥25 mm who underwent cerclage, both in singleton and twin pregnancies. No difference in mode of delivery existed between the singleton group and twin group. Our results indicate a high risk of preterm delivery in both groups, especially in the twin group. Patients with a history of preterm labor and CL >25 mm in the current pregnancy, possibly in a twin pregnancy, could benefit from elective cervical cerclage; however, cervical cerclage was inadvisable for twin pregnancies with a CL >15 and <25 mm. Our data emphasize the importance of re-evaluating the efficacy of cervical cerclage for twin pregnancies in well-designed clinical trials.
[Mh] Termos MeSH primário: Cerclagem Cervical/mortalidade
Resultado da Gravidez/epidemiologia
Gravidez de Gêmeos/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Medida do Comprimento Cervical
Feminino
Idade Gestacional
Seres Humanos
Gravidez
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:171104
[Lr] Data última revisão:
171104
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170412
[St] Status:MEDLINE
[do] DOI:10.1007/s11596-017-1721-0


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[PMID]:28281278
[Au] Autor:Steenhaut P; Hubinont C; Bernard P; Debiève F
[Ad] Endereço:Department of Obstetrics, Saint Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium.
[Ti] Título:Retrospective comparison of perinatal outcomes following emergency cervical cerclage with or without prolapsed membranes.
[So] Source:Int J Gynaecol Obstet;137(3):260-264, 2017 Jun.
[Is] ISSN:1879-3479
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To compare perinatal outcomes following emergency cerclage between patients with singleton pregnancies with prolapsed and non-prolapsed membranes. METHODS: The present retrospective cohort study included data from women who underwent physical examination-indicated emergency cerclage at between 15 and 25 weeks of pregnancy at Saint Luc University Hospital, Brussels, Belgium, between January 1, 2000, and December 31, 2014. Outcomes were compared based on the presence of prolapsed or non-prolapsed membranes. The primary outcome measures were the duration of pregnancy at delivery and the interval between cerclage and delivery. Secondary outcomes included delivery weight, fetal or neonatal death, and neonatal morbidity, including neonatal intensive care unit admission. RESULTS: Data were included from 140 patients with cervical dilation of at least 1 cm; 85 women had non-prolapsed membranes and 55 women had prolapsed membranes. Among patients with non-prolapsed membranes, the mean duration of pregnancy at delivery was later (P<0.001), the latency between cerclage and delivery was longer (P<0.001), neonatal survival was higher (P=0.036), mean delivery weight was higher (P<0.001), the prevalence of preterm delivery was lower (P<0.001), and severe neonatal morbidity and neonatal intensive care unit admission were lower (P<0.001). CONCLUSION: Having non-prolapsed membranes was associated with improved perinatal outcomes following emergency cerclage.
[Mh] Termos MeSH primário: Cerclagem Cervical
Incompetência do Colo do Útero/cirurgia
[Mh] Termos MeSH secundário: Adulto
Emergências
Membranas Extraembrionárias/fisiopatologia
Feminino
Seres Humanos
Gravidez
Resultado da Gravidez
Prolapso
Estudos Retrospectivos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171020
[Lr] Data última revisão:
171020
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170311
[St] Status:MEDLINE
[do] DOI:10.1002/ijgo.12144


