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- W2033293035 abstract "While multiple trials have assessed the efficacy of cerclage, there is little information regarding technical aspects of the procedure. We sought to determine whether routine placement of a second stitch at the time of cervical cerclage improves its efficacy. This is a retrospective cohort study of patients who had cervical cerclage placement between Jan 2003 and Dec 2009 at a single institution. Operative reports were examined for indication and number of stitches placed. Ultrasound images were reviewed for pre-cerclage cervical length and post-cerclage cerclage height (defined as distance from external os to the most superior cerclage stitch). The primary outcome was spontaneous preterm delivery <35wks. Secondary outcomes were spontaneous preterm delivery <37wks and 24wks, cerclage height, chorioamnionitis, premature rupture of membranes (PROM), and perinatal death. Univariable, multivariable and Kaplan-Meier survival analysis were used to compare pregnancy outcomes among women with one stitch and two stitches. A priori power analysis showed that 59 patients were needed in each group for 80% power to detect a 3-fold decrease in preterm delivery < 35 weeks from a baseline rate of 30% (α = 0.05). Of 146 patients identified, 63 had two stitches while 83 had one stitch placed. Baseline characteristics and indications for cerclage in the two groups were similar except for differences in history of prior cerclage and multiple gestation. Over the study period, there was a trend in favor of the two stitch approach (χ2 for trend, p<0.005). The two-stitch approach was associated with a greater cerclage height despite similar pre-cerclage cervical length, but there was no difference in spontaneous preterm delivery <35wks (47.6% vs 41.0 %, aOR 0.99 95% CI 0.48 – 2.02). There were also no differences in the survival curves for the two groups (log-rank p=0.57) and no differences in any of the other secondary outcomes (Table).Tabled 1Two StitchOne StitchaOR (95% CI)p-valuePrimary outcomeSpontaneous Delivery <35weeks30 (47.6%)34 (41.0%)0.99 (0.48-2.02)0.973Secondary outcomesSpontaneous Delivery <37weeks38 (60.3%)39 (47%)1.15 (0.55-2.39)0.703Spontaneous Delivery <24weeks7 (11.1%)7 (8.43%)1.14 (0.37-3.52)0.808Chorioamnionitis9 (14.2%)17 (20.5%)0.59 (0.20-1.45)0.248PPROM37 (58.7%)39 (47%)1.07 (0.52-2.22)0.160Perinatal Death10 (15.9%)8 (9.6%)1.44 (0.56-4.31)0.386Cerclage Height (mm)20.4 ± 0.7218 ± 0.54-0.007Mean cerclage-to-delivery Interval (days)118 ± 6.78123 ± 0.59-0.609 Open table in a new tab A two-stitch approach to cervical cerclage increases cerclage height, but does not improve efficacy." @default.
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- W2033293035 date "2011-01-01" @default.
- W2033293035 modified "2023-09-25" @default.
- W2033293035 title "675: Cervical cerclage: one stitch or two?" @default.
- W2033293035 doi "https://doi.org/10.1016/j.ajog.2010.10.695" @default.
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