Pregnancy Outcomes According to Cervical Cerclage Indications and Factors Affecting Pregnancy Duration and Outcomes

NCT ID: NCT06443112

Last Updated: 2024-06-05

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

129 participants

Study Classification

OBSERVATIONAL

Study Start Date

2024-05-10

Study Completion Date

2024-05-10

Brief Summary

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This study aimed to asses predictive factors associated with successful cervical cerclage and poor pregnancy outcomes in all indications.129 pregnant women who underwent cerclage at 12-25 weeks gestation in a perinatal medical center were included. The patients were divided into three subgroups for data analysis. Groups included patients with respectively history-indicated cerclage (group 1), ultrasound-indicated cerclage (group 2), and rescue cerclage (group 3). The investigators defined successful cerclage as postponing birth until after the 28th week of gestation and a 'good outcome' was defined as delivery beyond 34 completed weeks.Factors associated with successful cervical cerclage and perinatal outcomes after the procedure for all three groups were analyzed. The investigators also calculated post-cerclage the cervical length cut-off value required to predict if birth could be postponed until after the 28th week of gestation in women with cervical insufficiency.

Detailed Description

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This study retrospectively reviewed data from pregnant women who underwent cerclage from July 2021 to July 2023 in Çam and Sakura City Hospital, which is a perinatal medical center in Istanbul, Turkey. The local ethics committee approved the study.

All procedures followed the relevant guidelines and regulations of the institutional ethics review board and the Declaration of Helsinki.

The patients were divided into three subgroups for data analysis. Group 1 included patients with history-indicated cerclage, who had second-trimester pregnancy loss associated with painless cervical dilatation in the absence of labor or placental abruption, or previous cerclage due to painless cervical dilatation in the second trimester. Group 2 comprised patients with ultrasound-indicated cerclage, who had a history of spontaneous preterm birth before the 34th week previously and their cervical length (CL) was \<25 mm before the 24th week of gestation in the current singleton pregnancy, or who had \<10 mm cervical length in the current singleton pregnancy without history. Group 3 consisted of patients undergoing rescue cerclage, who had premature cervical dilatation and exposure of fetal membranes in the vagina, was detected in ultrasound or speculum examination of the cervix. All cervical cerclage procedures were performed by a senior obstetrician using the McDonald technique with Mersilene tape or No:1 proline. The investigators collected the following data from medical records: maternal age at cervical cerclage, gravidity, parity, body mass index, history of a cervical cone biopsy, history of premature birth and cervical cerclage, procalcitonin level, C-reactive protein (CRP) level, gestational age at cerclage, pre-and post-cerclage CL, week of birth, pregnancy complications (preterm premature rupture of the membranes (PPROM), abruptio placenta, chorioamnionitis). The investigators defined successful cerclage as postponing birth until after the 28th week of gestation and a 'good outcome' was defined as delivery beyond 34 completed weeks. The indications and the pregnancy outcomes (miscarriage, gestational age at delivery, birth weight, prolongation of pregnancy, and rate of preterm birth before 34 weeks) of cervical cerclage were reviewed and the factors associated with successful cervical cerclage were analyzed.

Moreover, receiver operating characteristic (ROC) curves were used to calculate the pre-cerclage and post-cerclage CL cut-off value required to predict if birth could be postponed birth until after the 28th week of gestation in women with cervical insufficiency (CI). Thus, the investigators extracted significant factors for a successful cervical cerclage for long-term pregnancy sustenance in women with CI.

Conditions

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Cervical Incompetence (Complicating Pregnancy)

Study Design

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Observational Model Type

COHORT

Study Time Perspective

RETROSPECTIVE

Study Groups

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history-indicated cerclage group (group1)

Group 1 included patients with history-indicated cerclage, who had second-trimester pregnancy loss associated with painless cervical dilatation in the absence of labor or placental abruption, or previous cerclage due to painless cervical dilatation in the second trimester.

transvaginal cervical cerclage by Mc Donald technique

Intervention Type PROCEDURE

In the McDonald operation, a suture is is inserted around the exo-cervix as high as possible to approximate to the level of the internal os and thereby prevent second-trimester abortion.