  9 / 703 MEDLINE  
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[PMID]:28255763
[Au] Autor:Bolla D; Gasparri ML; Badir S; Bajka M; Mueller MD; Papadia A; Raio L
[Ad] Endereço:Department of Obstetrics and Gynaecology, University Hospital of Berne and University of Berne, Inselspital, Effingerstrasse 102, 3010, Bern, Switzerland. daniele.bolla@insel.ch.
[Ti] Título:Cervical length after cerclage: comparison between laparoscopic and vaginal approach.
[So] Source:Arch Gynecol Obstet;295(4):885-890, 2017 Apr.
[Is] ISSN:1432-0711
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:PURPOSE: The aim of our study was to investigate the sonographic changes of the cervical length during pregnancy after the placement of a transvaginal cervical cerclage (TVC) or a laparoscopic abdominal cerclage (LAC) in patients with cervical insufficiency (CI). METHODS: Between January 2008 and March 2015, a retrospective analysis of all women undergoing a prophylactic laparoscopic (LAC group) or transvaginal (TVC group) cerclage due to cervical insufficiency was conducted. Nonparametric variables were analysed with the Mann-Whitney (U) test, and categorical-type outcomes were analysed with the Fisher's exact test. A p value <0.05 was considered as significant. Data analysis was performed using Prism 5 for Mac OS X. RESULTS: Thirty-eight patients were included. Of these, 18 and 20 underwent an LAC and a TVC, respectively. Mean gestational age at surgery in the LAC and TVC groups was 11.4 ± 1.6 and 17 ± 3 weeks, respectively (p < 0.05). The cervical length prior to surgery was similar among the two groups. After cerclage placement, the distance between the tape and the external cervical os differed significantly between the two groups (LAC: 31.5 ± 8.8 mm vs TVC: 13.5 ± 4.9 mm; p < 0.0001) (Fig. 1). During pregnancy, the cervical length in the TVC group showed a significant shortening (from 26.6 ± 7 mm before surgery to 13.2 ± 7 mm at 33 weeks; p < 0.0001), while in the LAC group, the cervical length remained unchanged. CONCLUSIONS: In patients with CI, LAC is associated with a better preservation of the cervical length throughout pregnancy as compared to TVC.
[Mh] Termos MeSH primário: Cerclagem Cervical/métodos
Colo do Útero/diagnóstico por imagem
[Mh] Termos MeSH secundário: Adulto
Colo do Útero/cirurgia
Feminino
Idade Gestacional
Seres Humanos
Laparoscopia
Gravidez
Estudos Retrospectivos
Estatísticas não Paramétricas
Ultrassonografia
Incompetência do Colo do Útero/patologia
Incompetência do Colo do Útero/cirurgia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170911
[Lr] Data última revisão:
170911
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170304
[St] Status:MEDLINE
[do] DOI:10.1007/s00404-016-4285-5


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[PMID]:28254220
[Au] Autor:Matsui M; Takahashi Y; Iwagaki S; Chiaki R; Asai K; Kawabata I
[Ad] Endereço:Department of Fetal and Maternal Medicine, Nagara Medical Center, 1300-7 Nagara, Gifu City, Gifu 502-8558, Japan. Electronic address: cu_uchibikuma@mist.ocn.ne.jp.
[Ti] Título:Preliminary preventive protocol from first trimester of pregnancy to reduce preterm birth rate for dichorionic-diamniotic twins.
[So] Source:Taiwan J Obstet Gynecol;56(1):23-26, 2017 Feb.
[Is] ISSN:1875-6263
[Cp] País de publicação:China (Republic : 1949- )
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The preterm birth rate of twins is reportedly higher than that of single pregnancies. We performed preliminary preventive interventions at our center focused on evaluating the risk of each case before 14 weeks of gestation to reduce the spontaneous preterm birth rate. MATERIALS AND METHODS: The participants included 184 dichorionic-diamniotic twins delivered at our center during the 8 years from 2006. We evaluated each patient regarding high-risk status (at least 1 additional factor as follows: threatened abortion, history of chorioamnionitis, cervicitis, and bacterial vaginosis), based on available evidence; patients deemed high risk gave their informed consent and underwent treatment for cervicitis and cerclage if indicated. We divided the patients into two groups depending on whether the management was initiated before (Group A) or after (Group B) 14 weeks. We further divided Group A into three: Group 1 underwent treatment for cervicitis, Group 2 underwent cervical cerclage in addition to treatment for cervicitis, and Group 3 did not undergo preventive treatment. We retrospectively compared the preterm birth rates of the two groups, and we also compared them between the higher-risk group (Group 1 + 2) and the no additional risk group (Group 3) in Group A. RESULTS: The spontaneous preterm birth rate < 36 weeks was significantly lower in Group A (4/90; 4.4%) than in Group B (18/94; 19.1%) (p=0.001). However, there were no significant differences between Group 1 + 2 and Group 3 (2/42 vs. 2/46). Focusing on the spontaneous preterm birth rate < 34 weeks, Group A had a lower rate than Group B (2/90; 2.2% vs. 13/94; 13.8%, p=0.0012). CONCLUSION: Even though this was a preliminary study, the results are promising, and we propose custom-made management for dichorionic-diamniotic twins: (1) earlier management from before 14 weeks; (2) high-risk selection for cervicitis and a short cervix; and (3) intervention with anti-inflammatory agents and cerclage if indicated.
[Mh] Termos MeSH primário: Antibacterianos/uso terapêutico
Cerclagem Cervical
Gravidez de Gêmeos
Nascimento Prematuro/prevenção & controle
Cervicite Uterina/terapia
[Mh] Termos MeSH secundário: Adulto
Estudos de Casos e Controles
Feminino
Idade Gestacional
Seres Humanos
Gravidez
Primeiro Trimestre da Gravidez
Estudos Retrospectivos
Gêmeos Dizigóticos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170825
[Lr] Data última revisão:
170825
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170304
[St] Status:MEDLINE



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