Download PDF
Am J Perinatol 2019; 36(04): 341-345
DOI: 10.1055/s-0038-1673396
SMFM Fellowship Series Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Time to Delivery after Scheduled Shirodkar Cerclage Removal in Singleton Gestations based on the Original Indication for Cerclage Placement

Catherine A. Bigelow
1   Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
,
Nathan S. Fox
1   Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
,
Jennifer Lam-Rachlin
1   Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
,
Simi Gupta
1   Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
,
Mariam Naqvi
1   Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
,
Julie Romero
1   Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
,
Andrei Rebarber
1   Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
› Author Affiliations
Further Information

Publication History

03 July 2018

28 August 2018

Publication Date:
03 October 2018 (online)

Also available at
   Permissions and Reprints

Abstract

Objective To estimate the time to delivery after elective cerclage removal and evaluate whether there is a difference based on the indication for cerclage placement.

Study Design This was a retrospective cohort of singleton pregnancies that underwent Shirodkar cerclage placement at a single maternal–fetal medicine practice between June 2005 and June 2017. We included all scheduled elective cerclage removals >36 weeks. The primary outcome was latency to delivery. We further compared time to delivery based on the original indication for cerclage. Data were analyzed using the one-way analysis of variance and chi-square test.

Results A total of 143 patients met the inclusion criteria. Of these, 40.6% were history indicated, 51.0% ultrasound indicated, and 8.4% exam indicated. The mean time from removal to delivery was 13.3 ± 8.4 days; 12.6% (18/136) of patients delivered within 24 hours of removal. When stratified by indication for cerclage, there were no significant differences for all delivery outcomes. Delaying cerclage removal to >37 weeks resulted in a statistically significantly later gestational age at delivery compared with removal between 36 and 366/7 weeks (39.0 vs. 38.3 weeks, p = 0.001).

Conclusion The mean time from elective Shirodkar cerclage removal to delivery is 13 days with only 12.6% of patients delivering within 24 hours of removal.

Keywords

cerclage removal - latency to delivery - preterm birth - Shirodkar cerclage
 

  • References

  • 1 Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Mathews TJ. Births: final data for 2015. Natl Vital Stat Rep 2017; 66 (01) 1-70
    PubMedSearch in Google Scholar
  • 2 Suhag A, Berghella V. Cervical cerclage. Clin Obstet Gynecol 2014; 57 (03) 557-567
    CrossrefPubMedSearch in Google Scholar
  • 3 Berghella V, Rafael TJ, Szychowski JM, Rust OA, Owen J. Cerclage for short cervix on ultrasonography in women with singleton gestations and previous preterm birth: a meta-analysis. Obstet Gynecol 2011; 117 (03) 663-671
    CrossrefPubMedSearch in Google Scholar
  • 4 Pereira L, Cotter A, Gómez R. , et al. Expectant management compared with physical examination-indicated cerclage (EM-PEC) in selected women with a dilated cervix at 14(0/7)-25(6/7) weeks: results from the EM-PEC international cohort study. Am J Obstet Gynecol 2007; 197 (05) 483.e1-483.e8
    CrossrefPubMedSearch in Google Scholar
  • 5 Naqvi M, Barth Jr WH. Emergency cerclage: outcomes, patient selection, and operative considerations. Clin Obstet Gynecol 2016; 59 (02) 286-294
    CrossrefPubMedSearch in Google Scholar
  • 6 Schwartz RP, Chatwani A, Sullivan P. Cervical cerclage. A review of 74 cases. J Reprod Med 1984; 29 (02) 103-106
    PubMedSearch in Google Scholar
  • 7 Abdelhak YE, Aronov R, Roque H, Young BK. Management of cervical cerclage at term: remove the suture in labor?. J Perinat Med 2000; 28 (06) 453-457
    PubMedSearch in Google Scholar
  • 8 Bisulli M, Suhag A, Arvon R, Seibel-Seamon J, Visintine J, Berghella V. Interval to spontaneous delivery after elective removal of cerclage. Am J Obstet Gynecol 2009; 201 (02) 163.e1-163.e4
    CrossrefPubMedSearch in Google Scholar
  • 9 Alabi-Isama L, Sykes L, Chandiramani M. , et al. Time interval from elective removal of cervical cerclage to onset of spontaneous labour. Eur J Obstet Gynecol Reprod Biol 2012; 165 (02) 235-238
    CrossrefPubMedSearch in Google Scholar
  • 10 American College of Obstetricians and Gynecologists. Cerclage for the Management of Cervical Insufficiency. Practice Bulletin No. 142. Washington, DC: American College of Obstetricians and Gynecologists; 2014
    Search in Google Scholar
  • 11 Druzin ML, Berkeley AS. A simplified approach to Shirodkar cerclage procedure. Surg Gynecol Obstet 1986; 162 (04) 375-376
    PubMedSearch in Google Scholar
  • 12 Hume H, Rebarber A, Saltzman DH, Roman AS, Fox NS. Ultrasound-indicated cerclage: Shirodkar vs. McDonald. J Matern Fetal Neonatal Med 2012; 25 (12) 2690-2692
    CrossrefPubMedSearch in Google Scholar
  • 13 Fox NS, Rebarber A, Bender S, Saltzman DH. Labor outcomes after Shirodkar cerclage. J Reprod Med 2009; 54 (06) 361-365
    PubMedSearch in Google Scholar
  • 14 Shirodkar VN. Cervical incompetence and its treatment. In: Sturgis SH, Taylor ML, eds. Progress in Gynecology. New York: Grune and Stratton Inc; 1970: 483
    Search in Google Scholar
  • 15 Tita AT, Landon MB, Spong CY. , et al; Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Network. Timing of elective repeat cesarean delivery at term and neonatal outcomes. N Engl J Med 2009; 360 (02) 111-120
    CrossrefPubMedSearch in Google Scholar
  • 16 Spong CY, Mercer BM, D'alton M, Kilpatrick S, Blackwell S, Saade G. Timing of indicated late-preterm and early-term birth. Obstet Gynecol 2011; 118 (2 Pt 1): 323-333
    CrossrefPubMedSearch in Google Scholar