(Group 2) patients with ultrasound-indicated cerclage

Group 2 comprised patients with ultrasound-indicated cerclage, who had a history of spontaneous preterm birth before the 34th week previously and their cervical length was \<25 mm before the 24th week of gestation in the current singleton pregnancy, or who had \<10 mm cervical length in the current singleton pregnancy without history.

transvaginal cervical cerclage by Mc Donald technique

Intervention Type PROCEDURE

In the McDonald operation, a suture is is inserted around the exo-cervix as high as possible to approximate to the level of the internal os and thereby prevent second-trimester abortion.

Group 3 consisted of patients undergoing rescue cerclage

Group 3 consisted of patients undergoing rescue cerclage, who had premature cervical dilatation and exposure of fetal membranes in the vagina, was detected in ultrasound or speculum examination of the cervix.

transvaginal cervical cerclage by Mc Donald technique

Intervention Type PROCEDURE

In the McDonald operation, a suture is is inserted around the exo-cervix as high as possible to approximate to the level of the internal os and thereby prevent second-trimester abortion.

Interventions

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transvaginal cervical cerclage by Mc Donald technique

In the McDonald operation, a suture is is inserted around the exo-cervix as high as possible to approximate to the level of the internal os and thereby prevent second-trimester abortion.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Pregnants that underwent cervical cerclage between July 2021 and July 2023 with singleton pregnancies

Exclusion Criteria

* Pregnant women without follow-up whose post-procedure data cannot be accessed
* Multiple pregnancies
Minimum Eligible Age

18 Years

Maximum Eligible Age

45 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Başakşehir Çam & Sakura City Hospital

OTHER_GOV

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Zeynep Kayaoglu yıldırım, MD

Role: STUDY_DIRECTOR

Başakşehir Çam ve Sakura City Hospital

Elif Sagban Gedik, MD

Role: PRINCIPAL_INVESTIGATOR

Başakşehir Çam ve Sakura City Hospital

Locations

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İstanbul Başakşehir Çam ve Sakura City Hospital

Istanbul, Basaksehir, Turkey (Türkiye)

Site Status

Countries

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Turkey (Türkiye)

References

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Song RK, Cha HH, Shin MY, Choi SJ, Oh SY, Kim JH, Roh CR. Post-cerclage ultrasonographic cervical length can predict preterm delivery in elective cervical cerclage patients. Obstet Gynecol Sci. 2016 Jan;59(1):17-23. doi: 10.5468/ogs.2016.59.1.17. Epub 2016 Jan 15.

Reference Type RESULT
PMID: 26866031 (View on PubMed)

Chan LL, Leung TW, Lo TK, Lau WL, Leung WC. Indications for and pregnancy outcomes of cervical cerclage: 11-year comparison of patients undergoing history-indicated, ultrasound-indicated, or rescue cerclage. Hong Kong Med J. 2015 Aug;21(4):310-7. doi: 10.12809/hkmj144393. Epub 2015 Jul 17.

Reference Type RESULT
PMID: 26183455 (View on PubMed)

Cook JR, Chatfield S, Chandiramani M, Kindinger L, Cacciatore S, Sykes L, Teoh T, Shennan A, Terzidou V, Bennett PR. Cerclage position, cervical length and preterm delivery in women undergoing ultrasound indicated cervical cerclage: A retrospective cohort study. PLoS One. 2017 Jun 1;12(6):e0178072. doi: 10.1371/journal.pone.0178072. eCollection 2017.

Reference Type RESULT
PMID: 28570639 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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BasaksehirCamveSakuraH

Identifier Type: -

Identifier Source: org_study_id

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